Cognitive Therapy and Research

, Volume 43, Issue 1, pp 259–271 | Cite as

Posttraumatic Mental Contamination and the Interpersonal Psychological Theory of Suicide: Effects via DSM-5 PTSD Symptom Clusters

  • C. Alex BrakeEmail author
  • Thomas G. Adams
  • Caitlyn O. Hood
  • Christal L. Badour
Original Article


Research has yet to establish a relationship between posttraumatic mental contamination and suicide risk, despite theoretical overlap. The present study examined relationships between posttraumatic mental contamination and suicide risk via posttraumatic stress symptom clusters and appraisals of perceived burdensomeness and thwarted belongingness. Trauma-exposed participants (N = 183) completed measures of posttraumatic mental contamination, posttraumatic stress symptoms, thwarted belongingness, perceived burdensomeness, and suicide risk. Findings revealed significant indirect effects of posttraumatic mental contamination on suicide risk via all posttraumatic stress symptom clusters. Significant serial indirect effects of posttraumatic mental contamination on suicide risk were observed via posttraumatic avoidance and arousal/reactivity and, subsequently, via thwarted belongingness and perceived burdensomeness. Serial models via posttraumatic re-experiencing and negative cognitions/mood symptoms were nonsignificant. Results suggest that posttraumatic mental contamination may increase suicide risk via posttraumatic stress symptom severity, and maladaptive interpersonal appraisals may explain these links through distinct symptom pathways. Implications for posttraumatic suicide risk are discussed.


Mental contamination PTSD Suicide Perceived burdensomeness Thwarted belongingness Appraisals 



Dr. Adams receives support from Grant Numbers K23 MH111977 and L30 MH111037 through the National Institutes of Health (NIH), as well as an International Obsessive–Compulsive Disorder Foundation (IOCDF) research award. Dr. Badour receives support from Grant Number K12 DA14040 through the Office of Women’s Health Research and the National Institute on Drug Abuse (NIDA) at NIH. Caitlyn Hood also receives support from T32 DA035200 through NIDA at NIH. This publication’s contents are solely the responsibility of the authors and do not necessarily represent the official views of NIH or IOCDF.

Compliance with Ethical Standards

Conflict of Interest

C. Alex Brake, Thomas G. Adams, Caitlyn O. Hood, and Christal L. Badour declare they have no conflict of interest.

Informed Consent

Informed consent was obtained from all participants included in the present study.

Animal Rights

No animal studies were carried out by any of the authors for this article.


  1. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington: Author.Google Scholar
  2. Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., & Swinson, R. P. (1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychological Assessment, 10(2), 176–181.Google Scholar
  3. Badour, C. L., Feldner, M. T., Babson, K. A., Blumenthal, H., & Dutton, C. E. (2013a). Disgust, mental contamination, and posttraumatic stress: Unique relations following sexual versus non-sexual assault. Journal of Anxiety Disorders, 27(1), 155–162.PubMedGoogle Scholar
  4. Badour, C. L., Feldner, M. T., Blumenthal, H., & Bujarski, S. J. (2013b). Examination of increased mental contamination as a potential mechanism in the association between disgust sensitivity and sexual assault-related posttraumatic stress. Cognitive Therapy and Research, 37(4), 697–703.PubMedPubMedCentralGoogle Scholar
  5. Badour, C. L., Ojserkis, R., McKay, D., & Feldner, M. T. (2014). Disgust as a unique affective predictor of mental contamination following sexual trauma. Journal of Anxiety Disorders, 28(7), 704–711. Scholar
  6. Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The posttraumatic stress disorder checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. Journal of Traumatic Stress, 28(6), 489–498.PubMedGoogle Scholar
  7. Brake, C. A., Jones, A. C., Wakefield, J. R., & Badour, C. L. (2018). Mental contamination and trauma: Understanding posttraumatic stress, risky behaviors, and help-seeking attitudes. Journal of Obsessive-Compulsive and Related Disorders, 17, 31–38.Google Scholar
  8. Bryan, C. J., Morrow, C. E., Anestis, M. D., & Joiner, T. E. (2010). A preliminary test of the interpersonal-psychological theory of suicidal behavior in a military sample. Personality and Individual Differences, 48, 347–350. Scholar
  9. Casler, K., Bickel, L., & Hackett, E. (2013). Separate but equal? A comparison of participants and data gathered via Amazon’s MTurk, social media, and face-to-face behavioral testing. Computers in Human Behavior, 29(6), 2156–2160.Google Scholar
  10. Chu, C., Buchman-Schmitt, J. M., Stanley, I. H., Hom, M. A., Tucker, R. P., Hagan, C. R., … Joiner, T. J. (2017). The interpersonal theory of suicide: A systematic review and meta-analysis of a decade of cross-national research. Psychological Bulletin, 143(12), 1313–1345. Scholar
  11. Coughtrey, A. E., Shafran, R., Lee, M., & Rachman, S. (2013). The treatment of mental contamination: A case series. Cognitive and Behavioral Practice, 20, 221–231.Google Scholar
  12. Coughtrey, A. E., Shafran, R., Lee, M., & Rachman, S. J. (2012). It’s the feeling inside my head: A qualitative analysis of mental contamination in obsessive-compulsive disorder. Behavioural and Cognitive Psychotherapy, 40, 163–173.PubMedGoogle Scholar
  13. Coughtrey, A. E., Shafran, R., & Rachman, S. J. (2014). The spread of mental contamination. Journal of Behavior Therapy and Experimental Psychiatry, 45(1), 33–38.PubMedGoogle Scholar
  14. Davis, M. T., Witte, T. K., & Weathers, F. W. (2014). Posttraumatic stress disorder and suicidal ideation: The role of specific symptoms within the framework of the interpersonal-psychological theory of suicide. Psychological Trauma: Theory, Research, Practice, and Policy, 6, 610–618. Scholar
  15. Elliott, C. M., & Radomsky, A. S. (2009). Analyses of mental contamination: Part I, experimental manipulations of morality. Behaviour Research and Therapy, 47(12), 995–1003.PubMedGoogle Scholar
  16. Elliott, C. M., & Radomsky, A. S. (2012). Mental contamination: The effects of imagined physical dirt and immoral behaviour. Behaviour Research and Therapy, 50, 422–427.PubMedGoogle Scholar
  17. Elliott, C. M., & Radomsky, A. S. (2013). Meaning and mental contamination: Focus on appraisals. Clinical Psychologist, 17, 17–25. Scholar
  18. Fairbrother, N., Newth, S. J., & Rachman, S. (2005). Mental pollution: Feelings of dirtiness without physical contact. Behaviour Research and Therapy, 43(1), 121–130.PubMedGoogle Scholar
  19. Fairbrother, N., & Rachman, S. J. (2004). Feelings of mental pollution subsequent to sexual assault. Behavior Research and Therapy, 42(2), 173–190.Google Scholar
  20. Fergus, T. A., & Bardeen, J. R. (2016). Main and interactive effects of mental contamination and tolerance of negative emotions in relation to posttraumatic stress symptoms following sexual trauma. Journal of Psychopathology and Behavioral Assessment, 38, 274–283.Google Scholar
  21. Guerra, V. S., & Calhoun, P. S. (2011). Examining the relation between posttraumatic stress disorder and suicidal ideation in an OEF/OIF veteran sample. Journal of Anxiety Disorders, 25, 12–18. Scholar
  22. Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: Guilford Press.Google Scholar
  23. Henry, J. D., & Crawford, J. R. (2005). The short-form version of the Depression Anxiety Stress Scales (DASS-21): Construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 44(22), 227–239.PubMedGoogle Scholar
  24. Hill, R. M., Rey, Y., Marin, C. E., Sharp, C., Green, K. L., & Pettit, J. W. (2015). Evaluating the Interpersonal Needs Questionnaire: Comparison of the reliability, factor structure, and predictive validity across five versions. Suicide and Life-Threatening Behavior, 45(3), 302–314.PubMedGoogle Scholar
  25. Hooper, L. M., Stockton, P., Krupnick, J. L., & Green, B. L. (2011). Development, use, and psychometric properties of the Trauma History Questionnaire. Journal of Loss and Trauma, 16(3), 258–283.Google Scholar
  26. Ishikawa, R., Kobori, O., & Shimizu, E. (2015). Unwanted sexual experiences and cognitive appraisals that evoke mental contamination. Behavioural and Cognitive Psychotherapy, 43, 15. Scholar
  27. Joiner, T. E. (2005). Why people die by suicide. Cambridge: Harvard University Press.Google Scholar
  28. Krysinska, K., & Lester, D. (2010). Post-traumatic stress disorder and suicide risk: A systematic review. Archives of Suicide Research, 14, 1–23. Scholar
  29. Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335–343.PubMedGoogle Scholar
  30. Ma, J., Batterham, P. J., Calear, A. L., & Han, J. (2016). A systematic review of the predictions of the Interpersonal–psychological theory of suicidal behavior. Clinical Psychology Review, 46, 34–45. Scholar
  31. McKinney, J. M., Hirsch, J. K., & Britton, P. C. (2017). PTSD symptoms and suicide risk in veterans: Serial indirect effects via depression and anger. Journal of Affective Disorders, 214, 100–107.PubMedGoogle Scholar
  32. Nock, M. K., Hwand, I., Sampson, N., Kessler, R. C., Angermeyer, M., Beautrais, A. A., … Williams, D. R. (2009). Cross-national analysis of the associations among mental disorders and suicidal behavior: Findings from the WHO World Mental Health Surveys. PLoS Medicine, 6(8), 1–17.Google Scholar
  33. Olatunji, B. O., Elwood, L. S., Williams, N. L., & Lohr, J. M. (2008). Mental pollution and PTSD symptoms in victims of sexual assault: A preliminary examination of the mediating role of trauma-related cognitions. Journal of Cognitive Psychotherapy, 22, 37–47. Scholar
  34. Oppenheimer, D. M., Meyvis, T., & Davidenko, N. (2009). Instructional manipulation checks: Detecting satisficing to increase statistical power. Journal of Experimental Social Psychology, 45, 867–872. Scholar
  35. Osman, A., Bagge, C. L., Gutierrez, P. M., Konick, L. C., Kopper, B. A., & Barrios, F. X. (2001). The Suicidal Behaviors Questionnaire-Revised (SBQ-R): Validation with clinical and nonclinical samples. Assessment, 8(4), 443–454.PubMedGoogle Scholar
  36. Panagioti, M., Gooding, P., & Tarrier, N. (2009). Post-traumatic stress disorder and suicidal behavior: A narrative review. Clinical Psychology Review, 29, 471–482.PubMedGoogle Scholar
  37. Panagioti, M., Gooding, P., Taylor, P. J., & Tarrier, N. (2013). A model of suicidal behavior in posttraumatic stress disorder (PTSD): The mediating role of defeat and entrapment. Psychiatry Research, 209, 55–59. Scholar
  38. Paolacci, G., Chandler, J., & Ipeirotis, P. G. (2010). Running experiments on amazon mechanical turk. Judgement and Decision Making, 5(5), 411–419.Google Scholar
  39. Pennings, S. M., Finn, J., Houtsma, C., Green, B. A., & Anestis, M. D. (2017). Posttraumatic stress disorder symptom clusters and the interpersonal theory of suicide in a large military sample. Suicide and Life-Threatening Behavior, 47, 538–550.PubMedGoogle Scholar
  40. Rachman, S. (1994). Pollution of the mind. Behaviour Research and Therapy, 32, 311–314.PubMedGoogle Scholar
  41. Rachman, S. (2005). Vancouver obsessional compulsive inventory (VOCI-MC). Vancouver: Rachman Lab, University of British Columbia.Google Scholar
  42. Rachman, S. (2010). Betrayal: A psychological analysis. Behaviour Research and Therapy, 48, 304–311. Scholar
  43. Rachman, S. J., Coughtrey, A. E., Shafran, R., & Radomsky, A. S. (2015). Oxford guide to the treatment of mental contamination. Oxford: Oxford University Press.Google Scholar
  44. Radomsky, A. S., & Elliott, C. M. (2009). Analyses of mental contamination: Part II, individual differences. Behaviour Research and Therapy, 47, 1004–1011.PubMedGoogle Scholar
  45. Ruscio, A. M., Ruscio, J., & Keane, T. M. (2002). The latent structure of posttraumatic stress disorder: A taxometric investigation of reactions to extreme stress. Journal of Abnormal Psychology, 111, 290–301. Scholar
  46. Steil, R., Jung, K., & Stangier, U. (2011). Efficacy of a two-session program of cognitive restructuring and imagery modification to reduce the feeling of being contaminated in adult survivors of childhood sexual abuse: A pilot study. Journal of Behavior Therapy and Experimental Psychiatry, 42, 325–329. Scholar
  47. Stein, M. B., Walker, J. R., Hazen, A. L., & Forde, D. R. (1997). Full and partial posttraumatic stress disorder: Findings from a community survey. American Journal of Psychiatry, 154, 1114–1119.PubMedGoogle Scholar
  48. Thordarson, D. S., Radomsky, A. S., Rachman, S., Shafran, R., Sawchuk, C. N., & Hakstian, A. R. (2004). The Vancouver obsessional compulsive inventory (VOCI). Behaviour Research and Therapy, 42(11), 1289–1314.PubMedGoogle Scholar
  49. Van Orden, K. A., Cukrowicz, K. C., Witte, T. K., & Joiner, T. E. Jr. (2012). Thwarted belongingness and perceived burdensomeness: Construct validity and psychometric properties of the Interpersonal Needs Questionnaire. Psychological Assessment, 24(1), 197–215.PubMedGoogle Scholar
  50. Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. J. (2010). The interpersonal theory of suicide. Psychological Review, 117, 575–600.PubMedPubMedCentralGoogle Scholar
  51. Watkins, M. (2000). Monte Carlo PCA for parallel analysis (Computer Software). State College: Ed & Psych Associates.Google Scholar
  52. Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013). The PTSD checklist for DSM-5 (PCL-5). Scale available from the National Center for PTSD at
  53. Zhong, C., & Liljenquist, K. (2006). Washing away your sins: Threatened morality and physical cleansing. Science, 313, 1451–1452. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • C. Alex Brake
    • 1
    Email author
  • Thomas G. Adams
    • 2
    • 3
  • Caitlyn O. Hood
    • 1
  • Christal L. Badour
    • 1
  1. 1.Department of PsychologyUniversity of KentuckyLexingtonUSA
  2. 2.Department of Psychiatry, School of MedicineYale UniversityNew HavenUSA
  3. 3.Clinical Neuroscience Division of the VA National Center for PTSDWest HavenUSA

Personalised recommendations