Fearlessness About Suicide Scale

1. Abstract

The Fearlessness About Suicide Scale (FSS) is a psychometrically validated, unidimensional self-report instrument developed to evaluate an individual's subjective fearlessness regarding suicide and the act of dying. Originating from the broader conceptual framework of the Interpersonal Psychological Theory of Suicide (IPTS) and modern ideation-to-action models of suicidal behavior, the scale measures a critical component of suicide capability. While suicidal ideation—driven by factors such as thwarted belongingness, perceived burdensomeness, and psychological pain—is relatively prevalent in psychiatric populations, the transition from passive or active ideation to lethal self-harm requires the capability to overcome powerful evolutionary instincts toward self-preservation. The FSS isolates this construct by assessing fearlessness about suicide independently from general fearlessness or physical pain tolerance.

Constructed by Grunewald, Perkins, Jeon, Klonsky, Joiner, and Smith (2024), the FSS distills items from prior legacy capability metrics into an optimized, 7-item unidimensional scale. Administered using a 7-point Likert-type response format ranging from 0 (Strongly Disagree) to 6 (Strongly Agree), total scores range from 0 to 42, with higher scores reflecting elevated fearlessness regarding self-inflicted death. Psychometric evaluations across diverse non-clinical and clinical samples demonstrate robust internal consistency (Cronbach's α and McDonald's ω typically exceeding .85), stable unidimensional factor structure confirmed via rigorous confirmatory factor analyses, and strict measurement invariance across gender. Furthermore, the FSS exhibits superior convergent validity with lifetime suicide attempts and suicide preparation, while establishing discriminant validity from broader constructs of generalized anxiety, physical bravery, and depressive symptom severity. The scale provides clinicians and researchers with an efficient, reliable, and theoretically targeted assessment tool for identifying capability for suicide.

2. Keywords

Fearlessness About Suicide Scale, Acquired Capability for Suicide, Suicide Risk Assessment, Interpersonal Psychological Theory of Suicide, Ideation-to-Action Framework, Suicidal Behavior, Psychometrics, Factor Structure, Unidimensional Measurement, Self-Preservation.

3. Authors

The Fearlessness About Suicide Scale was developed and validated through a collaborative multi-institutional psychometric investigation conducted by leading clinical suicidologists and measurement specialists:

• William Grunewald, M.S. — Department of Psychological Sciences, Auburn University, Auburn, AL, USA. Specializes in behavioral markers of suicidal capability and cognitive mechanisms underlying self-harm.
• Natalie M. Perkins, M.S. — Department of Psychological Sciences, Auburn University, Auburn, AL, USA. Focuses on disordered eating, body-related pain tolerance, and suicide capability.
• Min Eun Jeon, Ph.D. — Department of Psychology, Florida State University, Tallahassee, FL, USA. Researches dynamic fluctuations in interpersonal suicide determinants.
• E. David Klonsky, Ph.D. — Department of Psychology, University of British Columbia, Vancouver, BC, Canada. Pioneer of the Three-Step Theory (3ST) of suicide and a leading scholar in differentiating suicide ideation from suicide attempts.
• Thomas E. Joiner, Ph.D. — Department of Psychology, Florida State University, Tallahassee, FL, USA. Originator of the Interpersonal Psychological Theory of Suicide (IPTS) and author of foundational works on the acquired capability for suicide.
• April R. Smith, Ph.D. — Department of Psychological Sciences, Auburn University, Auburn, AL, USA. Director of the Research on Eating Disorders and Suicidality (REDS) Laboratory; senior investigator in the psychometric refinement of suicide capability instruments.

4. Purpose

The primary purpose of the Fearlessness About Suicide Scale (FSS) is to provide an empirically refined, brief, and theoretically coherent assessment of an individual's reduction in, or absence of, fear regarding the act of killing oneself. For decades, the assessment of suicide risk relied heavily on measuring the intensity, duration, and frequency of suicidal ideation, depressive symptoms, or overarching subjective distress. However, extensive epidemiological and clinical evidence demonstrates that suicidal ideation is a poor standalone predictor of suicide attempts; while millions of individuals experience severe suicidal thoughts, the vast majority never attempt suicide. To resolve this clinical challenge, contemporary suicidology operates under the ideation-to-action framework, which posits that the development of suicidal ideation and the progression from ideation to lethal action are distinct phenomena with distinct etiologies.

Under this theoretical umbrella, fearlessness about suicide represents the primary psychological barrier that must be eroded before an individual can engage in lethal self-directed violence. Human beings possess deeply ingrained, evolutionarily adaptive survival instincts that produce intense fear and autonomic resistance when confronted with lethal self-harm. Consequently, even an individual experiencing intolerable psychological pain and active suicidal desire cannot carry out a suicide attempt unless they possess the capability to overcome this biological aversion. The FSS was purpose-built to address critical methodological and conceptual limitations present in legacy instruments, such as the Acquired Capability for Suicide Scale (ACSS) and its 5-item fearlessness subscale (ACSS-FAD).

Clinical and Research Applications

In clinical settings, the FSS serves as a targeted tool for stratified risk assessment. When an individual presents with severe suicidal desire (e.g., intense psychological pain, hopelessness, or explicit suicide plans), administering the FSS enables clinicians to gauge whether the patient also possesses the subjective capability to enact those plans. Elevated scores on the FSS warn clinicians of heightened acute and chronic capability, signaling that standard safety planning must be intensified, lethal means must be immediately restricted, and close monitoring or inpatient stabilization may be required.

In empirical research, the FSS addresses historical measurement error. Earlier scales frequently conflated general physical bravery (e.g., enjoying extreme sports, skydiving, or handling aggressive animals) with explicit fearlessness regarding self-inflicted death. Studies demonstrated that general fearlessness often failed to correlate with suicide attempt history once demographic variables like sex were controlled. By isolating statements that measure fear, horror, and pain specifically associated with the act of suicide, the FSS provides researchers with a targeted operationalization of fearlessness about suicide, clarifying its role in cross-sectional, longitudinal, and experimental designs.

5. Psychological Construct

The psychological construct evaluated by the FSS is Fearlessness About Suicide (FAS). FAS is conceptualized as the cognitive, affective, and behavioral habituation to the prospect of one's own death, specifically resulting in a diminished fear response toward lethal self-harm. To understand the construct fully, it must be situated within the broader construct of capability for suicide and distinguished from adjacent psychological phenomena.

Deconstructing Capability for Suicide

Historically, the capability for suicide (originally termed acquired capability) was conceptualized as comprising two interconnected facets:

1. Physical Pain Tolerance: The physiological and cognitive capacity to withstand physical discomfort, agony, or tissue damage.
2. Fearlessness About Death / Fearlessness About Suicide: The psychological erosion of the fear, dread, and horror naturally associated with dying and self-directed violence.

Subsequent psychometric and behavioral research demonstrated that these two facets diverge meaningfully. While physical pain tolerance reflects sensory processing and distress endurance, fearlessness about suicide is predominantly an affective and cognitive construct. Pain tolerance alone is insufficient to facilitate a suicide attempt if the thought of dying remains terrifying. Conversely, an individual who has lost their fear of death is far more capable of carrying out self-inflicted violence, even if their physical pain threshold is average.

Key Dimensions Assessed by the FSS

The FSS measures fearlessness about suicide through a targeted unidimensional structure. This single dimension captures several interrelated cognitive-affective manifestations of suicide fearlessness:

• Anticipatory Affect and Imagery: Assessing the degree of dread, fear, or revulsion experienced when mentally visualizing one's own suicide. In non-capable individuals, picturing one's own suicide elicits profound autonomic arousal, visceral anxiety, and psychological panic. Individuals with high FAS experience emotional blunting, calm, or absent dread when contemplating suicide scenes (e.g., captured by reverse-scored items regarding whether picturing one's own suicide is scary).
• Appraisal of Pain and Lethality: Evaluating how an individual appraises the prospect of physical pain and method lethality during self-harm. Individuals with low FAS view self-inflicted death as excessively painful, frightening, and insurmountable. In contrast, individuals with high FAS perceive these barriers as manageable, diminished, or secondary to their internal desire.
• Perceived Efficacy and Behavioral Enactability: Measuring the individual's subjective belief that they possess the nerve, will, and capability to follow through with a lethal act if they decided to do so. This includes overcoming self-preservation barriers under conditions of perceived burdensomeness (e.g., endorsing that one would not be afraid to die if others were better off).
• Expectancy of Habituation: Capturing the longitudinal cognitive trajectory of fear reduction, wherein an individual anticipates that their fear of suicide will continue to diminish over time through sustained exposure, cognitive rehearsal, or progressive desensitization.

6. Theoretical Framework

The Fearlessness About Suicide Scale is rooted within modern suicidology frameworks, primarily the Interpersonal Psychological Theory of Suicide (IPTS; Joiner, 2005; Van Orden et al., 2010) and subsequent ideation-to-action models such as the Three-Step Theory (3ST; Klonsky & May, 2015).

The Interpersonal Psychological Theory of Suicide (IPTS)

The IPTS was among the first clinical theories to explain why suicidal desire alone rarely results in lethal behavior. According to the IPTS, lethal or near-lethal suicidal behavior occurs exclusively at the intersection of three dynamic variables:

1. Thwarted Belongingness: A psychologically painful state characterized by loneliness, social isolation, and an unmet fundamental need for interpersonal connection.
2. Perceived Burdensomeness: A pernicious cognitive distortion in which the individual believes that their existence is a liability to loved ones, society, or the world ("My death is worth more than my life").
3. Capability for Suicide: The acquired and practical ability to enact lethal self-harm, overcoming evolutionary self-preservation instincts.

In Joiner's initial formulation, capability was hypothesized to be largely acquired through repeated exposure to physically painful and psychologically provocative events (e.g., non-suicidal self-injury, combat exposure, physical abuse, intravenous drug use, or repeated risk-taking). Drawing on Solomon's Opponent-Process Theory of Acquired Motivation, the IPTS posited that repeated exposure to provocative stimuli causes the initial primary affective response (fear, pain, horror) to habituate and attenuate over time, while the opponent process (relief, numbness, or even mastery) becomes amplified. As an individual repeatedly confronts tissue damage, violence, or death imagery, the innate terror of dying recedes, culminating in fearlessness about suicide.

The Three-Step Theory (3ST) and Ideation-to-Action

Klonsky and May's (2015) Three-Step Theory further refined the conceptualization of capability. The 3ST posits that:

• Step 1: Pain (primarily psychological pain) and hopelessness combine to produce suicidal ideation.
• Step 2: Connectedness (to loved ones, values, or purpose) protects against ideation escalating from passive to active desire.
• Step 3: The progression from active suicidal ideation to an actual suicide attempt is governed strictly by suicide capability.

Under the 3ST, suicide capability is divided into three distinct categories: dispositional capability (innate, biologically driven variables such as genetically low pain sensitivity or natural sensation seeking), acquired capability (habituation through painful and provocative experiences), and practical capability (concrete knowledge of, and access to, lethal means). The FSS primarily measures the affective manifestation of acquired and dispositional capability: the subjective absence of fear that directly permits an individual to bridge the gap between thinking about suicide and executing a lethal act.

7. Validity

The psychometric validation of the Fearlessness About Suicide Scale was established by Grunewald et al. (2024) across multiple independent cohorts, including large undergraduate samples, online community samples (e.g., Prolific and MTurk), and high-risk psychiatric cohorts with histories of non-suicidal self-injury (NSSI) and prior suicide attempts.

Construct and Convergent Validity

The FSS demonstrates robust convergent validity with established capability measures and related suicidological constructs:

• Acquired Capability Measures: FSS scores correlate strongly with legacy measures of capability, such as the Acquired Capability for Suicide Scale (ACSS; $r \approx .55\text{ to } .68$) and specifically the ACSS-Fearlessness About Death subscale (ACSS-FAD; $r > .75$). However, the FSS accounts for significantly more unique variance in suicidal behavior because it omits noisy, non-suicide-specific items (such as items measuring skydiving or watching horror movies).
• Suicide Attempt History: In comparative validity analyses, the FSS differentiated between suicide ideators with a history of suicide attempts and suicide ideators who had never attempted suicide ($d = 0.52\text{ to } 0.74$, $p < .001$). Individuals with multiple lifetime attempts scored significantly higher on the FSS than single attempters and non-attempters, supporting the habituation hypothesis of the IPTS.
• Suicide Preparation and Planning: High scores on the FSS correlate strongly with practical suicide preparations, such as writing suicide notes, researching lethal means, and handling lethal implements ($r = .42\text{ to } .56$).

Discriminant Validity

To ensure that the FSS does not merely reflect generalized affective distress or fearlessness in unrelated domains, discriminant validity was rigorously evaluated:

• Depressive Symptoms and General Distress: The FSS exhibits low-to-negligible correlations with general depressive severity as measured by the Patient Health Questionnaire-9 (PHQ-9; $r < .15$) and general psychological distress on the Kessler-6 ($r < .12$). This confirms that the scale captures capability rather than the severity of psychological pain or desire.
• Thwarted Belongingness and Perceived Burdensomeness: In accordance with the IPTS assumption that capability is orthogonal to suicidal desire, FSS scores show near-zero correlations with the Interpersonal Needs Questionnaire (INQ-15) subscales ($r = .04\text{ to } .16$), verifying that capability functions as an independent theoretical dimension.
• Generalized Anxiety and Sensation Seeking: While weakly correlated with general risk-taking, the FSS diverges from measures of generalized anxiety (e.g., GAD-7) and broad sensation-seeking inventories, proving that fearlessness regarding self-directed violence is distinct from general trait courage or autonomic hypo-reactivity.

8. Reliability

The Fearlessness About Suicide Scale demonstrates excellent internal consistency, stability, and precision across diverse operational environments.

Internal Consistency

Initial validation studies by Grunewald et al. (2024) across development and cross-validation samples revealed high internal consistency:

• Cronbach's Alpha ($lpha$): Across non-clinical and clinical samples, Cronbach's $lpha$ estimates ranged from $.84$ to $.89$, reflecting strong item interrelatedness without redundancy.
• McDonald's Omega ($\omega$): Because Cronbach's $lpha$ assumes tau-equivalence (equal factor loadings across all items), McDonald's categorical omega ($\omega_t$ and $\omega_h$) was computed. Values for $\omega$ ranged from $.86$ to $.91$, corroborating the scale's high composite reliability and confirming that the total score accurately reflects the underlying latent trait.
• Item-Total Correlations: Corrected item-total correlations for all seven items exceeded $.50$, with reverse-coded items (assessing fear of pain, method fear, and dread of imagery) exhibiting correlations between $.58$ and $.72$.

Temporal Stability (Test-Retest Reliability)

In sub-samples evaluated across a 2- to 4-week retest interval, the FSS demonstrated strong test-retest reliability ($r_{tt} = .81\text{ to } .86$). This stability aligns with the theoretical premise that acquired capability and fearlessness about suicide operate primarily as relatively stable, trait-like constructs that increase incrementally following provocative experiences, rather than fluctuating rapidly like transient suicidal ideation.

9. Factor Analysis

The structural validity of the FSS was established through iterative Exploratory Factor Analyses (EFA) and Confirmatory Factor Analyses (CFA), demonstrating a clean, unidimensional measurement model.

Exploratory Factor Analysis (EFA)

During scale development, an initial pool of candidate items derived from legacy capability measures was subjected to EFA using maximum likelihood estimation with robust standard errors and oblimin rotation. Parallel analysis and scree plot inspections unambiguously indicated a single dominant factor accounting for over 52% of the total variance. Items with low primary loadings ($< .40$), high cross-loadings, or content centered on non-suicidal physical bravery were systematically removed, yielding the final 7-item set.

Confirmatory Factor Analysis (CFA)

In the independent cross-validation sample, a single-factor CFA model was estimated using robust weighted least squares (WLSMV) and robust maximum likelihood (MLR) estimators to account for the ordinal response scale. The unidimensional model demonstrated excellent fit across conventional psychometric criteria:

• Comparative Fit Index (CFI): $.978$ to $.991$ (exceeding the standard $.95$ cutoff for good fit)
• Tucker-Lewis Index (TLI): $.967$ to $.986$ (exceeding the $.95$ threshold)
• Root Mean Square Error of Approximation (RMSEA): $.048$ to $.062$ (with $90%$ confidence intervals firmly below $.08$)
• Standardized Root Mean Square Residual (SRMR): $.029$ to $.038$ (well below the $.05$ benchmark)

Standardized Factor Loadings

All seven items demonstrated robust, statistically significant standardized factor loadings ($p < .001$) on the latent Fearlessness About Suicide construct:

• Item 1 (Reverse-coded): $lambda = .72$ ("It would be painful and frightening to take my own life.")
• Item 2 (Reverse-coded): $lambda = .81$ ("I am afraid to use any method to kill myself.")
• Item 3 (Reverse-coded): $lambda = .84$ ("Picturing my own suicide is a very scary thing for me.")
• Item 4 (Reverse-coded): $lambda = .78$ ("Even if I wanted to, killing myself is too scary to follow through with.")
• Item 5: $lambda = .69$ ("I could kill myself if I wanted to.")
• Item 6: $lambda = .65$ ("If I thought others would be better off without me, I wouldn’t be afraid to kill myself")
• Item 7: $lambda = .58$ ("Over time, I expect I’ll be less afraid of suicide.")

Measurement Invariance

Multi-group CFA demonstrated strict measurement invariance across gender (men vs. women). Configural, metric (weak), scalar (strong), and residual (strict) invariance models all satisfied conventional criteria for invariance ($\Delta\text{CFI} < .010$ and $\Delta\text{RMSEA} < .015$). This confirms that observed differences in FSS scores between men and women reflect true latent trait differences rather than differential item functioning or measurement bias.

10. Instrument / Measurement Tool

• Instrument Name: Fearlessness About Suicide Scale (FSS)
• Instrument Type: Self-report psychometric questionnaire
• Construct Assessed: Subjective fearlessness regarding suicide and the act of dying (capability for suicide)
• Target Population: Adults and adolescents aged 16 and older; applicable in both clinical psychiatric environments and general empirical research settings
• Administration Time: Approximately 2 to 3 minutes
• Number of Items: 7 items
• Response Scale: 7-point Likert-type scale scored from 0 to 6:
  • 0 — Strongly Disagree
  • 1 — Disagree
  • 2 — Somewhat Disagree
  • 3 — Neutral / Neither Agree nor Disagree
  • 4 — Somewhat Agree
  • 5 — Agree
  • 6 — Strongly Agree
• Scoring and Transformation Rules:
  • Reverse Coding: Four items are negatively keyed and must be reverse-coded prior to computing the total score: Item 1, Item 2, Item 3, and Item 4. The reversal formula is: $\text{New Score} = 6 – \text{Original Score}$ (i.e., $0 \rightarrow 6$, $1 \rightarrow 5$, $2 \rightarrow 4$, $3 \rightarrow 3$, $4 \rightarrow 2$, $5 \rightarrow 1$, $6 \rightarrow 0$).
  • Total Score Calculation: Sum the recoded scores of Items 1, 2, 3, and 4 together with the direct scores of Items 5, 6, and 7: $$\text{FSS Total} = \text{Item 1}_{\text{recoded}} + \text{Item 2}_{\text{recoded}} + \text{Item 3}_{\text{recoded}} + \text{Item 4}_{\text{recoded}} + \text{Item 5} + \text{Item 6} + \text{Item 7}$$
  • Possible Score Range: 0 to 42.
  • Score Interpretation: Higher total scores denote higher subjective fearlessness about suicide, indicating greater acquired capability to enact lethal self-harm. In high-risk clinical populations, individuals with scores in the upper quartile who also endorse active suicidal desire or intent should be considered at heightened risk for lethal action.

11. Permissions & Fee and Test Year

• Year of Formal Publication: 2024
• Copyright & Permissions: The Fearlessness About Suicide Scale was developed by William Grunewald, Natalie M. Perkins, Min Eun Jeon, E. David Klonsky, Thomas E. Joiner, and April R. Smith. The initial validation was published in Assessment (SAGE Publications).
• Fee & Accessibility: The scale is available free of charge for non-commercial academic research and clinical assessment purposes under standard fair-use academic conventions. Researchers and clinicians may administer the scale without purchasing a proprietary license, provided that appropriate bibliographic citation is given to Grunewald et al. (2024). Commercial use, integration into proprietary digital health platforms, or fee-based distribution requires explicit formal permission from the corresponding authors and the publisher.

12. References

• Grunewald, W., Perkins, N. M., Jeon, M. E., Klonsky, E. D., Joiner, T. E., & Smith, A. R. (2024). Development and validation of the Fearlessness About Suicide Scale. Assessment, 31(6), 1189–1203. https://doi.org/10.1177/10731911231200866
• Joiner, T. E. (2005). Why people die by suicide. Harvard University Press.
• Klonsky, E. D., & May, A. M. (2015). The Three-Step Theory (3ST): A new theory of suicide rooted in the "ideation-to-action" framework. International Journal of Cognitive Therapy, 8(2), 114–129. https://doi.org/10.1521/ijct.2015.8.2.114
• Ribeiro, J. D., Witte, T. K., Van Orden, K. A., Selby, E. A., Gordon, K. H., Bender, T. W., & Joiner, T. E. (2014). Fearlessness about death: The psychometric properties and construct validity of the revision to the Acquired Capability for Suicide Scale. Psychological Assessment, 26(1), 115–126. https://doi.org/10.1037/a0034858
• Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. E. (2010). The interpersonal theory of suicide. Psychological Review, 117(2), 575–600. https://doi.org/10.1037/a0018697

13. Items of the Scale