Big ideas series: avoidance-to-embrace: the death discontinuity continuum between panic disorder and acute suicidal affective disturbance.

Abstract

Background: Acute Suicidal Affective Disturbance (ASAD) is a proposed clinical diagnosis characterized by sudden, intense escalations in suicidal intent, profound social and self-alienation, hopelessness, and heightened physiological arousal. Unlike traditional linear frameworks implying an "ideation-to-action" trajectory, ASAD captures temporally discrete, high-risk states occurring within hours or days. Although accumulating evidence supports the construct validity of ASAD, direct research remains constrained by ethical and practical challenges.

Objectives: This paper proposes Panic Disorder (PD) as a useful analogue for advancing the study of ASAD. The two share phenomenological features, including abrupt affective surges, intense physiological activation, and compromised cognitive control. Importantly, PD offers an experimentally tractable and ethically feasible model: panic-like states can be reliably induced and studied through well-established paradigms (e.g., CO₂ inhalation, interoceptive exposure). Leveraging PD as a proxy provides a unique opportunity to examine underlying mechanisms of ASAD while bypassing the risks inherent to provoking suicidal crises.

Methods: We propose a Discontinuity Continuum Model, positioning PD and ASAD along a shared spectrum of death-related affective experiences, separated by a psychological threshold of suicidal desire.

Conclusion: By integrating insights from panic science into ASAD research, new pathways for mechanistic discovery, diagnostic refinement, and development of targeted interventions will likely emerge.