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this study have been reported elsewhere [5] . Basically, 82 individuals who had attempted suicide at least once during their lifetime were recruited from a psychiatric short-stay unit in 2012. All participants were administered the Spanish version of the Self-Injurious Thoughts and Behaviors Interview (SITBI) [5] . The characteristics of suicide attempts included the reported functions using a Likert scale (from 0 to 4) and referred to the most lethal suicide attempt recalled by the participant, as stated in the SITBI. Significant variables (p < 0.05) in univariate analyses were introduced in multivariate logistic regression models ( table 1 ). Most of the 82 individuals were Caucasian, single and had high school education. 49% were women. The mean age was 43.3 years (SD = 10.3). Among these 82 individuals there were 11 (13%) major repeaters ( ≥ 5 attempts) [2] and 71 (87%) nonmajor repeaters, respectively, including 35 (42%) with a single attempt and 36 (45%) with 2–4 lifetime suicide attempts. The univariate analyses of clinical variables indicated that there were no significant differences in clinical variables between repeaters and nonmajor repeaters, with the exception of borderline personality disorder (BPD; 45 vs. 14%; Fisher’s exact test, p = 0.027; OR = 5.0; 95% CI = 1.3–19.5). All major repeaters and 93% of the remaining suicide attempters had at least one axis I diagnosis. Major repeaters were statistically more likely to report APR than nonmajor repeaters (OR = 4.9; 95% CI = 1.3–18.3). ANR and social negative and social positive reinforcement were not significantly more frequent in major repeaters ( table 1 ). A logistic regression model with ‘major attempter’ as the dependent variable verified that the association between major repeater status and APR was not completely explained by the association between major attempter status and BPD ( table 1 , footnotes b and c). The present pilot study confirms that ANR (‘to stop bad feelings, psychological pain’) is reported most frequently as the reason for SB. In our sample, these reports were present in almost all attempters (86% of nonmajor repeaters and 91% of major repeaters). This finding supports the concept that people may attempt suicide to relieve a painful or unbearable internal state [6] and places psychological pain at the core of SB [7] . Shneidman [7] and, more recently, Tossani [8] stressed the strong link between psychological pain and SB. However, ANR did not differentiate between major and nonmajor repeaters in our pilot study. On the other hand, major repeaters were nearly 5 times more likely than nonmajor repeaters to endorse APR (‘to feel something, Empty societies create empty people. No societies perhaps have ever been more empty than those that exist in our present time, on the frontiers of modernity.1

Horror Vacui: Emptiness Might Distinguish between Major Suicide Repeaters and Nonmajor Suicide Repeaters: A Pilot Study