Call of the Void Scale

Abstract

The Call of the Void Scale (COVS) is an advanced, multidimensional psychometric instrument developed to assess and quantify a widely experienced yet historically under-investigated psychological phenomenon: the sudden, intrusive urge to engage in a potentially fatal act, colloquially recognized by the French phrase l'appel du vide. While foundational empirical research originally operationalized this experience primarily as the High Place Phenomenon (HPP)—the sudden impulse to jump when standing at an elevated precipice—the 27-item COVS substantially broadens this clinical and scientific inquiry. It integrates additional prevalent situational triggers, including operating a motor vehicle (e.g., urges to swerve into oncoming traffic) and standing near railway platforms (e.g., urges to step before an approaching train).

Crucially, the COVS transcends mere behavioral frequency tracking by operationalizing key cognitive-behavioral parameters: the degree of ego-dystonia characterizing the intrusive impulse and the employment of safety behaviors designed to neutralize, suppress, or avoid the distress provoked by these cognitions. Developed and validated by Lara Wiesmann, Laura Melzer, and Tobias Teismann (2025) using a split-sample structural equation modeling design ($N = 476$), the COVS demonstrates a robust five-factor architecture confirmed through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Subscales exhibit strong internal consistency (Cronbach's $\alpha ge .70$) and meaningful construct validity through differential associations with the Depression Anxiety Stress Scales (DASS) and the Suicide Ideation and Behavior Scale (SIBS). By clearly distinguishing ego-dystonic cognitive glitches from genuine, ego-syntonic suicidal intent, the COVS represents a vital clinical and investigative instrument for suicidology, obsessive-compulsive spectrum research, and psychiatric differential assessment.

Keywords

Call of the Void, High Place Phenomenon, Intrusive Thoughts, Suicidal Ideation, Ego-dystonia, Safety Behaviors, Psychometrics, Factor Analysis, Obsessive-Compulsive Cognitions, Risk Assessment, Cognitive Psychology, Cognitive Appraisal

Authors

The Call of the Void Scale was conceptualized, operationalized, and psychometrically validated by a collaborative team of clinical psychologists and psychopathology researchers based in Germany:

• Lara Wiesmann, M.Sc. (Corresponding Author) — Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany. Email: [email protected]. Wiesmann's empirical work focuses on anxiety disorders, specific phobias, agoraphobia, and the cognitive mechanisms underpinning high place phenomena and intrusive fatal impulses.
• Laura Melzer, M.Sc. — Department of Clinical Psychological Intervention, University of Wuppertal, Wuppertal, Germany. Melzer specializes in experimental psychopathology, cognitive interventions, and clinical test development.
• Prof. Dr. Tobias Teismann — Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany. Professor Teismann is an internationally acknowledged authority in clinical suicidology, cognitive-behavioral therapy for affective disorders, and the psychometric profiling of suicidal ideation and acute psychological crises.

Purpose

The fundamental purpose of the Call of the Void Scale (COVS) is to provide clinicians and clinical researchers with an empirically rigorous, standardized tool capable of capturing the full phenomenological spectrum of sudden, non-suicidal fatal cognitive intrusions. For decades, the experience of a brief, unexpected urge to leap from a balcony, steer a moving car into an oncoming vehicle, or lunge before an approaching subway train resided largely in philosophical discourse, existential literature, and anecdotal clinical observations. When Hames et al. (2012) first operationalized the High Place Phenomenon (HPP), they demonstrated that such urges are widely reported across non-clinical populations and do not necessarily stem from a conscious death wish. However, psychometric methodology remained constrained to single-situation assessments—predominantly heights—overlooking other ubiquitously reported settings such as transit platforms and vehicular operation.

From a diagnostic and psychiatric perspective, the clinical utility of the COVS addresses an urgent diagnostic dilemma: the differential assessment between benign, ego-dystonic intrusive cognitions and emergent, lethal suicidal ideation. When patients report intrusive images or sudden urges involving fatal scenarios to mental health professionals, these revelations often trigger acute concern, resulting in diagnostic misclassification, inappropriate involuntary commitments, or overly restrictive interventions that may exacerbate client anxiety. The COVS resolves this tension by evaluating not only the frequency of situational intrusions across multiple environmental contexts (heights, driving, train platforms) but also the qualitative appraisal of those intrusions—specifically their ego-dystonic quality (how alien, unacceptable, and unrepresentative of true intent the thought feels) and the secondary implementation of safety behaviors (efforts to physically retreat, grasp a railing, pull over a car, or cognitively neutralize the cognition).

In research settings, the COVS provides a standardized operationalization necessary to unpack the neurocognitive, affective, and personality correlates of fatal intrusions. It enables investigators to integrate the call of the void into contemporary models of unwanted intrusive thoughts (UITs), obsessive-compulsive disorder (OCD), panic disorder, acrophobia, and Joiner's Interpersonal Theory of Suicide. By elucidating how situational cues trigger cognitive misfires, the COVS equips behavioral scientists with the data needed to formulate nuanced, evidence-based cognitive interventions that alleviate catastrophic misinterpretations without pathologizing common cognitive phenomena.

Psychological Construct

The construct captured by the Call of the Void Scale is multidimensional, situated at the intersection of cognitive psychology, threat-processing biology, and clinical psychopathology. The scale conceptualizes the "call of the void" not as latent self-destructive motivation or covert suicidal volition, but rather as an acute, involuntary cognitive intrusion resulting from complex perceptual-motor threat misinterpretations. This overarching construct is operationalized through five correlated yet distinct latent dimensions:

1. Situational Frequency: High Place Phenomenon (Frequency HPP)

This dimension measures the lifetime and recurrent frequency with which an individual experiences an abrupt urge or flash mental image of jumping, falling, or stepping off when physically located at an elevated height. Typical environmental contexts encompass balconies, observation decks, cliff edges, bridge walkways, and high-rise windows. These intrusions typically manifest instantaneously, often triggering an abrupt somatic startle reflex and an intense surge of vertigo or acute physiological arousal.

2. Situational Frequency: Vehicular Operation (Frequency Car)

This subscale evaluates the temporal frequency of sudden, catastrophic impulses occurring while operating or riding within a motor vehicle. Manifestations include the momentary impulse to abruptly steer into oncoming traffic, veer off a highway bridge, accelerate into a concrete barrier, or release the steering wheel at high speeds. Because driving demands sustained motor control and presents ubiquitous physical hazards, such intrusions evoke significant cognitive shock and heightened concern regarding loss of self-regulation.

3. Situational Frequency: Rail and Transit Platforms (Frequency Train)

This dimension captures intrusive cognitions centering on train platforms, subway stations, and light-rail crossings. The specific behavioral imagery involves stepping, leaning, or lunging in front of a rapidly approaching train or falling onto an electrified rail line. The proximity to an uncontrollable, massive kinetic object generates a distinct environmental trigger profile characterized by acute sensory salience (e.g., vibrations, loud engine noise, shifting air currents).

4. Cognitive Appraisal: Ego-Dystonia

Ego-dystonia represents a fundamental cognitive dimension of the COVS, assessing the degree to which the individual evaluates the fatal intrusion as bizarre, exaggerated, fundamentally abhorrent, and completely incongruent with their actual values, desires, and core self-concept. In psychopathological terms, an ego-dystonic thought is perceived as an unwelcome mental invader ("This thought is horrifying and completely opposite to who I am and what I want"). A high score on ego-dystonia confirms that the fatal intrusion is experienced as internally alien, an essential psychometric marker differentiating cognitive misfires from genuine suicidal wishes, which frequently exhibit ego-syntonic characteristics (where death is viewed as a desirable, purposeful relief from psychological pain).

5. Behavioral and Cognitive Response: Safety Behaviors

This subscale assesses the cognitive and overt behavioral strategies executed to prevent the imagined catastrophe, eliminate immediate risk, or neutralize associated psychological distress. Drawing directly from cognitive-behavioral formulations of anxiety, safety behaviors in this context include physical actions (e.g., violently stepping back from platform edges, clenching the steering wheel until knuckles whiten, clutching handrails, sitting on the floor) and covert mental rituals (e.g., repeating neutralizing phrases, actively suppressing the thought, praying, distracting oneself). While intended to re-establish subjective security, these behaviors paradoxically reinforce the perceived threat of the intrusion across subsequent exposures.

Theoretical Framework

The Call of the Void Scale is theoretically grounded in two converging paradigms within contemporary clinical psychology: the cognitive misattribution model of survival signals and the cognitive-behavioral model of intrusive thoughts.

The Cognitive Misattribution Model

Originally proposed by Hames et al. (2012) in their foundational study on the High Place Phenomenon, this theoretical framework posits that fatal urges arise from an erroneous retrospective cognitive interpretation of an automatic, evolutionary survival reflex. When an individual approaches a lethal drop, their fast, pre-attentive vestibular and visual threat-detection circuitry triggers an involuntary, somatic retreat reflex (e.g., an abrupt startle, stepping back, postural stiffening) long before conscious cognitive appraisal completes its assessment.

A fraction of a second later, conscious cognitive processing assesses the sudden motor recoil and queries: "Why did I just jump back? What was the danger?" Because no external entity pushed them and the physical barrier was technically secure, the cognitive system rapidly constructs a post-hoc attribution: "I must have wanted to jump." In this manner, what was fundamentally an ultra-rapid survival signal affirming the drive to live is paradoxically misinterpreted by conscious meta-cognition as a suicidal urge. Wiesmann, Melzer, and Teismann (2025) extended this theoretical framework beyond heights, arguing that identical rapid motor-perceptual mismatches occur during high-speed driving and rail transit observation, where subconscious micro-corrections are retrospectively appraised as dangerous impulses.

Cognitive-Behavioral Theories of Intrusions (Rachman & Clark)

The second theoretical anchor stems from the classic cognitive models of obsessions articulated by S.J. Rachman (1997, 1998) and David A. Clark (2004). Rachman demonstrated that unwanted intrusive thoughts (UITs) involving harm, violence, and catastrophic blunders occur ubiquitously in more than 80% to 90% of non-clinical populations. The crucial factor distinguishing normal intrusions from clinical obsession or severe distress is not the intrusion itself, but rather the individual's catastrophic meta-cognitive appraisal of the intrusion.

According to this model, individuals who evaluate intrusive thoughts as dangerous, personally revelatory, or morally indicative of hidden desires experience acute distress. In response, they deploy thought suppression and behavioral avoidance—the very safety behaviors evaluated by the COVS. As demonstrated by Daniel Wegner's ironic process theory, conscious attempts to suppress a specific cognition paradoxically amplify its cognitive accessibility, producing an escalating cycle of intrusion frequency, heightened distress, and increasingly rigid safety behaviors.

Validity

The psychometric validation of the Call of the Void Scale was executed through rigorous construct, convergent, and discriminant validation analyses within a comprehensive cross-sectional study ($N = 476$).

Convergent Validity

The scale developers assessed convergent validity by examining bivariate associations between the five COVS subscales and two established clinical reference measures:

• Depression Anxiety Stress Scales (DASS): Standardized instrument assessing tripartite symptom clusters of general negative affect.
• Suicide Ideation and Behavior Scale (SIBS / SSEV): A validated measure quantifying active and passive suicidal thoughts and intent (Teismann et al., 2021).

Consistent with theoretical predictions, all three situational frequency subscales (Frequency HPP, Frequency Car, Frequency Train) demonstrated statistically significant, positive correlations with general anxiety, stress, and depressive symptoms on the DASS. Individuals experiencing higher psychological vulnerability, heightened somatic arousal, and baseline emotional exhaustion appear more susceptible to intrusive cognitive glitches across environments. Furthermore, frequency dimensions exhibited modest positive correlations with suicidal ideation on the SIBS, supporting prior literature (e.g., Teismann et al., 2020) indicating that general psychological pain renders fatal cognitions more cognitively accessible.

Similarly, the Safety Behaviors subscale correlated significantly and positively with both DASS subscales and the SIBS. This provides strong empirical corroboration of Salkovskis' (1991) cognitive-behavioral model: individuals reporting elevated anxiety and existential distress actively engage in extensive cognitive and behavioral neutralization maneuvers, which reflect heightened subjective distress and functional interference.

Discriminant and Divergent Validity

A pivotal psychometric finding affirming the theoretical integrity of the COVS concerns the Ego-Dystonia subscale. Unlike the situational frequency and safety behavior dimensions, Ego-Dystonia demonstrated distinct divergent orthogonality:

• It exhibited no statistically significant correlation with the DASS depressive, anxiety, or stress dimensions.
• It showed non-significant correlations with suicidal ideation on the SIBS.
• It correlated selectively and positively with the Safety Behavior subscale.

This empirical isolation of Ego-Dystonia is theoretically profound. It provides concrete statistical proof that viewing a sudden fatal thought as alien, bizarre, and unacceptable is not an artifact of general psychopathology or acute depression. Rather, ego-dystonia represents an independent meta-cognitive evaluation mechanism: the more an individual recognizes an intrusion as thoroughly opposed to their true identity, the more compelled they feel to utilize safety behaviors to neutralize it, completely independent of whether they possess genuine suicidal intent.

Reliability

The internal consistency and measurement reliability of the Call of the Void Scale were evaluated following Classical Test Theory (CTT) principles across the total sample and within its independent cross-validation split halves.

Internal Consistency

The scale developers computed internal consistency estimates using Cronbach's alpha ($lpha$) for each of the five extracted latent factors. Consistent with standard psychometric thresholds established by Nunnally (1975), an alpha coefficient of $ge .70$ denotes acceptable reliability, while values exceeding $.80$ signify good to excellent internal consistency:

• Frequency High Place Phenomenon: Demonstrated high internal consistency, with items clustering coherently around height-specific intrusions.
• Frequency Car: Exhibited robust item-total correlations and satisfactory alpha values, confirming homogeneity in capturing vehicular impulses.
• Frequency Train: Displayed solid internal consistency across transit platform scenarios.
• Ego-Dystonia: Demonstrated cohesive internal consistency, confirming that appraisal items reliably reflect the perceived alien nature of intrusions.
• Safety Behaviors: Demonstrated strong inter-item reliability, effectively measuring behavioral and cognitive neutralization strategies.

All finalized COVS subscales met or exceeded the empirical threshold of $lpha ge .70$, ensuring low measurement error and confirming that each dimensional domain reliably assesses its intended latent construct without excessive item redundancy.

Measurement Stability

While the initial validation focused on cross-sectional psychometric structure and internal consistency, longitudinal stability parameters (test-retest reliability) represent an active area of investigation. Given that situational frequency items measure episodic life experiences while ego-dystonia measures meta-cognitive appraisal tendencies, future longitudinal test-retest assessments will help delineate state versus trait variance across non-clinical and psychiatric cohorts.

Factor Analysis

The structural validity and factorial composition of the COVS were determined utilizing a rigorous split-sample cross-validation methodology on a total sample of 476 participants. The full dataset was randomly bifurcated into two equal, independent halves ($n_1 = 238$ and $n_2 = 238$), mitigating risk of empirical overfitting.

Exploratory Factor Analysis (EFA)

On the calibration sample ($n_1 = 238$), researchers conducted an Exploratory Factor Analysis utilizing Maximum Likelihood (ML) estimation. Because cognitive and behavioral facets of intrusive thoughts are theoretically related rather than fully orthogonal, an oblique oblimin rotation was specified. The Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy and Bartlett's test of sphericity confirmed the suitability of the correlation matrix for factor extraction.

The EFA yielded an unequivocal, interpretable five-factor solution. The factor pattern matrix cleanly separated items into their theoretical categories without problematic cross-loadings:

1. Factor 1 (Frequency HPP): Cleanly loaded items assessing heights and elevated edges.
2. Factor 2 (Frequency Car): Items capturing urges to swerve, crash, or accelerate while driving.
3. Factor 3 (Frequency Train): Items assessing intrusions on railway and transit platforms.
4. Factor 4 (Ego-Dystonia): Items evaluating the alien, exaggerated, and personality-inconsistent appraisal of the thoughts.
5. Factor 5 (Safety Behaviors): Items assessing physical withdrawal, clutching objects, and cognitive thought suppression.

Confirmatory Factor Analysis (CFA)

To confirm the stability of this architecture, a Confirmatory Factor Analysis was executed on the validation sample ($n_2 = 238$) using the lavaan package within the R environment (Rosseel, 2012). The completely standardized five-factor measurement model was evaluated against standard goodness-of-fit benchmarks formulated by Hu and Bentler (1999) and Brown (2015):

• Root Mean Square Error of Approximation (RMSEA): Values between $.05$ and $.08$, indicating acceptable to close approximation.
• Comparative Fit Index (CFI): Values exceeding $.90$ to $.95$, denoting superior model fit relative to the null independence model.
• Tucker-Lewis Index (TLI): Coefficients exceeding $.90$ to $.95$, confirming strong factor saturation.
• Standardized Root Mean Square Residual (SRMR): Values lower than $.08$, reflecting minimal residual covariation.

The five-factor model demonstrated an excellent fit to the empirical validation data. All standardized factor loadings from latent variables to their respective observed indicators were statistically significant ($p < .001$) and structurally substantial, empirically demonstrating that the Call of the Void is fundamentally multidimensional rather than a single unitary construct.

Instrument / Measurement Tool

The Call of the Void Scale (COVS) is structured as a standardized, multidimensional self-report inventory. Its design, administration parameters, and scoring protocols are detailed below:

• Test Type: Multi-scale psychological self-report questionnaire / diagnostic assessment tool.
• Item Count: 27 items across five specialized subscales.
• Response Format: Standardized 5-point Likert scale ranging from 1 to 5:
  • 1 = Never / Not at all (Nie / Überhaupt nicht)
  • 2 = Rarely / A little (Selten / Ein wenig)
  • 3 = Sometimes / Moderately (Manchmal / Mäßig)
  • 4 = Often / Considerably (Oft / Ziemlich)
  • 5 = Always / Very much (Immer / Sehr stark)
• Target Population: Adults (18 years and older); validated in non-clinical adult populations, university cohorts, and community samples.
• Original Language: German (validation conducted by Ruhr-Universität Bochum and University of Wuppertal).
• Administration Modality: Paper-and-pencil or anonymous digital survey formats; self-administered in approximately 5 to 10 minutes.
• Subscale Architecture:
  • Frequency High Place Phenomenon (HPP): Assesses the occurrence of urges to jump or step from heights.
  • Frequency Car: Assesses the occurrence of urges to crash, veer into traffic, or release steering while operating a motor vehicle.
  • Frequency Train: Assesses the occurrence of urges to step or lean in front of approaching trains at platforms.
  • Ego-Dystonia: Evaluates how alien, bizarre, and contrary to personal character the thoughts are perceived.
  • Safety Behaviors: Measures the deployment of motoric avoidance, holding onto objects, and mental thought suppression to neutralize impulses.
• Scoring and Interpretation Guidelines: Subscale scores are derived by summing or averaging the items comprising each discrete factor. No single composite "total score" should be interpreted in isolation, as combining frequency with appraisal obscures critical clinical distinctions:
  • High Frequency + High Ego-Dystonia + High Safety Behaviors: Suggests an obsessive-compulsive cognitive pattern, characterized by benign intrusive misfires that provoke significant secondary anxiety and avoidance, but low genuine suicidal intent.
  • High Frequency + Low Ego-Dystonia + Low Safety Behaviors: Represents an urgent clinical warning sign, potentially indicating that fatal cognitions are ego-syntonic, necessitating comprehensive suicide risk evaluation.

Permissions & Fee and Test Year

The Call of the Void Scale was developed and finalized in 2025 by Lara Wiesmann, Laura Melzer, and Tobias Teismann at the Mental Health Research and Treatment Center, Ruhr-Universität Bochum, and the University of Wuppertal. The primary empirical validation paper is published open-access in Frontiers in Psychiatry (DOI: 10.3389/fpsyt.2025.1685791).

In accordance with standard open science and academic practices, the theoretical architecture and factor metrics are publicly accessible. However, the exact operationalized 27 questionnaire items are under academic copyright by the original authors and institutional research centers. Non-commercial academic researchers, qualified clinicians, and institutional investigators wishing to obtain the complete, official German item inventory or to seek formal permission for cross-cultural translation and validation projects must contact the corresponding author directly:

Lara Wiesmann, M.Sc.
Mental Health Research and Treatment Center
Ruhr-Universität Bochum, Massenbergstraße 9–13, 44787 Bochum, Germany
E-Mail: [email protected]

No commercial reproduction, test bank inclusion, or fee-based clinical software distribution is permitted without written authorization from the copyright holders.

References

• Berry, E., & Laskey, B. (2012). A review of obsessive intrusive thoughts in the general population. Journal of Obsessive-Compulsive and Related Disorders, 1(2), 125–132. https://doi.org/10.1016/j.jocrd.2012.02.002
• Brown, T. A. (2015). Confirmatory factor analysis for applied research (2nd ed.). Guilford Press.
• Clark, D. A. (2004). Cognitive-behavioral therapy for OCD. Guilford Press.
• Hames, J. L., Ribeiro, J. D., Smith, A. R., & Joiner, T. E. (2012). An urge to jump affirms the urge to live: An empirical examination of the high place phenomenon. Journal of Affective Disorders, 136(3), 1114–1120. https://doi.org/10.1016/j.jad.2011.10.035
• Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55. https://doi.org/10.1080/10705519909540118
• Joiner, T. E. (2005). Why people die by suicide. Harvard University Press.
• Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales (2nd ed.). Psychology Foundation of Australia.
• Mattera, M. G., Steer, C., & Hermans, D. (2024). Suicidal obsessions or suicidal ideation? A case report and practical guide for differential assessment. Cognitive and Behavioral Practice, 31(2), 195–211. https://doi.org/10.1016/j.cbpra.2022.09.002
• Nunnally, J. C. (1975). Psychometric theory—25 years ago and now. Educational Researcher, 4(10), 7–21.
• Purdon, C. (2005). Thought suppression and its effects on thought frequency, appraisal and mood state in individuals with obsessive-compulsive disorder. Behaviour Research and Therapy, 43(1), 93–108. https://doi.org/10.1016/j.brat.2003.11.007
• Rachman, S. (1997). A cognitive theory of obsessions. Behaviour Research and Therapy, 35(9), 793–802. https://doi.org/10.1016/S0005-7967(97)00040-5
• Rachman, S. (1998). A cognitive theory of obsessions: Elaborations. Behaviour Research and Therapy, 36(4), 385–401. https://doi.org/10.1016/S0005-7967(97)10041-9
• Rosseel, Y. (2012). lavaan: An R package for structural equation modeling. Journal of Statistical Software, 48(2), 1–36. https://doi.org/10.18637/jss.v048.i02
• Salkovskis, P. M. (1991). The importance of behaviour in the maintenance of anxiety and panic: A cognitive account. Behavioural Psychotherapy, 19(1), 6–19. https://doi.org/10.1017/S0141347300011472
• Teismann, T., Brailovskaia, J., & Margraf, J. (2020). High place phenomenon: Prevalence and clinical correlates in two German samples. BMC Psychiatry, 20, Article 478. https://doi.org/10.1186/s12888-020-02875-8
• Teismann, T., Glaesmer, H., & Spangenberg, L. (2021). Skala Suizidales Erleben und Verhalten (SSEV, SIBS): Factor structure and psychometric properties. Diagnostica, 67(4), 185–194. https://doi.org/10.1026/0012-1924/a000269
• Wiesmann, L., Melzer, L., & Teismann, T. (2025). Call of the Void Scale. Frontiers in Psychiatry, 16, Article 1685791. https://doi.org/10.3389/fpsyt.2025.1685791
• Wiesmann, L., Willutzki, U., & Teismann, T. (2025). The high place phenomenon: Associations with markers of positive and negative mental health in individuals suffering from specific phobia or agoraphobia. Clinical Psychology & Psychotherapy, 32(1), Article e70038. https://doi.org/10.1002/cpp.70038

Items of the Scale