Clinical PsychologyPsychological AssessmentSuicidology

Reasons for Living Scales

The Reasons for Living Inventory (RFL), developed by Marsha M. Linehan, is a seminal psychometric instrument designed to evaluate the cognitive, interpersonal, and moral protective factors that prevent individuals from dying by suicide.

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Scientifically Reviewed · Dr. Marwa Abd-Alazim · September 26, 2026
Medically & Scientifically Reviewed Verified: September 26, 2026
Dr. Marwa Abd-Alazim Ph.D.
Professor of Psychology • University of Kerbala
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This content undergoes rigorous scientific peer-review and medical editorial standards at Arab Psychology Network to ensure clinical accuracy, validity, and compliance with evidence-based guidelines from leading psychological and healthcare authorities (APA / WHO).

Abstract

The Reasons for Living Inventory (RFL), developed initially by Dr. Marsha M. Linehan and colleagues in 1983, represents a foundational paradigm shift in suicidology and clinical psychometrics. Historically, suicide risk assessment focused almost exclusively on risk-enhancing pathologies, such as depressive symptom severity, psychiatric diagnosis, psychological pain, and hopelessness. In contrast, the RFL operationalizes an explicit cognitive-behavioral framework centered on protective factors, existential commitments, perceived survival abilities, and moral or relational prohibitions that buffer individuals against acting on self-destructive impulses. The comprehensive item pool comprises 72 items, while the validated standard clinical psychometric instrument is widely utilized as a 48-item self-report questionnaire, complemented by validated brief iterations (BRFL) and youth-specific adaptations such as the Reasons for Living Inventory for Adolescents (RFL-A).

Respondents evaluate each item on a 6-point Likert scale ranging from 1 (Not at all important) to 6 (Extremely important) as a rationale for continuing life when experiencing suicidal ideation. The standard 48-item instrument measures six psychometrically robust subscales: Survival and Coping Beliefs (SCB), Responsibility to Family (RF), Child-Related Concerns (CRC), Fear of Suicide (FS), Fear of Social Disapproval (FSD), and Moral Objections (MO). Extensive psychometric evaluations demonstrate high internal consistency (Cronbach’s alpha typically ranging from .72 to .93 across subscales), robust test-retest reliability, well-defined factor stability through exploratory and confirmatory factor analyses, and pronounced criterion validity. Crucially, the RFL uniquely differentiates individuals with suicidal ideation who do not attempt suicide from those who transition into suicide attempts, making it an indispensable instrument across clinical assessment, crisis intervention, psychiatric rehabilitation, and empirically supported suicide-specific therapies such as Dialectical Behavior Therapy (DBT).

Keywords

Reasons for Living Inventory, RFL, Marsha Linehan, Suicide Risk Assessment, Protective Factors, Dialectical Behavior Therapy, Suicidal Ideation, Psychometrics, Cognitive-Behavioral Assessment, Survival and Coping Beliefs, Clinical Suicidology

Authors

The primary architectural development and psychometric validation of the Reasons for Living Inventory were spearheaded by:

  • Marsha M. Linehan, Ph.D., ABPP — Professor Emeritus of Psychology and Director Emeritus of the Behavioral Research and Therapy Clinics (BRTC) at the University of Washington, Seattle, Washington, USA. Dr. Linehan is globally recognized as the developer of Dialectical Behavior Therapy (DBT) and a seminal scholar in the behavioral treatment of suicidal behavior and borderline personality disorder.
  • John L. Goodstein, Ph.D. — Department of Psychology, University of Washington, Seattle, Washington, USA.
  • Stevan L. Nielsen, Ph.D. — Department of Psychology, University of Washington, Seattle, Washington; currently affiliated with Brigham Young University, Provo, Utah, USA.
  • John A. Chiles, M.D. — Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.

Subsequent psychometric refinements, factorial re-evaluations, and the development of the Brief RFL and the Adolescent version (RFL-A) were led by:

  • Augustine Osman, Ph.D. — Professor of Psychology, University of Northern Iowa and University of Texas at San Antonio, recognized for extensive psychometric scale evaluations in depression, suicidology, and anxiety.
  • Beverly A. Kopper, Ph.D., Francisco X. Barrios, Ph.D., and Jack R. Osman, Ph.D., who co-authored seminal validation trials of adolescent adaptations.

Purpose

The explicit clinical and theoretical purpose of the Reasons for Living (RFL) Scales is to systematically assess the adaptive beliefs, functional expectations, cognitive prohibitions, and emotional attachments that an individual maintains against dying by suicide when experiencing profound psychological distress. Prior to the RFL’s introduction in 1983, the vast majority of suicidological assessment instruments were pathology-dominant, capturing variables such as the depth of depressive symptoms, the severity of active suicide ideation, intent, planning, and generalized hopelessness (such as the Beck Depression Inventory or Beck Hopelessness Scale). Although assessing deficit-based variables is essential, these indicators do not explain why many individuals experiencing acute emotional distress or intense suicidal thoughts actively decide not to make a suicide attempt.

The RFL operationalizes the clinical hypothesis that suicidal behavior results from a dynamic, transactional balance between forces driving an individual toward self-destruction (e.g., untreatable psychic pain, burdensomeness, severe despair) and cognitive-behavioral counterweights pulling them toward life. By identifying and quantifying specific reasons for living, clinicians and researchers can achieve multiple clinical objectives:

  • Differential Triage and Risk Stratification: In emergency departments, psychiatric crisis units, and outpatient clinics, standard psychopathology scales frequently produce high false-positive rates for suicide attempts because hopelessness and depressive ideation are common. The RFL significantly refines risk assessment by identifying individuals who retain powerful protective barriers, distinguishing pure ideators from imminent suicide attempters.
  • Cognitive-Behavioral Treatment Planning: In modalities such as Dialectical Behavior Therapy (DBT) and Cognitive Therapy for Suicide Prevention (CTSP), RFL subscales provide specific targets for intervention. If a patient scores near zero on Survival and Coping Beliefs but high on Responsibility to Family, therapy can initially leverage familial attachment as an external life jacket while systematically building internal behavioral coping repertoires and self-efficacy.
  • Longitudinal Treatment Monitoring: As patients progress through psychotherapy or pharmacotherapy, RFL scores reflect the recovery of cognitive flexibility, future-oriented planning, self-acceptance, and meaningful social attachments. Changes in specific subscales provide quantifiable evidence of therapeutic response.
  • Empirical Research into Resilience: Researchers utilize the RFL across adult, collegiate, forensic, geriatric, and adolescent samples to investigate the mechanistic architecture of psychological resilience, meaning-making, and coping under stress.

Psychological Construct

The construct captured by the Reasons for Living Scales is multidimensional cognitive-affective buffering. Rather than assuming that “reasons for living” form an undifferentiated positive attitude, Linehan and colleagues structured the construct into discrete cognitive domains that function as inhibiting mechanisms against suicidal acts.

1. Survival and Coping Beliefs (SCB)

This central dimension reflects the individual’s perceived self-efficacy, internal locus of control, emotional resilience, and belief in the transient nature of distress. Individuals with high SCB endorse statements indicating that emotional agony will eventually abate, that alternative solutions to acute crises exist, and that they possess the intrinsic agency to solve complex life problems. Items emphasize psychological endurance (e.g., “No matter how badly I feel, I know that it will not last” and “I believe I can find other solutions to my problems”). A collapse in this construct is strongly associated with active, lethal suicide attempts.

2. Responsibility to Family (RF)

Responsibility to Family measures perceived obligations to, interpersonal bonds with, and emotional attachment toward primary family members. This dimension taps the affective anticipation of inflicting unbearable grief, trauma, or emotional guilt upon loved ones (e.g., “My family depends upon me and needs me” and “It would hurt my family too much and I would not want them to suffer”). It captures the cognitive appraisal that one’s presence is vital to the well-being of their familial network, directly counteracting perceptions of burdensomeness.

3. Child-Related Concerns (CRC)

Extracted from the relational items in empirical factor analyses, Child-Related Concerns specifically evaluates the moral, emotional, developmental, and practical obligations of parenthood. Endorsing items within this construct reflects the belief that leaving children behind would be catastrophic for the offspring’s psychological trajectory (e.g., “I want to watch my children as they grow” and “The effect on my children could be harmful”). It serves as an exceptionally robust protective factor among adult clinical populations with dependent children.

4. Fear of Suicide (FS)

Fear of Suicide evaluates aversion to the actual act of dying and self-inflicted violence, anxiety regarding physical pain, fear of lethal failure leading to permanent bodily disfigurement or neurological impairment, and dread of the existential unknown (e.g., “I am afraid of the actual ‘act’ of killing myself (the pain, blood, violence)” and “I am afraid that my method of killing myself would fail”). While not reflecting positive existential meaning, this self-preservation drive acts as an acute visceral inhibitor against suicidal behavior.

5. Fear of Social Disapproval (FSD)

This subscale captures cognitive sensitivity to societal stigmatization, post-mortem judgment, and interpersonal reputation. It measures an individual’s concern that suicide will be interpreted as a sign of personal weakness, selfishness, or cowardice (e.g., “Other people would think I am weak and selfish” and “I am concerned about what others would think of me”). It operationalizes the inhibitory power of social norms and peer evaluation.

6. Moral Objections (MO)

Moral Objections evaluates internal ethical standards, traditional spiritual values, and religious proscriptions that define suicide as morally impermissible or spiritually destructive (e.g., “I believe only God has the right to end a life” and “I consider it morally wrong”). This construct functions as an absolute cognitive barrier for individuals embedded in religious, philosophical, or deontological frameworks that view self-termination as unacceptable.

Theoretical Framework

The Reasons for Living Scales are rooted in the Cognitive-Behavioral Theory of psychopathology, synthesized with the biosocial theory of emotional vulnerability and existential-behavioral theory developed by Marsha M. Linehan.

The Cognitive Mediation of Behavioral Action

Cognitive behavioral models posit that human behavior—including self-directed lethal violence—is mediated by internal cognitive structures, automatic thoughts, core schemas, and expectancy values. In traditional models formulated by Aaron T. Beck, suicidal behavior emerges from cognitive triads of pervasive negative views of the self, the world, and the future, culminating in pervasive hopelessness. Linehan expanded this paradigm by asserting that suicide is an operant behavior serving an escape function from intolerable emotional suffering. Crucially, the decision to engage in this escape behavior is regulated not only by the intensity of the aversive stimulus (the emotional pain), but also by the presence or absence of cognitive inhibitions and life-affirming expectations.

The Dialectical Equilibrium Model

Within Linehan’s biosocial formulation of Dialectical Behavior Therapy, suicidal behavior represents a dysfunctional attempt to resolve an intense dialectical dilemma: the agony of living within an emotionally invalidating environment versus the biological instinct for self-preservation. When an individual lacks distress tolerance and emotion regulation skills, suicide emerges as a logical escape strategy. The Reasons for Living construct conceptualizes the adaptive cognitive network that counteracts this drive. If an individual maintains strong survival beliefs, meaningful interpersonal attachments, and moral commitments, these cognitions introduce friction against the suicidal impulse, allowing the individual to endure the crisis until emotional arousal de-escalates.

Integration with Contemporary Interpersonal-Psychological Models

The theoretical framework of the RFL strongly aligns with Thomas Joiner’s Interpersonal Theory of Suicide. Joiner posits that suicidal desire requires two cognitive-affective states: Thwarted Belongingness (loneliness and absence of reciprocal care) and Perceived Burdensomeness (the belief that one’s existence harms others). When cross-referenced with the RFL, the Responsibility to Family and Child-Related Concerns subscales measure the exact cognitive antithesis of perceived burdensomeness, demonstrating that the individual recognizes their existence as essential to others. Similarly, Joiner’s third component, the Acquired Capability for Suicide (the degradation of fear and pain sensitivity required to enact lethal violence), is directly counteracted by the Fear of Suicide subscale of the RFL.

Validity

The Reasons for Living Scales have undergone extensive psychometric validation across clinical, non-clinical, collegiate, and forensic populations worldwide.

Construct and Discriminant Validity

In the seminal validation investigation by Linehan, Goodstein, Nielsen, and Chiles (1983), the 48-item RFL was administered to three distinct samples: psychiatric inpatients hospitalized for suicidal behavior, psychiatric inpatients hospitalized without suicidal behavior, and a non-clinical community sample. Multivariate analyses of variance (MANOVA) indicated that individuals without a history of suicidal behavior scored significantly higher across all subscales than clinical suicide attempters (p < .001). More importantly, when comparing suicidal psychiatric patients who had engaged in suicide attempts with those who experienced suicidal ideation without acting, the Survival and Coping Beliefs subscale differentiated attempters from ideators with significant diagnostic precision (F = 18.42, p < .001).

Convergent and Divergent Validity

Convergent validity has been evaluated against established suicidology metrics:

  • Beck Hopelessness Scale (BHS): Demonstrates moderate to strong negative correlations, particularly with the Survival and Coping Beliefs subscale (r = −.52 to −.68, p < .001), indicating that higher adaptive coping beliefs correspond to reduced hopelessness.
  • Beck Depression Inventory (BDI): Moderately negatively correlated with the overall RFL total score and SCB (r = −.40 to −.55, p < .001). However, the correlation is not redundant, proving that the RFL measures protective assets rather than simply reflecting the inverse of depressive symptomatology.
  • Suicidal Behaviors Questionnaire (SBQ-R): Yields strong negative correlations with RFL total scores (r = −.48 to −.61), confirming that higher reasons for living directly map onto lower lifetime suicidal behaviors and future intent.

Incremental and Predictive Validity

Subsequent investigations by Osman et al. (1993, 1999) demonstrated that RFL subscale scores account for unique, incremental variance in predicting future suicide attempts over and above standard measures of depression, hopelessness, and general anxiety. In prospective clinical trials of DBT, increases in the Survival and Coping Beliefs score across treatment significantly predicted reduced incidence of parasuicidal and suicidal acts at 12-month follow-up, validating the clinical utility of the RFL as a predictive treatment outcome metric.

Reliability

The psychometric literature confirms robust internal consistency, temporal stability, and test-retest reliability across multiple demographic and clinical cohorts.

Internal Consistency (Cronbach’s Alpha)

In the original normative psychometric study by Linehan et al. (1983), internal consistency reliability coefficients across the primary validated subscales demonstrated strong homogeneity:

  • Survival and Coping Beliefs (SCB; 23 items): α = .89 to .93
  • Responsibility to Family (RF; 10 items): α = .86 to .89
  • Child-Related Concerns (CRC; 3 items): α = .72 to .85
  • Fear of Suicide (FS; 7 items): α = .80 to .84
  • Fear of Social Disapproval (FSD; 3 items): α = .72 to .79
  • Moral Objections (MO; 4 items): α = .75 to .84
  • Total Scale (48 items): α = .91 to .95

Subsequent psychometric replications conducted by Osman et al. (1991, 1992, 1993) across university students and clinical psychiatric inpatients confirmed similar alpha coefficients, with the total scale consistently yielding α ≥ .90, and all individual subscales exceeding the psychometric acceptability threshold of α = .70.

Test-Retest Stability

Evaluating the temporal stability of the RFL is nuanced because reasons for living fluctuate alongside acute crisis state resolution. In stable, non-crisis samples over a 3-week interval, test-retest reliability coefficients ranged between r = .75 and r = .86 across subscales (Linehan et al., 1983). Over prolonged periods (e.g., 6 months to 1 year) within clinical populations receiving evidence-based psychotherapy, test-retest correlations are moderately positive (r = .55 to .68), demonstrating that while the RFL reflects a stable underlying trait-like cognitive structure, it remains dynamic and sensitive to therapeutic skill acquisition and clinical recovery.

Factor Analysis

The structural composition of the Reasons for Living Inventory has been confirmed through both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA).

Exploratory Factor Analysis (EFA)

Linehan and colleagues (1983) initiated development from an initial pool of 72 self-report items derived from clinical interviews with suicidal and non-suicidal individuals. Principal Components Analysis (PCA) accompanied by orthogonal (Varimax) and oblique rotations was conducted on community and clinical samples. The analysis yielded a primary 6-factor solution that accounted for the majority of the common variance, isolating 48 items that demonstrated primary factor loadings ≥ .40 and minimal cross-loadings:

  • Factor 1: Survival and Coping Beliefs — 23 items capturing emotional resilience, perceived ability to manage adversity, and optimistic future orientation.
  • Factor 2: Responsibility to Family — 10 items accounting for obligations to parents, siblings, and relational networks.
  • Factor 3: Child-Related Concerns — 3 items loading specifically on the protective responsibilities toward dependent children (frequently integrated with or isolated from Family Responsibility).
  • Factor 4: Fear of Suicide — 7 items centering on somatic anxiety, dread of lethal methods, and fear of the unknown.
  • Factor 5: Fear of Social Disapproval — 3 items focused on post-mortem social stigma and reputation.
  • Factor 6: Moral Objections — 4 items capturing religious and moral proscriptions.

Confirmatory Factor Analysis (CFA)

Osman, Jones, and Osman (1991) and Osman et al. (1993) subjected the 48-item, 6-factor model to structural equation modeling. The empirical findings demonstrated satisfactory goodness-of-fit indices:

  • Comparative Fit Index (CFI): .91 to .94
  • Non-Normed Fit Index (NNFI / TLI): .90 to .93
  • Root Mean Square Error of Approximation (RMSEA): .048 to .058 (90% CI: .042–.063)
  • Standardized Root Mean Square Residual (SRMR): .052

CFA studies have also evaluated hierarchical models. While a second-order general factor (“Reasons for Living”) is statistically viable, the 6-factor correlated model consistently provides superior fit across both adult and college cohorts. This confirms that reasons for living operate as a heterogeneous, multi-domain cognitive matrix rather than a singular unidimensional construct.

Instrument / Measurement Tool

  • Instrument Name: Reasons for Living Inventory (RFL) / Reasons for Living Scales
  • Primary Author: Dr. Marsha M. Linehan
  • Administration Format: Self-report questionnaire; paper-and-pencil or secure computer-based testing; clinical interview format acceptable for severe acute crisis presentations.
  • Target Population: Adults (aged 18 and older). Adolescent adaptations (RFL-A; 32 items) exist for youth aged 12–18.
  • Item Count:
    • Full Source Inventory / Long Form: 72 items
    • Standard Clinical Factor-Validated Inventory: 48 items
    • Brief RFL (BRFL): 14 to 12 items
  • Response Scale: 6-point Likert rating system:
    • 1 = Not At All Important (as a reason for not killing myself, or, does not apply to me, I don’t believe this at all)
    • 2 = Quite Unimportant
    • 3 = Somewhat Unimportant
    • 4 = Somewhat Important
    • 5 = Quite Important
    • 6 = Extremely Important (as a reason for not killing myself, I believe this very much and it is very important)
  • Scoring and Indexing:
    • Subscale scores are typically calculated as the mean item score (sum of raw scores divided by the number of endorsed items in that subscale) to allow direct comparison across subscales of unequal item length:
    • Survival and Coping Beliefs (SCB): Items 2, 3, 4, 8, 10, 11, 13, 14, 17, 19, 20, 22, 24, 25, 29, 32, 35, 36, 37, 39, 40, 44, 45 (Note: In standard 48-item scoring, Item 11 is grouped into Child-Related Concerns if scored as 6 subscales).
    • Responsibility to Family (RF): Items 1, 7, 9, 16, 30, 47, 48 (Child items 11, 21, 28 form the CRC subscale).
    • Child-Related Concerns (CRC): Items 11, 21, 28 (when analyzed as a dedicated 3-item subscale for respondents with children).
    • Fear of Suicide (FS): Items 6, 15, 18, 26, 33, 38, 46.
    • Fear of Social Disapproval (FSD): Items 31, 41, 43.
    • Moral Objections (MO): Items 5, 23, 27, 34.
    • Clinical Interpretation: Mean subscale scores < 3.0 denote depleted protective cognitive buffers in that domain. Mean scores > 4.5 indicate robust, active protective factors. Depressed SCB scores (< 2.5) paired with low RF/CRC scores indicate imminent suicide vulnerability requiring intensive clinical stabilization.
  • Average Completion Time: 10 to 15 minutes for the 48-item scale; 15 to 20 minutes for the 72-item long form.

Permissions & Fee and Test Year

The original Reasons for Living Inventory was formulated and psychometrically published in 1983 by Dr. Marsha M. Linehan, John L. Goodstein, Stevan L. Nielsen, and John A. Chiles in the Journal of Consulting and Clinical Psychology. The expanded 72-item pool reflects Dr. Linehan’s clinical research development throughout the 1980s and 1990s at the Behavioral Research and Therapy Clinics (BRTC), University of Washington.

The RFL scales are copyrighted by Dr. Marsha M. Linehan. While the instrument has been reproduced across clinical reference manuals (such as Fischer & Corcoran’s Measures for Clinical Practice and Research, Oxford University Press) and academic repositories, its formal deployment requires adherence to standard intellectual property and clinical usage guidelines:

  • Academic and Non-Commercial Research Use: Academic researchers and graduate scholars may generally utilize the Reasons for Living Inventory for non-commercial research, institutional reviews, and clinical trials without licensing fees, provided formal attribution to Dr. Marsha M. Linehan and the primary 1983 publication is preserved. The 72-item instrument and clinical forms are maintained for research dissemination through the University of Washington Behavioral Research and Therapy Clinics (BRTC).
  • Commercial and Electronic Health Record (EHR) Integration: Deployment within proprietary software platforms, for-profit telehealth portals, commercial EHR integrations, or published diagnostic testing batteries requires written permission and formal licensing from the copyright holder or designated licensing entities (e.g., Behavioral Tech LLC).

References

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