Suicidal Behavior Disorder

By: Lourie W. Reichemberg

Suicide is a leading cause of death worldwide. As many as 25% to 35% of persons who make one suicide attempt will make another. The risk of suicide increases with the co-occurrence of many of the mental, including depression and bipolar disorders, disorders on the schizophrenia spectrum, anxiety and trauma-related disorders, eating disorders, and adjustment disorders.

The inclusion of suicidal behavior disorder as a condition for further study in DSM-5, and the addition of suicide risk factors to appropriate disorders, are part of an ongoing recognition that despite efforts to reduce the number of people who take their own lives each year, the suicide rate has remained steady, at 10 to 13 suicides per 100,000 people, for more than 70 years. Tools for risk assessment and prevention may be found on the DSM-5 website (www.DSM5.org) or in the Appendix of Selecting Effective Treatments (Seligman & Reichenberg, 2012).

Proposed criteria for suicidal behavior disorder include a suicide attempt within the last 24 months, which was self-initiated, was expected to lead to death, did not meet the criteria for non-suicidal self-injury, did not occur in a state of delirium or confusion, and was not undertaken solely for a political or religious objective. The diagnosis does not apply to suicidal ideation or preparatory acts in the absence of an attempt. Specify if “current” (not more than 12 months have elapsed since the last suicide attempt) or “in early remission” (12 to 24 months since the last attempt).

Suicidal behavior is difficult to predict. One study found that as many as 76% of people who completed suicide while inpatients in a psychiatric hospital had denied any suicidal ideation in the week preceding their deaths (Busch, Fawcett, & Jacobs, 2003). Other research confirms that neither psychiatrists nor the patients themselves were able to predict future suicide (Nock, Hwang, Sampson, & Kessler, 2010). Current research is underway to determine other methods of identifying people who are at high risk of suicide (Tingley, 2013). Readers are reminded that if clinically significant manifestations of these proposed disorders occur, they may be coded as Other Specified.

References

Lourie W. Reichemberg, DSM-5™ Essentials The Savvy Clinician’s Guide to the Changes in Criteria, 2014 by John Wiley & Sons, Inc

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