SUICIDE and suicidal thoughts INFORMATION PAGE

MAYO CLINIChttps://www.mayoclinic.org/diseases-conditions/suicide/symptoms-causes/syc-20378048


Suicidal Behavior Disorder DSM-5

DSM-5 Category: Conditions for Further Study

Introduction

Suicidal Behavior Disorder is a proposed DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), diagnosis which would be assigned to individuals who have made a suicide attempt within the past two years. A suicide attempt is defined, as a self-destructive act deliberately carried out where there is a clear expectation of death. Considering suicidal behavior as a condition independent of depression or other mental disorders is a paradigm shift, as suicidal ideation, attempts, and successful attempts were defined as behaviors associated with mood disorders, and other mental disorders. It is noted that about 10% of people who commit suicide do not have a mental illness, and

“Most people” who have depression or another mood disorder do not attempt suicide (Reardon, 2013). Th previous findiing are very debatable, and must be considered critically. To state that 10% of people who commit suicide do not have a mental illness assumes that the individual was properly diagnosed, or that a potential mental illness was ever self reported to a health care provider or associate- e.g., family or friend. It is also a major assumpotion to state that most people with a mood disorder have not attempted suicide, as attempts may be denied or hidden. Differences in neuroanatomy have also been noted in post-mortems of individuals who have committed suicide speciifcally in the prefrontal cortex, which is associated with inhibition, self-regulation, impulse control and consideration of long terrm consequences, as well as altered serotonergic function (Courtet, Gottesman, Jollant, & Gould, 2011.; Reardon, 2013). However causality has not been established, and is most likely much more complex than the observed neuroanatomical variations.

Men tend to commit suicde at a higher rather than women, as it has long been established that men are likely to use more lethal and reliable means, such as a firearm or jumping for a height, while women ar more likely to use unreliable , less lethal means such as cutting or taking an overdose of medication (Schrijvers, Bollen and Sabbe, 2011).

Symptoms of Suicidal Behavior Disorder

According to the DSM-5, there are five proposed criterion Suicidal Behavior Disorder, with two specifiers

  1. The individual has made a suicide attempt within the past two years.
  2. The criterion for non-suicidal self-injurious behavior is not met during the aforementioned suicide attempts.
  3. The diagnosis is not applied to preparation for a suicide attempt, or suicidal ideation.
  4. the act was not attempted during an altered mental state, such as delirium or “ confusion”.
  5. The act was not ideologically motivated- e.g. – religious or political.

Other specifiers are:

  • Current- Not more than 12- 24 months since last attempt.
  • In Remission- more than 24 months since last attempt. (American Psychiatric Association, 2013).

Onset

The DSM-5 notes that Suicidal Behavior Disorder could occur at any point in the lifespan, very rarely under age five. (American Psychiatric Association, 2013).

Prevalence

The DSM -5 does not indicate the prevalence of Suicidal Behavior Disorder (American Psychiatric Association, 2013). About 5-8% of teens attempt suicide each year according to some studies (Blaszczak-Boxe, 2014 ).The actual numbers are unknown of course, as attempts may be hidden or denied, and this is not including suicidal ideation which is not acted out behaviorally.

Risk Factors

The DSM-5 indicates that risk factors for Suicidal Behavior Disorder are mental illnesses such as bipolar disorder, major depressive disorder, schizophrenia, schizoaffective disorder, anxiety disorders panic disorder and PTSD, substance use disorders (especially alcohol use disorder), borderline personality disorder, antisocial personality disorder, eating disorders, and adjustment disorders (American Psychiatric Association, 2013). Chronic pain and terminal or chronic illnesses, which cause impairment and loss of physical ability, may be co-morbid with Suicidal Behavior Disorder. In recent years, there has been increasing attention to children and teens contemplating or carrying out suicide in response to bullying. It has been found that there is an especially robust correlation between cyber bullying and suicidality (Blaszczak-Boxe,2014).Cybrbullying can be overwhlming. Several peers bullying a child or teen is difficutl enough, and causes emotional harm and psychological stress, which can hav a long term impact. Cyber-bullying can involve an onslaught of abuse. Opening an email inbox and finding several hundred emails from people, many of which you don’t know, making threats or mocking you, or postings on a social networking sight for a wide audience to see, would be overwhelming to a stable adult with well developed coping skills and supports. This type of situation has the potential to drive a child or teen to suicide. In a study done in Greece of n= 5614 subjects between ages 16-18, it was found that being a victim of bullying increased suicidal ideation, (Skapinakis, Bellos, Gkatsa, Magklara, Lewis, Araya, Stylianidis, & Mavreas, 2011).The veterans of the conflicts in Iraq and Afghanistan having an extremely high suicide rate. The number of veterans who have died by suicide between 2005 and 2011 is approximately 49,000- this is five times more than the number of suicides among civilians, and almost seven times the number of combat fatalities in both of these conflicts from 2001 to 2013 ( Statistics Brain, 2014; Hargarten, Burnson, Campo, & Cook, 2013)

Comorbidity

The DSM-5 indicates that Suicidal Behavior Disorder is comorbid with a variety of mental disorders, listed in Risk Factors (American Psychiatric Association, 2013).

Treatment for Suicidal Behavior Disorder

The DSM-5 does not specify treatment options for Suicidal behavior Disorder(American Psychiatric Association, 2013). Treatment of an underlying mental or physical disorder may alleviate suicidal impulses, or improved coping with the source of distress. Instillation of hope is essential, as the individual must find reasons to continue living, rather than seeking self-destruction.

Impact on Functioning

Suicidal behavior disorder may result in injuries from unsuccessful attempts (American Psychiatric Association, 2013).