Suicidal Behavior Disorder Diagnosis Gaining Favor: DSM-5 Work Group Thinks Stand-Alone Diagnosis Might Help Increase Emphasis on Suicide Prevention

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PORTLAND, ORE. -- A stand-alone diagnosis of suicidal behavior disorder is being considered for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to increase the manual's emphasis on suicide prevention, according to Dr. Jan Fawcett, chairman of the DSM-5 Mood Disorders Work Group.

The current version, DSM-IV, includes suicide only as a manifestation of major depressive episodes and bipolar disorder, which is problematic for several reasons.

First, although those diagnoses persist in a patient's psychiatric history, the fact that they attempted suicide frequently gets lost in the shuffle, even though past attempts significantly increase the risk for future attempts, Dr. Fawcett said.

Psychiatric patients often are not even asked whether they have attempted suicide, and might not be treated any differently if they have, he said (Am. J. Psychiatry 2002;159:1746-51).

Also, the risk of suicide "clearly goes across diagnoses. It's more common in mood disorders, fairly high in borderline disorder, but also high in schizophrenia and elevated in anxiety disorders," as well as substance and alcohol abuse disorders, said Dr. Fawcett, professor of psychiatry at the University of New Mexico, Albuquerque.

His group believes that a standalone suicidal behavior disorder (SBD) diagnosis would address those problems by encouraging clinicians to ask about past attempts and address risk factors.

"The idea is to make clinicians more aware of recording these things and factoring them into [their] assessment of the patient. We are trying to get beyond 'no SI' [suicidal ideation] or 'no plan' as a suicide assessment," Dr. Fawcett said.

There's a need for that. Most people who see their therapists the day they kill themselves never admit to suicidal ideation, he said (Br. J. Psychiatry 1998;173:531-5).

The diagnosis also would likely increase research into the problem, which is sorely needed," he said. …