SUICIDAL BEHAVIOR DISORDER
Suicidal Behavior Disorder is a proposed separate diagnosis in the Diagnostic and Statistical Manual, Fifth Edition.
Suicidal Behavior Disorder (proposed in DSM-5) is a behavioral or psychological syndrome or pattern that can include cognitive, emotional, temperament and personality domains along with biological markers associated with risk including the central nervous system.
According to the DSM-5, there are five proposed criterion Suicidal Behavior Disorder:
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, i.e., religious or political (APA, 2013, p. 801).
A prior history of suicidal behavior is a key predictor for future suicidal behavior. Other environmental factors such as unemployment, financial crisis bullying, military combat, or relationship disruptions are also associated with risk. Although suicidal behavior may co-occur with another psychiatric condition, this is not always the case. Many people who die by suicide have not been diagnosed with a mental disorder.
Suicidal behavior is the cause of over a million deaths worldwide every year. Non-fatal suicidal behavior is estimated to be even more common. It is important to create strategies to identify those individuals at risk within the health care system. This is critical because, as mentioned above, many people who complete suicides have not interacted with a mental health worker but may have been seen by a medical professional such as a primary care physician. Defining suicidal behavior disorder as a separate diagnosis in the DSM-5 is important to standardize care in order to develop methods to identify suicidal behavior, document in medical records, and track patients at every level of care.
The fact that suicidal ideation waxes and wanes over time can create perilous situation in which key information may be missed. Continuity of care is very important with patients with a risk of suicidal behavioral—some healthcare systems have more robust medical records systems than others. Even in cases when the past suicide attempt is identified, data about suicide risk is often lost during hand-offs and may not be included in discharge summaries (Orquendo & Baca-Garcia, 2014).
Direct advice for overwhelming urges to kill self or use opioids
— Shut it down — Sleep (no overdosing). Can’t sleep? Cold shower or face in ice-water (30 seconds and repeat).* This is a reset button. It slows everything way down. — No Important Decisions — Especially deciding to die. Do not panic. Ignore thoughts that you don’t care if you die. Stop drugs and alcohol. — Make Eye Contact — A difficult but powerful pain reliever. Look in their eyes and say “Can you help me get out of my head?” Try video chat. Keep trying until you find someone. Video Guide (if you would like help following these steps). Here is a guided Eye Contact video to compliment the Guide.
*Not medical advice. Rapid reduction in heart rate may occur. Consult provider if concerned (e.g. heart condition, severe eating disorder).
Suicide Prevention Lifeline
24-hour, toll-free, confidential suicide prevention hotline available to anyone in suicidal crisis or emotional distress. Your call is routed to the nearest crisis center in the national network of more than 150 crisis centers.
Dr. Ursula Whiteside Interview
Dr. Ursula Whiteside is a licensed clinical psychologist and a member of the Clinical Faculty at the University of Washington. Dr. Whiteside trained under Dr. Marsha Linehan, the creator of Dialectical Behavioral Therapy, and later served as a DBT-adherent research therapist on a clinical trial led by Dr. Linehan that was funded by the National Institute of Mental Health. As a researcher, she has been awarded grants from the National Institute of Mental Health and the American Foundation for Suicide Prevention. Dr. Whiteside is the CEO of NowMattersNow.org which was conceived from her research study involving over 18,000 high-risk suicidal patients in four major health systems. This study includes a guided version of NowMattersNow.org which is a program she developed that includes skills for managing suicidal thoughts and is based on DBT and paired with Lived Experience stories. Dr. Whiteside is national faculty for the Zero Suicide Initiative, a practical approach to suicide prevention in healthcare and behavioral healthcare systems. Dr. Whiteside serves on the faculty of the National Action Alliance Zero Suicide Academy. She is also a founding board member of United Suicide Survivors International and a member of the Standards Trainings and Practices Committee for the National Suicide Prevention Lifeline. As a person with Lived Experience, she strives to decrease the gap between "us and them" and to ensure that the voices of those who have been there are included in all relevant conversations. Nothing about us without us.
Click the links below to find out more about Suicidal Behavior Disorder.