____________________________________________________________ A Clinician’s Guide to the DSM-5-TR
Proposed Criteria for SBD • Within the last 24 months, the individual has made a suicide attempt. Note: A suicide attempt is a self- initiated sequence of behaviors by an individual who, at the time of initiation, expected that the set of actions would lead to his or her own death. (The “time of initiation” is the time when a behavior took place that involved applying the method.) • The act does not meet criteria for nonsuicidal self- injury—that is, it does not involve self-injury directed to the surface of the body undertaken to induce relief from a negative feeling/cognitive state or to achieve a positive mood state. • The diagnosis is not applied to suicidal ideation or to preparatory acts. • The act was not initiated during a state of delirium or confusion. • The act was not undertaken solely for a political or religious objective. • Specify if: ‒ Current: not more than 12 months since the last attempt ‒ In early remission: 12 to 24 months since the last attempt NONSUICIDAL SELF-INJURY Nonsuicidal self-injury disorder (NSSID) is a condition included in the Conditions for Further Study section of the DSM-5-TR, indicating that more research is needed before it can be considered an official diagnosis [1]. NSSID is character- ized by deliberate self-inflicted damage to the surface of one’s body without suicidal intent. To meet the diagnostic criteria, an individual must have engaged in self-injury for at least five days within the past year, with the expectation that the injury will lead to minor or moderate physical harm. The behavior is typically associated with interpersonal difficulties or negative feelings and thoughts, such as depression, anxiety, or self- criticism. Individuals with NSSID often report engaging in self-injury to obtain relief from negative emotions, to resolve interpersonal difficulties, or to induce positive feelings. Studies have shown that individuals meeting NSSID criteria often experience more severe psychopathology and impairment compared to those who self-injure but do not meet full criteria. NSSID can occur both independently and comorbidly with other mental health conditions, such as depression, anxiety disorders, and borderline personality disorder. Including NSSID in the DSM-5-TR aims to improve the recognition and treatment of clinically significant self-injurious behaviors while stimulating further research to understand this condition better. However, there is ongoing debate regarding the opti- mal diagnostic criteria, particularly concerning the frequency threshold and the potential risk of pathologizing behaviors that may be transient or part of normal development, especially in adolescents [1].
Proposed Criteria for NSSID • In the last year, the individual has, on five or more days, engaged in intentional self-inflicted damage to the surface of his or her body of a sort likely to induce bleeding, bruising, or pain (e.g., cutting, burning, stabbing, hitting, excessive rubbing), with the expectation that the injury will lead to only minor or moderate physical harm (i.e., there is no suicidal intent). Note: The absence of suicidal intent has either been stated by the individual or can be inferred by the individual’s repeated engagement in a behavior that the individual knows, or has learned, is not likely to result in death. • The individual engages in the self-injurious behavior with one or more of the following expectations: ‒ To obtain relief from a negative feeling or cognitive state ‒ To resolve an interpersonal difficulty ‒ To induce a positive feeling state Note: The desired relief or response is experienced during or shortly after the self-injury, and the individual may display patterns of behavior suggesting a dependence on repeatedly engaging in it. • The intentional self-injury is associated with at least one of the following: ‒ Interpersonal difficulties or negative feelings or thoughts, such as depression, anxiety, tension, anger, generalized distress, or self-criticism, occurring in the period immediately prior to the self-injurious act ‒ Prior to engaging in the act, a period of preoccupation with the intended behavior that is difficult to control ‒ Thinking about self-injury that occurs frequently, even when it is not acted upon • The behavior is not socially sanctioned (e.g., body piercing, tattooing, part of a religious or cultural ritual) and is not restricted to picking a scab or nail biting. • The behavior or its consequences cause clinically significant distress or interference in interpersonal, academic, or other important areas of functioning. • The behavior does not occur exclusively during psychotic episodes, delirium, substance intoxication, or substance withdrawal. In individuals with a neurodevelopmental disorder, the behavior is not part of a pattern of repetitive stereotypies. The behavior is not better explained by another mental disorder or medical condition (e.g., psychotic disorder, autism spectrum disorder, intellectual developmental
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