● The danger of an attempted suicide/NSSI dichotomy is that those with NSSI will be given lower priority and receive poorer treatment than other patients. (Cipriano, Cella, & Cotrufo, 2017) In most cases, NSSI functions as a behavioral coping mechanism through which highly-emotional vulnerable individuals use the pain and vividness of the NSSI behavior to distract themselves from these distressing emotions (Selby et al., 2019). However, in some cases NSSI behavior can present as a function of interpersonal motivations, to either receive attention or avoid unwanted tasks or responsibilities, although these motivations Other childhood diagnoses Although the childhood disorders most associated with suicidal behavior are depression, bipolar disorders, and DMDD (Dir et al., 2020), there are a few additional childhood disorders that are linked to suicide, namely conduct disorder, oppositional defiant disorder, and attention deficit/hyperactivity disorder (Orri et al., 2020). Conduct disorder, which involves repetitive and persistent behaviors involving difficulty following rules, respecting the rights of others, and behaving in a socially acceptable way, has been found to be connected to increased risk of suicidal behavior (Wei et al., 2016). The primary symptom categories of conduct disorder include aggression to people and animals, destruction of property, deceitfulness, lying or stealing, and serious violation of rules (APA, 2013). Symptoms can range from moderate to severe, with some cases involving physical violence or harm toward others by the youth. Of note, because the behaviors exhibited in conduct disorder can be so problematic across a variety of settings, it can be easy for clinicians to miss warning signs for suicidal behavior in conduct disorder, so careful suicide risk assessment is warranted in conduct disorder cases even when affective features such as depression may not be a primary presenting problem. Related to conduct disorder is the less severe but still problematic oppositional defiant disorder (ODD), which also has elevated risk of suicidal behavior relative to the general population (Martin et al., 2016; Orri et al., 2020). ODD is characterized by a child or adolescent exhibiting frequent and persistent anger, irritability, arguing, defiance, or vindictiveness Suicidal behavior disorder As has been demonstrated in this section, suicidal behavior cuts across a great many diagnostic categories and conditions. Not surprisingly, because of the transdiagnostic nature of suicidal behavior, some researchers have proposed the inclusion of a new, comprehensive diagnosis for suicidal behavior in a future version of the DSM (Obegi, 2019). This proposal is best characterized by the inclusion of suicidal behavior disorder (SBD) in Section III of the DSM-5 , pertaining to disorders in need of further investigation prior to official inclusion as an official DSM diagnosis. The DSM-5 -proposed diagnostic criteria of suicidal behavior disorder are as follows: ● Within the last 24 months, the individual has made a suicide attempt. Note : A suicide attempt is defined as 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 act does not meet the criteria for non-suicidal self-injury; that is, it does not involve self-injury directed toward the body’s surface 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 the attempt is: ○ Current (not more than 12 months since the last attempt).
are far less common than the emotion-regulation function of NSSI. Substantial research is also being conducted regarding whether a future version of the DSM should include a NSSI disorder diagnosis so that clinicians better recognize this behavior (Selby et al., 2015). In a recent adolescent community study, the prevalence rate of NSSI using the proposed criteria for DSM-5 was 7.6% (Buelens et al., 2020). Establishing a classification for NSSI would allow for delivering treatment to patients with self- injurious behavior which otherwise might not fulfill criteria for any other disorder. toward parents and other authority figures. Primary symptoms include angry and irritable mood, argumentative and defiant behavior, and vindictiveness occurring at least twice in the past six months (APA, 2013). ODD symptom severity can range from mild to severe. Like those with conduct disorder, youth with ODD may be overlooked with regard to suicidal behavior due to increased focus on the oppositional behavior, meaning additional vigilance in suicide risk assessment is warranted in cases of ODD. Likewise, attention deficit/hyperactivity disorder (ADHD) has also been linked to youth and future suicidal behavior for children of both sexes (Balazs & Kereszteny, 2017; Orri et al., 2020). ADHD is a disorder characterized by substantial heterogeny in behavioral features but can be summarized as involving two primary types of symptoms: inattentive and hyperactive. Primary inattentive symptoms can include disorganization and problems prioritizing activities, poor time management skills, problems focusing on a task, difficulty with multitasking, problems following through and completing tasks, and poor planning. Primary hyperactivity symptoms include impulsiveness, excessive activity or restlessness, low frustration intolerance, frequent mood swings, hot temper, and trouble coping with stress. Similar to conduct disorder and ODD, parental and educator focus may be on externalizing or problematic behavior while overlooking potential for suicidal behavior, so careful attention and monitoring of suicide risk should be made in cases of ADHD, particularly when youth exhibit symptoms of emotional reactivity. ○ In early remission (12 to 24 months since the last attempt). (APA, 2013) Clinicians should further specify the violence of the method (i.e., overdose vs. gunshot), the medical consequences of the behavior, and the degree of planning vs. impulsiveness of the suicide attempt. As can been observed in these criteria, careful attention is paid to defining suicidal behavior, especially as distinguished from NSSI, and further from suicidal ideation (which is neither necessary nor sufficient for an SBD diagnosis). Proponents of creating a SBD diagnosis have argued that officially doing so will have several benefits, such as creating a way to organize and perhaps track risk for suicide, as well as the ability to “call out” suicidal risk in an individual’s clinical record, distinguishing it from being “just a symptom” of other psychiatric conditions. As it stands, suicidal behaviors (both death and attempts) are commonly seen as complications of other diagnoses, most commonly mood disorders, but also schizophrenia, substance use disorders (particularly alcohol), and personality or anxiety disorders. However, approximately 10% of people who attempt suicide do not have an identifiable mental disorder, and approximately 25 to 30% of people who attempt suicide will go on to make more attempts in their lifetime (Obergi, 2019). If SBD were included in future versions of the DSM , for the first time, suicidality would have the status of a separate syndrome. The current diagnostic structure implies that suicidal behavior is not as central a concern in schizophrenia, alcohol use disorder, or post-traumatic stress disorder, for example, yet all these
EliteLearning.com/Psychology
Book Code: PYCA1423
Page 62
Powered by FlippingBook