08/10/2013 12:32 pm ET Updated Oct 10, 2013

DSM-5's New Approach to Suicide Risk, Behavior

Nobody wants to talk about suicide. It's taboo -- something to be discussed in hushed tones, behind closed doors, and often not until it's too late. But our discomfort with the subject has only made it worse; suicide is now a serious public health problem in this country. Every year, more than 750,000 people attempt suicide and 36,000 commit it -- a loss of life greater than that from car accidents and more than double that of homicides. Untold numbers of families and friends are left to mourn.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) shines a spotlight on suicide to help reduce, if not reverse, this tragic trend. The new guidebook, published in May, has a greater focus on suicidal ideation and behaviors as a cross-cutting issue of mental disorders and introduces new ways of interpreting and reacting to both.

First, chapters throughout DSM-5 now identify particular characteristics that make people more vulnerable to suicide. This risk is specifically recognized in diagnoses from anorexia nervosa to schizophrenia to post-traumatic stress disorder, a reflection of research that has shown elevated risk to be a concern not just with depressive or personality disorders. For example, the text notes that suicide rates of 12 per 100,000 annually are reported with anorexia and that comprehensive evaluation of individuals with this diagnosis should include assessment of suicide-related ideation and behaviors. By directing attention to the suicidal patterns associated with a range of diagnoses, DSM-5 helps clinicians provide the best patient care -- and save lives.

In addition, a new component of the manual called Section III includes several assessment tools to assist clinicians in evaluating patients consistently and comprehensively. These cross-cutting symptom measures target more general mental function as well as severity measures that are disorder specific. They assess an individual in 13 different psychological domains, one of which is suicide. The measures are directed toward the diagnostic and treatment limitations of a strictly categorical construct. Symptoms, like suicidal behavior, often do not fit precisely into a single category.

Section III reflects some of the latest research and thinking on the challenging questions of how to address different types of suicidal and self-harming thoughts and behaviors. It aims to help clinicians distinguish a possible suicide attempt from suicidal ideation and forms of self-harm such as cutting or burning, which, while dangerous, are not meant to end a person's life.

This section includes two new conditions for further study: Suicidal behavior disorder describes someone who has attempted suicide within the last 24 months and may help identify the risk factors associated with suicide attempts, including depression, substance abuse, or a lack of impulse control. Non-suicidal self-injury is defined as self-harm without the intention of suicide. The latter condition is regarded as a major problem on college campuses and a public health issue that needs to be better understood.

The increased emphasis on suicide throughout DSM-5 will lead to more effective recognition of individuals with symptoms and behaviors that put them at risk. With improved diagnosis and care, the nation may finally be able to turn the tide on this loss and grief.

Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.

For more by David J. Kupfer, M.D., click here.

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