Suicidal behavior varies in frequency and form across cultures. Cultural differences might be due to method availability (e.g., poisoning with pesticides in developing countries; gunshot wounds in the southwestern United States) or the presence of culturally specific syndromes (e.g., ataques de nervios, which in some Latino groups might lead to behaviors that closely resemble suicide attempts or might facilitate suicide attempts).
Laboratory abnormalities consequent to the suicidal attempt are often evident. Suicidal behavior that leads to blood loss can be accompanied by anemia, hypotension, or shock.
Overdoses might lead to coma or obtundation and associated laboratory abnormalities such as electrolyte imbalances.
Functional Consequences of Suicidal Behavior Disorder
Medical conditions (e.g., lacerations or skeletal trauma, cardiopulmonary instability, in- halation of vomit and suffocation, hepatic failure consequent to use of paracetamol) can occur as a consequence of suicidal behavior.
Suicidal behavior is seen in the context of a variety of mental disorders, most commonly bipo— lar disorder, major depressive disorder, schizophrenia, schizoaffective disorder, anxiety dis- orders (in particular, panic disorders associated with catastrophic content and PTSD ﬂashbacks), substance use disorders (especially alcohol use disorders), borderline personality disorder, antisocial personality disorder, eating disorders, and adjustment disorders. It is rarely manifested by individuals with no discernible pathology, unless it is undertaken be- cause of a painful medical condition with the intention of drawing attention to martyrdom for political or religious reasons, or in partners in a suicide pact, both of which are excluded from this diagnosis, or when thiId-party informants wish to conceal the nature of the behavior.
A. In the last year, the individual has, on 5 or more days, engaged in intentional seIf-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.
B. The individual engages in the seIf-injurious behavior with one or more of the following expectations: 1. To obtain relief from a negative feeling or cognitive state.
2. To resolve an interpersonal difficulty.
3. 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.
C. The intentional self-injury is associated with at least one of the following: 1. Interpersonal difficulties or negative feelings or thoughts, such as depression, anx- iety, tension, anger, generalized distress, or seIf—criticism, occurring in the period immediately prior to the seIf-injurious act.
2. Prior to engaging in the act, a period of preoccupation with the intended behavior that is difficult to control.
3. Thinking about seIf-injury that occurs frequently, even when it is not acted upon.
D. 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.
E. The behavior or its consequences cause clinically significant distress or interference in interpersonal, academic, or other important areas of functioning.