Specify if:
Current: Not more than 12 months since the last attempt.
In early remission: 12—24 months since the last attempt.
Suicidal behavior is often categorized in terms of violence of the method. Generally, over— doses with legal or illegal substances are considered nonviolent in method, whereas jump- ing, gunshot wounds, and other methods are considered violent. Another dimension for classification is medical consequences of the behavior, with high—lethality attempts being defined as those requiring medical hospitalization beyond a visit to an emergency depart- ment. An additional dimension considered includes the degree of planning versus impul— siveness of the attempt, a characteristic that might have consequences for the medical outcome of a suicide attempt.
If the suicidal behavior occurred 12—24 months prior to evaluation, the condition is considered to be in early remission. Individuals remain at higher risk for further suicide at- tempts and death in the 24 months after a suicide attempt, and the period 12—24 months af— ter the behavior took place is specified as "early remission."
The essential manifestation of suicidal behavior disorder is a suicide attempt. A suicide at— tempt is a behavior that the individual has undertaken with at least some intent to die. The behavior might or might not lead to injury or serious medical consequences. Several fac- tors can inﬂuence the medical consequences of the suicide attempt, including poor plan- ning, lack of knowledge about the lethality of the method chosen, low intentionality or ambivalence, or chance intervention by others after the behavior has been initiated. These should not be considered in assigning the diagnosis.
Determining the degree of intent can be challenging. Individuals might not acknowl— edge intent, especially in situations where doing so could result in hospitalization or cause distress to loved ones. Markers of risk include degree of planning, including selection of a time and place to minimize rescue or interruption; the individual’s mental state at the time of the behavior, with acute agitation being especially concerning; recent discharge from inpatient care; or recent discontinuation of a mood stabilizer such as lithium or an anti- psychotic such as clozapine in the case of schizophrenia. Examples of environmental “trig- gers” include recently learning of a potentially fatal medical diagnosis such as cancer, experiencing the sudden and unexpected loss of a close relative or partner, loss of employ— ment, or displacement from housing. Conversely, features such as talking to others about future events or preparedness to sign a contract for safety are less reliable indicators.
In order for the criteria to be met, the individual must have made at least one suicide at- tempt. Suicide attempts can include behaviors in which, after initiating the suicide attempt, the individual changed his or her mind or someone intervened. For example, an individual might intend to ingest a given amount of medication or poison, but either stop or be stopped by another before ingesting the full amount. If the individual is dissuaded by another or changes his or her mind before initiating the behavior, the diagnosis should not be made.
The act must not meet criteria for nonsuicidal self—injury—that is, it should not involve re- peated (at least five times within the past 12 months) self-injurious episodes undertaken to induce relief from a negative feeling/ cognitive state or to achieve a positive mood state. The act should not have been initiated during a state of delirium or confusion. If the individual deliberately became intoxicated before initiating the behavior, to reduce anticipatory anxi— ety and to minimize interference with the intended behavior, the diagnosis should be made.
Suicidal behavior can occur at any time in the lifespan but is rarely seen in children under the age of 5. In prepubertal children, the behavior will often consist of a behavior (e.g., sit- ting on a ledge) that a parent has forbidden because of the risk of accident. Approximately 25%—30% of persons who attempt suicide will go on to make more attempts.There is sig- nificant variability in terms of frequency, method, and lethality of attempts. However, this is not different from what is observed in other illnesses, such as major depressive disorder, in which frequency of episode, subtype of episode, and impairment for a given episode can vary significantly.