Citation

Obegi JH. Crisis 2019; 40(3): 209-219.

Affiliation

California Department of Corrections and Rehabilitation, California State Prison, Solano, Vacaville, CA, USA.

Copyright

(Copyright © 2019, International Association for Suicide Prevention, Publisher Hogrefe Publishing)

DOI

10.1027/0227-5910/a000543

PMID

30109964

Abstract

BACKGROUND: It is a peculiar fact that the deadliest psychiatric disturbance - suicidality - cannot be formally diagnosed. Suicidal behavior disorder (SBD), a condition for further study in the DSM-5, is the field's first attempt to capture suicidality in a diagnosis. AIMS: To provoke discussion about the standing of suicidality as a diagnosable psychiatric condition.

METHOD: I present pragmatic and conceptual rationales for why a diagnosis of suicidality is clinically useful but conclude that SBD does little to aid clinicians in assessing suicidality's symptoms, planning treatment, or monitoring progress.

RESULTS: To improve the clinical utility of SBD, I re-conceptualize it from the vantage point of descriptive psychiatry. I hypothesize that this revised SBD is an independent, episodic, and frequently co-occurring condition and propose new cognitive, affective, and behavioral criteria that more completely capture the phenomenology of suicidality.

CONCLUSION: The revised SBD is a starting place for dialogue about whether a clinically significant presentation of suicidality is a mental illness and, if it is, what its defining features should be.

Language: en

Keywords

clinical utility; diagnosis; suicidal behavior disorder; suicidality; suicide