Suicidal and Self-Destructive Behavior

●Suicidal and self-destructive behavior is one of the most common clinical problems encountered in both out-patient and in-patient behavioral health settings. Studies suggest that as many as 20% of out-patients and 50% of in-patients report suicidal behavior as a significant clinical issue (Crosby, Cheltenham & Sacks, 1999; Chiles & Strosahl 2004). Unlike many of the other mental health conditions described in this text, suicidal behavior is not considered to be a mental disorder; it spans a range of clinical diagnostic groups, including mood disorders, anxiety disorders, addictive disorders, psychotic disorders, and personality disorders. DSM-IV uses suicidal behavior as part of the diagnostic criteria for both Depression and Borderline Personality Disorder. There are several forms of suicidal and self destructive behavior that are encountered in clinical practice. Ranging from the most common to the least frequent they are: Suicidal ideation/verbalization. The act of thinking about killing oneself or verbalizing thoughts of suicide to other individuals. Suicide attempt. The act of deliberately inflicting a self injury which at the time of the injury is labeled by the patient or someone else close to the patient as an attempt at suicide. Suicide. The act of taking one’s own life, when the resulting death is determined by a medical examiner to be a self-inflicted death. Parasuicide. Originally introduced by Kreitman (1977) to describe a pattern of chronic, repetitious suicide attempting that “mimics” suicide attempts in form, but often involves less lethal methods and seems to serve a different function for the patient. This behavior pattern is often observed in patients diagnosed with borderline personality disorder. Self-mutilation. The act of inflicting self-injury, most commonly lacerating or burning the trunk or a limb, which is not described by the patient as a suicide attempt. Typically, the patient will use self injurious behavior to regulate intolerable mood states by diverting attention from emotional pain to physical pain. This behavior pattern is often observed in patients who exhibit parasuicidal behavior patterns, leading some theorists to claim that they are functionally correlated behaviors (Nock & Prinstein, 2004). WHA T IS A SUICIDAL CRISIS?