Suicidal behaviour is a disease, psychiatrists argue

“As suicide rates climb steeply in the US a growing number of psychiatrists are arguing that suicidal behaviour should be considered as a disease in its own right, rather than as a behaviour resulting from a mood disorder.

They base their argument on mounting evidence showing that the brains of people who have committed suicide have striking similarities, quite distinct from what is seen in the brains of people who have similar mood disorders but who died of natural causes.

Suicide also tends to be more common in some families, suggesting there may be genetic and other biological factors in play. What’s more, most people with mood disorders never attempt to kill themselves, and about 10 per cent of suicides have no history of mental disease.

The idea of classifying suicidal tendencies as a disease is being taken seriously. The team behind the fifth edition of the Diagnostic Standards Manual (DSM-5) – the newest version of psychiatry’s “bible”, released at the American Psychiatric Association’s meeting in San Francisco this week – considered a proposal to have “suicide behaviour disorder” listed as a distinct diagnosis. It was ultimately put on probation: put into a list of topics deemed to require further research for possible inclusion in future DSM revisions.” (New Scientist).

New Scientist has by far the best coverage of the core issues around diagnostic revision in psychiatry, as an aside. This issue is yet another challenge to diagnostic categorization. I have long felt that suicidal behavior cuts across labels, that suicidal patients with different diagnoses have more similarities than differences, and there is a dissociation between treatment of the underlying disorder and treatment fo the suicidal behavior. Suicide may have a distinct biocmistry and neurophysiology, or it may be an epiphenomenon of another phenomenon which cuts across diagnoses, namely impulsivity and dyscontrol.

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