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This week, clinicians, researchers, insurers and patients have a new handbook for diagnosing mental disorders. The DSM-5 (the fifth version of the Diagnostic and Statistical Manual of Mental Disorders) contains changes that will affect young people specifically, including new guidelines on how to measure and document suicidal behavior in adolescents.
Dr. David Shaffer, Professor of Psychiatry and Pediatrics at Columbia University, worked on this section of the new manual, and he gave us a little background.
Previously, a suicide attempt was always categorized under two disorders: depression or borderline personality disorder. But Shaffer says that most suicides do not occur within the context of depression — instead, they are a result of many disorders mixed together, including schizophrenia, anxiety and alcohol abuse.
“So what has been happening until now, if [a teenager] came to the emergency room because they made a suicide attempt, they would be given a diagnosis of depression, because you weren’t allowed to give a diagnosis of a personality disorder under age 18,” he said.
But when a teenager attempts suicide, or is hospitalized for cutting, they’re not necessarily depressed, and it’s not necessarily an attempt to die, said Shaffer. For adults, suicide is a calculated, planned action. Adolescents have been shown to think about attempting suicide for 20 – 45 minutes before they do it.
Because teen suicide attempts were roped into the depression category, hospitals and doctors didn’t have a way to keep track of a person’s suicidal behavior — or any larger trends regarding suicide attempts. And anti-depressants may be treating the wrong thing. That’s why the DSM-5 separates the behavior of “suicide attempt” from the diagnosis of depression.
“We had to escape from the clutches of depression to understand what’s really going on,” said Shaffer. “What I hope to see [after clinicians start using these new guidelines] is that people will pay much more attention to what is so different about these diagnoses,” said Shaffer.
Ideally, this separation will alert doctors to the fact that suicide is linked to more conditions than just depression and allow researchers to keep better public health records. The Center for Disease Control does a Youth Risk Behavior Survey every two years, and they ask young people if they’ve attempted suicide — but currently there is no way to verify these numbers, said Shaffer.