posted by kelly on .
should suicide be added to the DSM IV- TR and what are the reason for and aganist establishing a specific disorder related to suicide?
A person commits suicide for many reasons. A person with a fatal illness has a different motive than a depressed physically healthy person.
A psychologist would treat the motivations of a suicidal person.
After the fact -- there is no treatment.
so what are the necessary reason for and aganist establishing a specific disorder related to suicide?
It's impossible to establish a specific disorder related to suicide.
Here is a list of criteria that the American Psychiatric Association says it will use to determine what new diagnoses might appear in the new DSM.
After reading the half page of criteria, you can try and decide for yourself whether it seems like "suicide" would/should be listed as a disorder.
How are decisions made about what will be included, removed, or changed in DSM-5?
The DSM-5 work groups began with a review of research, including monographs from a series of planning conferences in concert with the World Health Organization funded by the National Institutes of Health.
Several principles were established to guide the DSM-5 revision process:
· The highest priority is “clinical utility” – that is, making the manual useful to clinicians diagnosing and treating people with mental disorders.
· Recommendations for revisions should be based on research evidence.
· When possible, continuity with the previous edition, DSM-IV, should be maintained in order to limit disruption for clinicians and research.
· There should be no pre-determined constraints on changes from DSM-IV in areas where the manual’s organization and criteria were problematic.
In addition the work groups were asked to:
· clarify the boundaries between mental disorders to reduce confusion of disorders with each other and to help guide effective treatment;
· consider “cross-cutting” symptoms (symptoms that commonly occur across different diagnoses);
· demonstrate the strength of research for the recommendations on as many evidence levels as possible; and
· clarify the boundaries between specific mental disorders and normal psychological functioning.
If you use a Google search to arrive at the document by the following name, you will see a list of reasons why certain diagnosis might and might not be included in the DSM-IV. "Guidelines for Making Changes to DSM-V
There are a lot of criteria that are applied to determine whether a new diagnosis is appropriate. Psychiatrist on a committee to make a decision will argue about whether a proposed diagnosis meets the criteria. Read the criteria for yourself and see what recommendation you would make about "suicide" being an independent diagnosis.
Diagnostic criteria are for treating people who are alive. (See "clinical utility" above.) So "suicide" would not help if one of the symptoms of "suicide" is that the person is dead.
The diagnosis would have to be "suicidal.
"I agree with Ms. Sue that there are many psychiatric and biological conditions that can cause a person to consider suicide and act "suicidal," like alcohol and drug use, depression, old age, a terminal medical diagnosis, and a teenage disappointment in a love relationship. Do all of these have enough in common that a "suicidal" diagnosis would help lead to treatment, or would the treatments in the above examples have to be completely different, depending on the REASON for being "suicidal."
As soon as you consider the REASON for being suicidal, you will be led to a medical diagnosis that has suicidality as a symptom. "Suicide" is a symptom of a condition, and not a condition by itself, just like "bleeding" is a symptom of a medical problem and not a medical diagnosis all by itself. "Bleeding" like suicidality, has to be treated in all sorts of different ways, based on the reason for the bleeding, be it a head injury or gum disease. Or menstruation!
Since there are no common underlying causes lead to bleeding and there are no common treatment steps that are appropriate in all cases of bleeding, therefore introducing "bleeding" into the DSM would lack "clinical utility;" it wouldn't tell doctors what to do or what to expect if they did nothing at all. I think the same is true, by analogy, with respect to "suicide" and "suicidal."