What if we’ve been treating suicidal behavior all wrong?
As New Scientist details, a significant and growing number of psychiatrists are suggesting that suicidal behavior may not just be a symptom of a mood disorder.
In fact, they say there is evidence enough to warrant investigating suicide as a disorder in its own right.
So what is the evidence? Below are a few talking points.
- A population study by Danish researchers published in 2008 tracked 4, 262 people between the ages of 9 and 45 who had taken their own lives and compared the details of their lives, including family history and history of psychiatric illness, to more than 80,000 controls. The researchers found that those study participants with a family history of suicide were two and a half times more likely to take their own life than those without. A family history of psychiatric illness, specifically illnesses that required hospital admission, increased subjects’ risk by 50% when compared to those without psychiatric problems. These two factors combined were a particularly strong predictor for suicide risk.
- Research has shown a clustering of suicides in families, something that, coupled with twin and sibling studies, leads researchers to suspect a genetic or hereditary component to suicidal behavior.
- Autopsies carried out in the 1980s on people who had committed suicide revealed they had marked differences in brain structure. In particular, researchers found changes in what is known as the prefrontal cortex, the part of the brain responsible for controlling high-level decision making. Crucially, these changes were observed regardless of whether the suicide victims had been diagnosed with a mood disorder like depression, schizophrenia, or bipolar disorder, or whether they had a “normal” mood history.
- Other studies, in line with the above, have detected very particular chemical imbalances in the brains of suicide victims.
- While no single neurological cause of suicide has been found, there is also strong evidence to suggest that environmental factors can trigger changes that heighten suicide risk. Environmental factors include a history of abuse as a child, post-traumatic stress disorder, long periods of anxiety, or prolonged and intense sleep deprivation.
- Around 10% of those who commit suicide do so having had no history of mental illness. While this may be attributed in part to a failure to catch a mood disorder, the number is large enough to indicate the potential for suicidal behavior occurring without mood disorders.
With all this in mind, clinicians are keen to break from the tradition of diagnosing and classifying patients with broad terms like depression, which risks creating biases in treatment, in favor of more evidence-led treatments based on particular patient behavior and biology.
Separating suicide from mood disorders would be in line with this emerging change in clinical diagnosis.
While there is as yet no specific plan for the naming of a “suicide behavior disorder,” clinicians calling for the change hope that making the distinction between this and mood disorders may create opportunities for much needed research into the phenomenon of suicide.
In turn, they hope that the research could at last suggest specific and targeted treatments for suicidal behavior that will lead to more life-saving early interventions — and there are a number of good reasons why action may be desirable sooner rather than later.
Chief among them is the fact that certain anti-depressants are known to increase the frequency of suicide attempts.
If a suicidal patient does not present with a wider mood disorder, but would be prescribed anti-depressants as a matter of routine per current diagnostic guidelines, there is a very clear need to carefully examine whether treating suicide as a separate disorder could benefit patient care and whether it could, in fact, even save lives.
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