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Suicide: A Disorder in Its Own Right?

Suicide: A Disorder in Its Own Right?

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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1:47AM PDT on Jun 2, 2013

Part 1 I have been diagnosed as "Homicidal, suicidal, and a possible potential danger to himself and others.” I accept it as true I also am afflicted with PTSD and surviver guilt. This resulted in a 'death wish' causing me to accept high risk assignments, recreation, and even in my brief civilian life, as a construction diver. I still contemplate suicide at times, but supporting a family, the responsibility of people and many pets who depend on me to live outweighs it. I'm old now, much older than anyone believed I would be, and I still take risks.

1:47AM PDT on Jun 2, 2013

Part 2 I freely admit something is wrong in my trauma-damaged brain, but . . . that's life! My VA Psychiatrist opines that I use humor as a coping mechanism, and people comment that they enjoy talking to me, sometimes they say they were depressed and conversation helped them. The secret is self control. I know that deep inside somewhere is a very different attitude, but I control it. Why am I writing this? Because out there somewhere is a brother or sister driven to the brink by the same urges and motivation, and I want them to know that they are not alone, and that they can beat the problem. The secret for me, and I suspect for others may be that I will never really enjoy the life I don't deserve, but I can cope with it, and that gives me the power to go on. We may not be victims after all.

12:10PM PDT on Jun 1, 2013

(continued)year where you spend a few minutes in their classrooms and teachers tell you about their class and how they do things. I tried to tell some not to do things like what they described with Brandon, some listened, most didn't. Counseling, oh yeah, lots of that, no effect. I asked him once, Brandon don't you know that when you fight with these teachers it hurts you too, you're the one who gets detention or suspended? He said, yes, dad, I know. But they don't want to deal with me and I MAKE them. Didn't care about the personal consequences, only cared about not letting them treat him in a way he didn't want to be treated. He was a difficult child, but I loved him so. I still do.

12:08PM PDT on Jun 1, 2013

The idea that suicide, or the propensity for it, runs in families isn't new to me. Each generation of my own family has had one or two, unusual members. We Swedes, or ancestral Swedes, are supposed to be known for our taciturn outlook, and our belief in societal welfare, and in my family that is true. Mostly. Each generation though has had one or two who were different from childhood, in my youngest son's case from birth really. Those have wonderful loving sides to them which is mostly what they are, but also mercurial mood swings, prone to addictions and suicides. The ones who don't suicide are deeply troubled people, though they would never admit it, and very hard to be around. So far of my children's generation only my Brandon has taken his own life. I'd say I should have seen that coming but coping with the day to day challenges was difficult enough. Most of the time he was the most loving child and young man, but he got caught up in meth and took his own life a month past his 21st birthday. My generation had just one too, earlier generations more, and more substance abuse too. Nothing got through to Brandon in one of his fugue's. I knew what set him off, tried telling his teachers, some listened, some didn't. The ones that didn't would say something he felt insulted by, you could not tease him or make a joke at his expense, and he'd war with them the rest of the year. I could pick those out in those parent teacher things at the beginning of the year where y

9:18PM PDT on May 31, 2013

thanks

8:08PM PDT on May 31, 2013

Psychiatrists finally are stepping forward regarding suicide (ACTS). What took them so long? However, by the increase of suicide rates with military personnel and teenagers raises the question that something is wrong with the foundation stability of the mind. It appears that they are not able to accept responsibility, rejection,failure nor process stress as a normal way of life. I doubt the hereditary component. An uncle by proxy committed suicide and his four sons have not and have served in combat. Is it chemical imbalance associated maybe, it's known that depression can trigger suicide thoughts and bi-polar conditions will too and will succeed if the person fails to take his medicine as prescribed. So the theory that it's a behavioral condition could be which derived from the home environment. The question now, was a weak father/mother that failed to develop the child mind to the harsh realities of the world he/she was brought in to? to face tough conditions, responsibilities and how to process stress conditions without falling apart.I keep referring to WWII War and the Korean Conflict in which suicide was unheard of.

7:35PM PDT on May 31, 2013

No one knows what's in the mind of someone. IMO if a person commits suicide they had to believe there was no other recourse.This is why I have a glass of wine occassionally & I still smoke cigarettes. It's my stress reducer.To each his own

1:45AM PDT on May 31, 2013

a bottle of wine will do wonders for you as well

11:00PM PDT on May 30, 2013

Hopefully this will help save some lives

2:57PM PDT on May 30, 2013

Pamela,

"Latency" is the official response by C2. The past few days have been terrible. I commented on a thread, someone else commented a minute after me. Both emails showed up in my In Box, but they would not open. It took almost an HOUR for both of our comments to appear.

I had thought it was my computer, I switched to other browsers, found that FireFox would NOT refresh, yet IE did!

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