Mental health professionals know that change is hard. But, the field itself has been put to the test over the past two years, as the “bible of psychiatry,” the Diagnostic and Statistical Manual of Mental Disorders (DSM), has been in the revision process.

You might not think that the revision of a book could be so controversial, but the way that the DSM is used — to define what is and what isn’t “normal” behavior — has become critically important. It’s important to mental health professionals, individuals in treatment with mental health professionals, and the pharmaceutical industry.

Many in the mental health community have been concerned that this latest revision of the DSM, to be called DSM-5, creates too many new disorders not grounded in science. Since the field has always struggled with being “scientific enough,” it’s at an important crossroads.

Right now, I’m most interested in the implications of changes to the DSM that could affect treatment of individuals at risk for suicide. Most directly, the DSM revisions propose the addition of Suicidal Behavior Disorder to the canon, a code that would allow providers to indicate an individual’s specific risk for suicide.

In current practice, suicidal behavior can be indicated as a cause of injury, or as symptoms of another diagnosis. The proposed Suicidal Behavior Disorder differentiates between suicide attempts or other suicidal behavior and non-suicidal self-injury.

What could be helpful about this new DSM code?

It creates a way to organize, and perhaps track, risk for suicide. Creating a code “calls out” suicidal risk in an individual’s clinical record, distinguishing it from being seen as “just a symptom.”

It’s also very good to see the DSM making a distinction between non-suicidal self-injury and suicide attempts, since research has shown that self-injury is not equivalent to suicidal behavior.

What could be problematic?

In order to be effective, mental health professionals need to be willing to ask the suicide question. It’s useless to have a mechanism to track a subject if that subject is avoided in the clinical encounter. So, effective implementation of this code, if it is added, requires equipping mental health professionals with the skills and confidence to ask and talk about  suicide.

Do you have other thoughts? How do you think the addition of a disorder related to suicide specifically could help, or hurt, individuals at risk?

If you’d like to offer comment, head over to, where you can add your thoughts until mid-June. The next few weeks are the last opportunity for public comment.

Copyright 2012 Elana Premack Sandler, All Rights Reserved


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