Suicidal Behavior as Sixth Axis in DSM V?

suicidal behavior

It is suggested in an editorial of the American Journal of Psychiatry that suicidal behavior be considered a separate diagnostic category documented on a sixth axis. Ridiculous. Suicidal behavior (death and attempts) is a symptom of various psychiatric conditions.

Their main concern is that during assessment, clinicians evaluate the principal diagnosis responsible for the chief complaint and use overview questions to identify comorbid conditions. They further reason that suicidality in high-risk groups can easily go unidentified.

What they overlook to my opinion is that this addition of another axis will not end. We will need a seventh axis for addiction, another item often overlooked. It is a kind of safe guard against lack of interest, lack of empathy for psychiatric patients. The lack of being able to feel the trouble these patients can have, even resulting in suicidal behavior. We should train our residents in empathy, in getting them to understand the consequences of the symptoms these patients suffer including suicidal behavior.

For that matter another editorial in the same issue hits the nail on the head:

The course asks residents to consider the fact that our sociocultural context is just as critical as basic neurobiology in shaping how we understand and intervene in our patients’ illnesses.

The authors of this editorial describe a course that focuses on the heterogeneity of mental illness
experience, and they describe outcomes in a comprehensive narrative. Texts on illness experience remind residents that they see an extremely brief slice of an individual’s life in the clinic.

In short: the person and his or her world behind the “patient”, that is what important, not another axis in DSM V.

The course consists of lectures, readings, and homework, the course engages residents in discussions about the psychiatric task. Social science is taught not as a set of abstract theories but as a set of tools to use as residents consider the responsibilities, complexities, and uncertainties of clinical work.
M. A. Oquendo, E. Baca-Garcia, J. J. Mann, J. Giner (2008). Issues for DSM-V: Suicidal Behavior as a Separate Diagnosis on a Separate Axis American Journal of Psychiatry, 165 (11), 1383-1384 DOI: 10.1176/appi.ajp.2008.08020281
E. Bromley, J. T. Braslow (2008). Teaching Critical Thinking in Psychiatric Training: A Role for the Social Sciences American Journal of Psychiatry, 165 (11), 1396-1401 DOI: 10.1176/appi.ajp.2008.08050690

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