Suicidality & Self-Harm
Cross-cutting; suicidal behavior disorder proposed in DSM-5-TR Section III
Suicidal ideation, planning, attempts, and non-suicidal self-injury. Not a diagnosis itself but a clinical priority cutting across many conditions. Safety planning, CAMS, and DBT have most evidence. Therapeutic relationship is critical.
Prevalence: ~5% of adults have serious suicidal thoughts in a given year (US)
10 Therapeutic Approaches
Sorted by evidence tier: guideline-recommended first, then RCT-supported, then emerging/limited evidence.
Guideline-Recommended (4)
Crisis
CAMS
David Jobes · 2006
SAMHSA and VA recognized
Cognitive-Behavioral
DBT
Marsha Linehan · 1993
Effect: OR = 0.46 (suicide attempts)
~50% reduction in attempts
NICE: recommended for BPD. APA Div 12: Strong Research Support for BPD
Cognitive-Behavioral
DBT for Adolescents
Alec Miller, Jill Rathus, Marsha Linehan · 2007
Effect: Significant reduction vs TAU
~50% reduction in self-harm episodes
NICE: Recommended for adolescent self-harm. APA: Supported
Crisis
Safety Planning
Stanley / Brown · 2012
VA/DoD: recommended. Joint Commission: recommended
RCT-Supported (6)
Cognitive-Behavioral
CBT
Aaron Beck · 1964
Psychoanalytic
Mentalization-Based Tx (MBT)
Fonagy / Bateman · 2004
Cognitive-Behavioral
Problem-Solving Therapy
D'Zurilla / Nezu · 1971
Cognitive-Behavioral
Compassion-Focused Therapy
Paul Gilbert · 2005
Cognitive-Behavioral
Compassionate Mind Training
Paul Gilbert · 2005
Crisis
Psychological First Aid
National Child Traumatic Stress Network / NCTSN · 2006
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