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)
Clinical Picture
Suicidality is not a diagnosis but a clinical emergency that cuts across all diagnostic categories. The therapist's task is to hold two things simultaneously: the urgency of safety and the dignity of the client's experience. Suicide is not simply a symptom to be managed — for the person experiencing it, it often represents the only perceived solution to unbearable pain. Effective treatment requires both immediate risk management and longer-term work on the underlying suffering. The evidence base here is unusually clear: specific interventions (CAMS, DBT, safety planning) outperform 'treatment as usual' for suicidal individuals.
Treatment Considerations
The Collaborative Assessment and Management of Suicidality (CAMS) provides a structured framework that treats the client as a collaborator in understanding and managing their suicidality. DBT's specific suicide-prevention protocols (including chain analysis of suicidal crises and distress tolerance skills) have the strongest evidence. Safety planning (Stanley-Brown) is now considered standard of care. The absence of suicidal ideation doesn't mean the absence of risk — clinicians should assess for capability, means access, and protective factors. Therapists working with chronically suicidal clients need their own consultation and support.
10 Therapeutic Approaches
Sorted by evidence tier: guideline-recommended first, then RCT-supported, then emerging/limited evidence.
Related Clinical Vignettes
Sources & References
Prevalence data from NIMH, WHO, and DSM-5-TR field trial publications. Evidence tiers reflect guideline status (APA, NICE, VA/DoD, WHO) and meta-analytic findings as of early 2025. Individual modality citations are listed on each modality page. Full bibliography available on the Sources page.