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Issues for DSM-V: Suicidal Behavior as a Separate Diagnosis on a Separate Axis

November 4, 2008

In an editorial in this month's American Journal of Psychiatry, Columbia University Medical Center researchers wrote: We recommend that suicidal behavior be considered a separate diagnostic category documented on a sixth axis. Suicidal behavior meets the criteria for diagnostic validity set forth by Robins and Guze (3), and it does so as well as most conditions we treat. It is clinically well described (4), research has identified postmortem and in vivo laboratory markers (1), it can be subjected to a strict differential diagnosis (4), follow-up studies confirm its presence at higher rates in those with a past diagnosis (2), and it is familial (5). With suicidal behavior in a sixth axis, it would be identified through review-of-systems questions, in addition to inquiry during the mental status examination.

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