Feb 8, 2020
Dr. Ursula Whiteside is a licensed clinical psychologist and a member of the Clinical Faculty at the University of Washington. Dr. Whiteside trained under Dr. Marsha Linehan, the creator of Dialectical Behavioral Therapy, and later served as a DBT-adherent research therapist on a clinical trial led by Dr. Linehan that was funded by the National Institute of Mental Health. As a researcher, she has been awarded grants from the National Institute of Mental Health and the American Foundation for Suicide Prevention. Dr. Whiteside is the CEO of NowMattersNow.org which was conceived from her research study involving over 18,000 high-risk suicidal patients in four major health systems. This study includes a guided version of NowMattersNow.org which is a program she developed that includes skills for managing suicidal thoughts and is based on DBT and paired with Lived Experience stories. Dr. Whiteside is national faculty for the Zero Suicide Initiative, a practical approach to suicide prevention in healthcare and behavioral healthcare systems. Dr. Whiteside serves on the faculty of the National Action Alliance Zero Suicide Academy. She is also a founding board member of United Suicide Survivors International and a member of the Standards Trainings and Practices Committee for the National Suicide Prevention Lifeline. As a person with Lived Experience, she strives to decrease the gap between "us and them" and to ensure that the voices of those who have been there are included in all relevant conversations. Nothing about us without us.
Suicidal Behavior Disorder is a proposed separate diagnosis in the Diagnostic and Statistical Manual, Fifth Edition. Firstly, in order to have this diagnosis, an individual has made a suicide attempt within the past two years. Secondly, the criterion for non-suicidal self-injurious behavior is not met during the aforementioned suicide attempts. Thirdly, the diagnosis is not applied to preparation for a suicide attempt, or suicidal ideation. Fourthly, the act was not attempted during an altered mental state, such as delirium or “ confusion.” Finally, the act was not ideologically motivated, i.e., religious or political.
A prior history of suicidal behavior is a key predictor for future suicidal behavior. Other environmental factors such as unemployment, financial crisis, bullying, military combat, incarceration, or relationship disruptions are also associated with risk. Although suicidal behavior may co-occur with another psychiatric condition, this is not always the case. Many people who die by suicide have not been diagnosed with a mental disorder.
Suicidal behavior is the cause of over a million deaths worldwide every year. Non-fatal suicidal behavior is estimated to be even more common. It is important to create strategies to identify those individuals at risk within the health care system. This is critical because, as mentioned above, many people who complete suicides have not interacted with a mental health worker but may have been seen by a medical professional such as a primary care physician. Defining suicidal behavior disorder as a separate diagnosis in the DSM-5 is important to standardize care in order to develop methods to identify suicidal behavior, document in medical records, and track patients at every level of care.
The fact that suicidal ideation waxes and wanes over time can create perilous situation in which key information may be missed. Continuity of care is very important with patients with a risk of suicidal behavioral—some healthcare systems have more robust medical records systems than others. Even in cases when the past suicide attempt is identified, data about suicide risk is often lost during hand-offs and may not be included in discharge summaries.
Twitter: @ursulawhiteside, @NowMattersNow
Lifeline: Suicide Prevention Hotline or call 800-273-8255
Disclaimer: The information shared in this podcast is not a substitute for getting help from a mental health professional.