802 Conditions for Further Study
Determining the degree of intent can be challenging. Individuals might not acknowl-
edge intent, especially in situations where doin g so could result in hospitalization or cause
distress to loved ones. Markers of risk includ e degree of planning, including selection of a
time and place to minimize rescue or interrupt ion; the individual’s mental state at the time
of the behavior, with acute agitation being especially concerning; recent discharge from
inpatient care; or recent discon tinuation of a mood stabilizer such as lithium or an anti-
psychotic such as clozapine in the case of schizophrenia. Examples of environmental “trig-
gers” include recently learning of a potentia lly fatal medical diagnosis such as cancer,
experiencing the sudden and unexpected loss of a close relative or partner, loss of employ-
ment, or displacement from h ousing. Conversely, features su ch as talking to others about
future events or preparedness to sign a contract for safety are less reliable indicators.
In order for the criteria to be met, the indivi dual must have made at least one suicide at-
tempt. Suicide attempts can incl ude behaviors in which, after initiating the suicide attempt,
the individual changed his or her mind or so meone intervened. For example, an individual
might intend to ingest a given amount of medication or pois on, but either stop or be stopped
by another before ingesting the full amount. If the individual is dissuaded by another or
changes his or her mind before initiating th e behavior, the diagnosis should not be made.
The act must not meet criteria for nonsuicidal self-i njury—that is, it should not involve re-
peated (at least five times within the past 12 months) self-injurious episodes undertaken to