induce relief from a negative feeling/cognitive state or to achieve a positive mood state. The
act should not have been initiated during a st ate of delirium or confusion. If the individual
deliberately became intoxicated before initiating  the behavior, to reduce anticipatory anxi-
ety and to minimize interference with the inte nded behavior, the diagnosis should be made.
Development and Course
Suicidal behavior can occur at any time in the lifespan but is rarely seen in children under
the age of 5. In prepubertal children, the behavi or will often consist of a behavior (e.g., sit-
ting on a ledge) that a parent has forbidden because of the risk of accident. Approximately
25%–30% of persons who attempt suicide will go on to make more attempts.There is sig-
nificant variability in terms of frequency, me thod, and lethality of attempts. However, this
is not different from what is observed in other illnesses, such as major depressive disorder,
in which frequency of episode,  subtype of episode, and impa irment for a given episode can
vary significantly.
Culture-Related Diagnostic Issues
Suicidal behavior varies in frequency and form  across cultures. Cultural differences might
be due to method availability (e.g., poisonin g with pesticides in developing countries;
gunshot wounds in the southwestern United St ates) or the presence of culturally specific
syndromes (e.g., ataques de nervios,  which in some Latino group s might lead to behaviors
that closely resemble suic ide attempts or might facilitate suicide attempts). 
Diagnostic Markers
Laboratory abnormalities consequent to the suicidal attempt are of ten evident. Suicidal
behavior that leads to blood loss can be a ccompanied by anemia, hypotension, or shock.