Assignment - Achiever Papers

One of the more frightening child and adolescent issues is suicide. Suicide is a tragic event and is the third leading cause of death among adolescents (Somers-Flanagan & Somers-Flanagan, 2007, p. 155). Assessing suicidal children and adolescents as well as those who self-mutilate can be very difficult for many clinicians, and it takes skill to assess these issues accurately. Clinicians must be able to differentiate between suicidality and self-mutilation in order to assess the problem and develop interventions effectively.

In most cases, suicide and self-mutilation (self-harm) assessments are conducted using clinical interviews. The most foundational principle in evaluating for self-harm is for the clinician to establish a positive working relationship with the child or adolescent. A valid assessment flows from a good working relationship because trust is established and communication is open. A good relationship does not negate the need to assess clinically the severity of the issue; therefore, clinicians must be skilled in assessing for self-harm.

For this Assignment, review the media program Mood Disorders and Self-Harm,and consider the differences between suicidality and self-mutilation. Also, consider why it is critical to assess these two conditions accurately. Also, review Suicide Assessment Procedures, Documentation, and Risk Factors (Sommers-Flanagan & Sommers-Flanagan, 2007, p. 179–180) and Child and Adolescent Suicide Risk Factors and Warning Signs located in this week’s resources. Think about the importance of the suicide assessment to determine suicide risk in conjunction with common risk factors and warning signs.

The Assignment (2–3 pages):

Analyze the standard components of an adolescent suicide assessment and explain the importance of each component in assessing for suicide risk and why. Make sure to support your analysis with evidence from the articles by Sommers-Flanagan and the Child and Adolescent Suicide Risk Factors Warning Signs.
Describe at least one component you might add or take away from the suicide assessment and explain why.
Explain two differences between suicidality and self-mutilation in terms of the severity of each issue. Then, explain how severity relates to possible intention of a child or adolescent presenting with suicidality or self-mutilation. Be specific and use the week’s resources and current literature to support your response.

Support your Assignment with specific references to all resources used in its preparation. You are asked to provide a reference list for all resources, including those in the week’s resources for this course.

https://www.socialworktoday.com/archive/SO17p32.shtml

Mood Disorders and Self-Harm

A significant change in the DSM-5 was to separate the bipolar disorders from the
depressive disorders. These two new classifications—formerly combined in the DSM-
IV under “Mood Disorders”—represent a shift to enhanced understanding of the
differences between these groups, despite some common criteria. In addition, the
DSM-5 includes suicidal behavior disorder, nonsuicidal self-injury, and persistent
complex bereavement disorder under the chapter “Conditions for Further Study.”
These are not recognized as clinical disorders (for purpose of diagnosis) at this time;
however, the specific descriptions provided can enhance clinicians’ understanding of
these presentations and provide guidance for treatment. Below is a brief overview of
significant changes to the diagnostic criteria and classifications.

Bipolar and Related Disorders

As noted above, this is a new classification in the DSM-5 and is placed between the
schizophrenia spectrum and depressive disorders to help represent its presence along
the continuum of diagnostic criteria. Bipolar and related disorders includes bipolar I
disorder; bipolar II disorder; cyclothymic disorder; substance/medication induced
bipolar and related disorder; bipolar and related disorder due to another medical
condition; other specified bipolar and related disorder; and unspecified bipolar disorder
and related disorder. This group includes several new or revised diagnoses. Changes
to Criterion A for both manic and hypomanic episodes now includes and emphasis on
change to activity or energy. In addition, the diagnosis of “bipolar I, mixed episode” has
been removed.

Specifiers for all bipolar disorders are described together and provide for specific
presenting characteristics related to the diagnoses. The DSM-5 also includes
explanations for using these specifiers, their clinical significance, and suggested
treatment approaches. In an attempt to more accurately diagnose this group of
disorders, these represent considerable expansion from the DSM-IV specifiers. A new
specifier “with anxious distress” was added to both the bipolar and depressive
classifications to more expressly identify anxiety symptoms not part of the diagnostic
criteria of bipolar or depressive disorders, yet commonly observed in both of these
classifications.

The diagnosis bipolar disorder not otherwise specified has been removed, and two new
diagnoses added: other specified bipolar and related disorder and unspecified
bipolar disorder and related disorder. Both of these diagnoses represent significant
clinical distress or impairment based on bipolar diagnostic criteria but do not meet full
criteria for a specific bipolar class diagnosis. Clinicians should use other specified
bipolar and related disorder with the specific reason for the more general diagnosis
(e.g., short duration manic or hypomanic episode). The latter diagnosis—unspecified
bipolar disorder and related disorder—is used when clinicians cannot (or choose not to)
identify reasons for the inability to make a more specific diagnosis, yet clearly observe
multiple criteria from the bipolar and related disorders classification.

Depressive Disorders

This is a new classification, separated from the more general class of mood
disorders in the DSM-IV. Several depressive diagnoses were added to the DSM-5,
including one specific to children. In addition, there have been several revisions to
existing diagnoses in an attempt to make the diagnostic process more clear and
reliable.

As with the bipolar and related disorders, specifiers for all depressive disorders are
described together and provide for specific presenting characteristics related to the
diagnoses. Many of these specifiers are identical to those found in the bipolar
classification; however, the clinical significance and treatment considerations
discussed vary. Included in the discussion of clinical significance for specifiers is
relation to suicide risk, potential precursors to other mood-related diagnoses, and
suggestions for additional differential diagnoses.

The diagnosis depressive disorder not otherwise specified has been removed, and two
new diagnoses added: other specified depressive disorder and unspecified
depressive disorder. Both of these diagnoses represent significant clinical distress or
impairment based on depressive diagnostic criteria but do not meet full criteria for a
specific depressive disorder diagnosis.

Clinicians should use other specified depressive disorder and add the specific reason for
the more general diagnosis (e.g., short duration, insufficient symptoms). The latter
diagnosis—unspecified depressive disorder—is used when clinicians cannot (or choose
not to) identify reasons for the inability to make a more specific diagnosis, yet clearly
observe multiple criteria from the bipolar and related disorders classification.

Disruptive Mood Dysregulation Disorder

For this new diagnosis, partial intent was to minimize the misdiagnosis of bipolar
disorder in children. It is important to note that this disorder is included in the
depressive disorder classification rather than the bipolar disorder classification—this is
largely due to the research supporting stronger correlations between this symptomology
in youth and the development of depressive (or anxious) disorders in adolescence and
adulthood. This diagnosis is characterized by persistent and recurrent outbursts of
temper significantly incongruent with circumstance and present in at least two settings
(e.g., home and school). The diagnosis cannot be made before age 6 nor after age 18,
and the initial age of onset must be before age 10. The diagnosis cannot be comorbid
with bipolar disorder, intermittent explosive disorder, or oppositional defiant disorder. In
addition, the observed symptomology cannot be due to substance effects nor to
general medical or neurological condition.

Persistent Depressive Disorder

This new diagnosis is a combination both chronic major depressive disorder and
dysthymic disorder from the DSM-IV. It was determined that there were few significant

differences between these two diagnoses; specifiers are now used to identify features,
onset, and severity.

Major Depressive Disorder

The most significant change to the diagnostic criteria for major depressive episode is the
removal of the “bereavement exclusion.” In the DSM-IV, a required criterion to meet this
diagnosis included that the observed symptoms were not better explained by
bereavement. This has been removed in the DSM-5, with emphasis given to clinical
judgment to differentiate these. Further, the DSM-5 notes the considerable variations in
symptom presentation as influenced by individual history and culture as well as
guidance for differential diagnosis between bereavement and major depressive
disorder. It is of note that bereavement has previously been considered a condition or
state of mind rather than a disorder. However, in the DSM-5, “persistent complex
bereavement” has been described in the “Conditions for Further Study” (see section
below).

Premenstrual Dysphoric Disorder

This new diagnosis is included in the depressive disorders classification and is
characterized by mood lability, anxiety, dysphoria, and irritability, and well as
physiological changes. The pattern of occurrence is cyclical and associated with
menstrual cycle. The diagnosis includes significant interference with normal daily
functioning and observed symptoms that are not merely an exacerbation of already
existing diagnoses.

Conditions for Further Study

This section of the DSM–5 includes a number of “conditions” not yet recognized as
clinical disorders for diagnostic and classification purposes. However, these conditions
are recognized for the patterns in presenting characteristics – thus, improved
understanding of these can enhance clinicians’ treatment planning and facilitate future
research.

Persistent Complex Bereavement Disorder

This disorder is marked by the persistence of sorrow; preoccupation with a deceased
loved one; reactive distress associated with the death; and social or identity disruption.
In adults, the loss must have occurred at least 12 months prior to diagnosis; in children,
the loss must have occurred at least 6 months prior. There must also be significant
impact on functioning, and the expression of symptoms must be inconsistent with
cultural norms. The disorder can occur at any age after 1 year. Expression of
symptomology may begin shortly after the loss or be delayed by months or years. In
children, the impact of loss can be highly traumatic, and may be expressed differently
than in adults. Complex bereavement in children may be expressed through play,
regressive behaviors, and/or intense separation distress. Risk for comorbid depression
rises in children and adolescents.

Suicidal Behavior Disorder

The key feature of this disorder is the existence of a suicide attempt within the last 24
months. If an attempt was made in the last 12–24 months, the disorder may be
considered “in early remission.” The behaviors do not include self-injury for the purpose
of emotional release nor simply suicidal ideation (as can be common with disorders of
affect). The diagnosis can be comorbid with many other disorders; it rarely exists
alone. The disorder can occur at any age but is generally absent in children under the
age of 5 years.

Nonsuicidal Self-Injury

The key feature of this diagnosis is the persistent physical harm to oneself without the
intention of death. Purpose of this behavior may be to diminish undesirable emotions; it
may also be a form of self-punishment. The behavior tends to become increasingly
frequent, with individuals often reporting a “craving” for the behavior; the behavioral
expression may ultimately resemble addiction. Onset of nonsuicidal self-injurious
behavior generally occurs during adolescence, and impairment or distress caused by
the behaviors must be significant. However, as many individuals who participate in this
behavior do not seek treatment, age of onset and severity of impairment may be
difficult to reliably determine.

Reference:

• American Psychiatric Association (2013). Highlights of changes from DSM-IV-TR
to DSM-5. Retrieved from
http://www.dsm5.org/Documents/changes%20from%20dsm-iv-
tr%20to%20dsm-5

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Child and Adolescent Suicide Risk Factors and Warning Signs

There are different approaches to conducting suicide assessments, but all approaches acknowledge the need to be familiar with suicide risk factors. The good news is that there have been many suicide risk factors identified through research and clinical work. The bad news is that suicide is essentially unpredictable. Despite this bad news, you should definitely be familiar with the following risk factors and warning signs. Generally, the risk factors are more research based, and the warning signs are more clinical based.

Suicide Risk Factors

___ 1.
Vulnerable group due to age/sex/ethnicity

___ 2.
Previous suicide attempt

___ 3.
Using alcohol/drugs excessively or abusively

___ 4.
DSM diagnosis

___ 5.
School problems

___ 6.
Isolated or harassed

___ 7.
Physical health problems

___ 8.
Recent significant personal loss (of ability, objects, or persons)

___ 9.
Struggling with sexuality issues

___ 10. Victim of childhood or current abuse

___ 11. Diagnosis of depression

___ 12. If depressed, the teen is also experiencing:

____
Panic attacks

____
General psychic anxiety

____
Lack of interest and pleasure

____
Alcohol abuse increase

____
Diminished concentration

____
Global insomnia

___ 13. Significant hopelessness, helplessness, or excessive guilt

___ 14. Suicidal thoughts are present.

Note: Evaluate for:

____ Frequency of thoughts (How often do these thoughts occur?)

____ Duration of thoughts (Once they begin, how long do the thoughts persist?)

____ Intensity of thoughts (From 1 to 10, how compelling are the thoughts?)

___ 15. There is a history of impulsive behavior.

___ 16. A suicide plan is present (evaluate the plan based on the SLAP acronym, which refers to specificity, lethality, accessibility of means, and proximity of social support).

___ 17. There is a moderate to high intent to kill self (or a previous lethal attempt).

___ 18. Recent prescription of an SSRI and associated disinhibition or agitation

___ 19. Possession of or access to firearms

Suicide Warning Signs

___ 1.
Suicide threats, both direct and indirect

___ 2.
Obsession with death

___ 3.
Sudden or abrupt loss of interest in usual activities

___ 4.
Sudden social withdrawal

___ 5.
An increase in dangerous or illegal or risk-taking activities

___ 6.
Poems, essays, and drawings that refer to death

___ 7.
Dramatic change in personality or appearance

___ 8.
Irrational, bizarre behavior