Psychological Disorders and Suicide

 Mental disorders account for many suicides.  In this brief essay, the relationship between mental disorders and suicide will be explored in accordance with the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5.  The evidence provides a warning that persons seeking suicide to end their misery are persons who need care, perhaps professional care.  Offering them suicide instead, even offering suicide as though it is a caring and kind solution, is in truth a failure to show compassion and to provide care.

For example, cases of assisted suicide in the Netherlands, assisted suicide is permissive.  People without physical disorders and merely mental anguish may receive assistance in suicide.  This permissiveness has led to an increase in suicides.  Among persons suffering from psychological distress, suicide increased by 60% between 2023 and 2024. In 2020, 88 cases of assisted suicide for psychological reasons were reported.  The increase is also notable among younger people.  In 2024, 219 cases were reported.  In 2020, 8 of these cases were people under 30; in 2024, 30 people were.

Bipolar disorders are characterized by manic and depressive episodes.  Type I involves at least one major manic episode, whereas Type II involves at least one major depressive episode and at least one hypomanic (not fully manic) episode.  According to the DSM-5, ‘The lifetime risk of suicide in individuals with bipolar disorder is estimated to be at least 15 times that of the general population. In fact, bipolar disorder may account for one-quarter of all completed suicides.’  In bipolar II disorder, impulsivity is another characteristic adding to the risk of suicide, and 1/3 of these persons struggle with suicidal thoughts and attempts throughout their lives. 

Between 5 and 6% of persons with schizophrenia die by suicide.  The Cleveland Clinic notes that ‘records show that persons (mostly female) diagnosed with borderline personality disorder have a 40 times higher risk of committing suicide, and about 8% to 10% die from suicide.  Persons with mental disability and certain mental disorders are at risk for suicide.  Also, persons with attention deficit hyperactivity disorder, mood, conduct, or substance abuse disorders, specific learning disorder, disruptive mood dysregulation, and major depressive disorder are at greater risk.  Anxiety found in several disorders increases the risk of suicide, as does depression.  Persons with a phobia, who often have other disorders contributing to suicidal thoughts or acts, are 60% more likely to attempt suicide than those without a phobia.  Persons who have experienced a traumatic event (e.g., childhood abuse) or with PTSD, or who have adjustment disorders, anorexia nervosa, bulimia nervosa, nightmare disorder, gender dysphoria, oppositional defiant disorder, or conduct disorder have an increased risk.  The same is true of persons (notably both children and adults) with body dysmorphic disorder.  Persons having panic attacks are also at increased risk.  About half of persons with obsessive/compulsive disorder have suicidal thoughts, and one quarter attempt suicide.  More than 70% of outpatients with dissociative identity disorder have attempted suicide. 

Medication and substance abuse may contribute to suicidal thoughts or acts.  ‘Intense or repeated sedative, hypnotic, or anxiolytic intoxication may be associated with severe depression that, although temporary, can lead to suicide attempt and completed suicide.’  The DSM-5 states that

Alcohol use disorder is associated with a significant increase in the risk of accidents, violence, and suicide. It is estimated that one in five intensive care unit admissions in some urban hospitals is related to alcohol and that 40% of individuals in the United States experience an alcohol-related adverse event at some time in their lives, with alcohol accounting for up to 55% of fatal driving events. Severe alcohol use disorder, especially in individuals with antisocial personality disorder, is associated with the commission of criminal acts, including homicide. Severe problematic alcohol use also contributes to disinhibition and feelings of sadness and irritability, which contribute to suicide attempts and completed suicides.

Cannabis (marijuana) is a gateway drug to other drug addictions and is correlated with alcohol use, tobacco, and adult inhalant use disorders.  Its use

has been associated with poorer life satisfaction; increased mental health treatment and hospitalization; and higher rates of depression, anxiety disorders, suicide attempts, and conduct disorder.

 Opioid use can be associated with depression and, therefore, suicide.  This is also true of persons with gambling disorder and antisocial disorder.

 Persons who attempt to commit suicide but who do not succeed are 20-30% more likely to try again.  One’s culture may affect the method chosen for suicide (what is available and common—guns, drugs, poisons, injury, etc.), and culture specific syndromes may play a role.