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.[1] 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.[2]
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.’[3] In bipolar II disorder, impulsivity is
another characteristic adding to the risk of suicide,[4]
and 1/3 of these persons struggle with suicidal thoughts and attempts
throughout their lives.[5]
Between 5 and 6%
of persons with schizophrenia die by suicide.[6] 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.[7] Persons with mental disability and certain
mental disorders are at risk for suicide.[8] Also, persons with attention deficit
hyperactivity disorder, mood, conduct, or substance abuse disorders,[9]
specific learning disorder,[10]
disruptive mood dysregulation,[11]
and major depressive disorder[12]
are at greater risk. Anxiety found in
several disorders increases the risk of suicide,[13]
as does depression.[14] 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.[15] Persons who have experienced a traumatic
event (e.g., childhood abuse) or with PTSD,[16]
or who have adjustment disorders,[17]
anorexia nervosa,[18]
bulimia nervosa,[19]
nightmare disorder,[20]
gender dysphoria,[21]
oppositional defiant disorder,[22]
or conduct disorder[23]
have an increased risk. The same is true
of persons (notably both children and adults) with body dysmorphic disorder.[24] Persons having panic attacks are also at
increased risk.[25] About half of persons with
obsessive/compulsive disorder have suicidal thoughts, and one quarter attempt
suicide.[26] More than 70% of outpatients with
dissociative identity disorder have attempted suicide.[27]
Medication and
substance abuse may contribute to suicidal thoughts or acts.[28] ‘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.’[29] 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.[30]
Cannabis
(marijuana) is a gateway drug to other drug addictions and is correlated with
alcohol use, tobacco, and adult inhalant use disorders.[31] 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.[32]
Opioid use can be associated with depression and, therefore, suicide.[33] This is also true of persons with gambling disorder[34] and antisocial disorder.[35]
Persons who attempt to commit suicide but who do not succeed are 20-30% more likely to try again.[36] 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.[37] Suicidal people need to be watched, dangerous items need to be kept from them, and they need compassionate care.
Conclusion
This overview of psychological disorders associated with suicide should give people great concern over assisting people with such issues to end their lives. Construing 'care' or 'kindness' as giving such assistance is anything but care and kindness. It is collusion in people's confusions and suffering, not compassion. People with suicidal thoughts need help, not a hand in carrying out the act.
Previously: The Value of Human Life: Are We More than Animals?
[1] Bruno Waterfield, ‘Dutch Rethink Euthanasia Law after 60% Rise in
Mental Health Cases,’ The Times (24
March, 2025); online: Dutch
rethink euthanasia law after 60% rise in mental health cases (accessed 25
March, 2025).
[2] Ibid.
[3]DSM-5 refers to the Diagnostic
and Statistical Manual of Mental Disorders, 5th ed. (Arlington, VA:
American Psychiatric Association, 2013), p. 131; online: Diagnostic and
Statistical Manual of Mental Disorders (5th ed.) : Free Download, Borrow, and
Streaming : Internet Archive (accessed 5 February, 2025).
[4] DSM-5, p. 136.
[5] DSM-5, p. 138. The risk of
suicide among first-degree relatives of bipolar II persons is 6.5% (p. 138).
[6] DSM-5, pp. 104, 109.
[7] ‘Borderline Personality Disorder (BPD),’ Cleveland Clinic; online at Borderline
Personality Disorder: Causes, Symptoms & Treatment (accessed 1
February, 2025). Also DSM-5, p. 664.
[8] DSM-5, p. 38.
[9] DSM-5, p. 61.
[10] DSM-5, p. 70.
[11] DSM-5, p. 158.
[12] DSM-5, pp. 160-168.
[13] DSM-5, pp. 149, 184.
[14] DSM-5, p. 167.
[15] DSM-5, p. 201.
[16] DSM-5, p. 278.
[17] DSM-5, p. 287.
[18] DSM-5, p. 343.
[19] DSM-5, pp. 347, 349.
[20] DSM-5, p. 405.
[21] DSM-5, p. 454. To quote, ‘Adolescents
and adults with gender dysphoria before gender reassignment are at increased
risk for suicidal ideation, suicide attempts, and suicides. After gender
reassignment, adjustment may vary, and suicide risk may persist.’ Indeed,
persons who have undergone gender reassignment surgery are ‘at significantly
higher risk for depression, anxiety, suicidal ideation, and substance use
disorders than those with surgery’, according to a study of 107, 583 patients
in the USA in
2025. Joshua E
Lewis, Amani R Patterson, Maame A Effirim, Manav M Patel, Shawn
E Lim, Victoria A Cuello, Marc H Phan, and Wei-Chen Lee, ‘Examining
gender-specific mental health risks after gender-affirming surgery: a national
database study,’ The Journal of Sexual
Medicine (25 February, 2025); abstract online: https://doi.org/10.1093/jsxmed/qdaf026
(accessed 5 March, 2025). While the
study concludes that patients undergoing such surgery therefore need support,
one might rather conclude that such surgeries—except in corrective surgery for
intersex persons after puberty—are based on a non-biological practice of
medicine and should be rejected.
[22] DSM-5, p. 464.
[23] DSM-5, p. 473.
[24] DSM-5, p. 245.
[25] DSM-5, pp. 212, 215.
[26] DSM-5, p. 240.
[27] DSM-5, p. 295.
[28] DSM-5, pp. 490, 493.
[29] DSM-5, p. 553.
[30] DSM-5, p. 496.
[31] DSM-5, pp. 496, 538.
[32] DSM-5, p. 515.
[33] DSM-5, p. 544.
[34] DSM-5, p. 587.
[35] DSM-5, p. 661. Premature
death is also increased because of homicides and accidents in this population
group.
[36] DSM-5, p. 802.
[37] DSM-5, p. 802.
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