Misclassification of Self-Directed Violence

What is it about?

Background: Inconsistent nomenclature and classification of suicidal behaviour have plagued the field of suicidology for a long time. Recently, the United States Centers for Disease Control (CDC) advocated for the usage of a specific classification system. Aim of the current study was to determine the extent of misdiagnosed acts of self-directed violence—controlling for the level of expertise in psychology/psychotherapy. Additionally, the effect of gender and diagnosis on misclassifications was assessed. Method: A total of 426 participants (laypersons, psychology students, psychotherapists-in-training, li- censed psychotherapists) were presented with an array of case vignettes describing different acts of self-directed violence (e.g., non-suicidal self-directed violence, suicide attempt, suicide ideation) and were asked to make a classification. Gender and given diagnosis were varied systematically in two vignettes. Results: Overall 51.6% of the cases were misclassified (according to the Self-Directed Violence Classifi- cation System). The level of expertise was almost unrelated to classification correctness. Yet, psychother- apists were more confident about their judgments. Female gender of the character described in the vignette and an ascribed diagnosis of Borderline Personality Disorder were associated with higher mis- classification rates. Limitations: The validity of case vignettes is discussible. Conclusions: The results highlight the importance of more methodological and diagnostic training of psychologists regarding suicidal issues.

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