Table 2.

Contrasting assessment paradigms: dichotomous vs. functional continuum.

Assessment dimension	Traditional intent-focused model	Functional continuum model (FCM)
Primary classification	Intent to die (binary: present/absent)	Psychological function served (spectrum: affect regulation, punishment, communication)
Focus on lethality	Potential lethality of the method (e.g., pill dosage)	Acquired capability (habituation to pain/fear) and intensity of underlying psychache
Risk factors	Static (e.g., past attempts, demographics)	Dynamic (e.g., real-time emotion dysregulation, skill deficits, current interpersonal conflict)
Long-term goal	Behavioral cessation (stopping NSSI/SA)	Functional rehabilitation (building an adaptive skill toolbox)
Acute utility	High (determines immediate need for hospitalization)	Complementary (provides context to predict when functional triggers will escalate risk)