Management of suicidal crisis in an adolescent with Becker muscular dystrophy: a case report

BACKGROUND: Becker muscular dystrophy (BMD) is a rare X-linked recessive disorder associated with progressive physical disability, which may increase the risk of suicidal ideation. However, acute suicidal crises are rarely reported in BMD, as neuromuscular vulnerability restricts standard emergency pharmacological and somatic interventions. We describe an adolescent with BMD complicated by severe suicidal crisis to highlight key diagnostic and therapeutic considerations. CASE PRESENTATION: A 16-year-old boy, who was diagnosed with BMD at the age of 8, became socially isolated due to progressive muscle weakness and long-term home confinement. He had experienced depressed mood for 3 years and recurrent self-injurious behavior for 6 months before admission, eventually engaging in wrist-cutting and an attempted jump from a building. Psychological assessment revealed severe depression and anxiety. To avoid premature definitive classification during an acute crisis, the patient was managed under a broader working diagnosis of mood disorder. Treatment emphasized psychotherapy and family intervention, with adjunctive low-dose fluoxetine (20 mg/day) and olanzapine (5 mg/day) to control impulsivity while minimizing sedation-related worsening of muscle weakness. Suicidal ideation resolved within 5 days, and no further severe suicidal behavior occurred over 10 months of follow-up. CONCLUSIONS: Severe suicidal behavior in BMD highlights the profound psychiatric impact of progressive physical and social decline. In adolescents with BMD and severe suicidal behaviors, dynamic assessment and early crisis intervention are essential. Psychological and family-based interventions should be prioritized, while pharmacotherapy, when needed, should be used cautiously to avoid exacerbating underlying neuromuscular weakness.