Types Of Suicidal Behaviour

The concept of suicide is relatively straightforward, as it is defined by a legal judgement where there is clear evidence that the person intended to take his or her own life. Cases where clear evidence is lacking but the suspicion is of suicide are usually recorded as undetermined deaths and are often included in the suicide statistics. Non-fatal suicidal behaviour is more complicated because of the range of behaviours encompassed and the variety of terms used. The terms usually imply something about the level of intent to die; for example, 'attempted suicide' implies a strong intention to die, whereas 'deliberate self-harm' does not. It is tempting to make judgements about the level of intent, but this is difficult to do in practice. People are often unaware of the medical lethality of the overdose they have taken (by far the most common type of self-harm), thus rendering this a poor criterion. Moreover, when asked, most commonly, people simply say they wanted to escape; they may not be clear

Mood Disorders: A Handbook of Science and Practice. Edited by M. Power. © 2004 John Wiley & Sons, Ltd. ISBN 0-470-84390-X.

about whether they wanted to die or not (Bancroft et al., 1979). Finally, individuals with more than one episode of self-harm are quite likely to have a mixture of levels of intent across different episodes (Brown et al., 2002; Sakinofsky, 2000). One solution suggested by Kreitman (1977) was to use the term 'parasuicide' as a descriptive term to cover all deliberate but non-fatal acts of self-harm, thus, remaining neutral about level of intent to die. As Kerkhof (2000) has pointed out, this term has not really caught on with clinicians, who tend to use attempted suicide or deliberate self-harm. In this chapter, the terms 'parasuicide', 'deliberate self-harm', and 'attempted suicide' will be used interchangeably to describe a deliberate but non-fatal act of self-harm whatever the medical lethality or motivation behind the behaviour. A final reason for not distinguishing types of parasuicide is that, although some studies have specifically addressed the issue of measuring intent, most have not; therefore, the literature typically groups together all non-lethal suicidal behaviour.

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