Classification

As previously mentioned, there is a considerable variety of behaviours within the broad category of non-fatal suicidal behaviour. A review of classification studies (25ยป revealed three types of suicide attempt(er)s: a 'mild' type, a 'severe' type, and a 'mixed' type in between.

The mild type of non-fatal suicidal behaviour encompasses mostly relatively non-violent methods followed by non-serious physical injury. Young age, living together, few precautions to prevent discovery, low level of suicidal preoccupation, low suicidal intent, interpersonal motivation are all characteristics associated with mild forms of attempted suicide/deliberate self-harm. The severe category consists mostly of relatively hard methods followed by serious physical consequences. Older age (over 40), many precautions to prevent discovery, high level of suicidal preoccupation, high suicidal intent, self-directed motivation, often relocated, previous attempted suicides, depression, drug dependence, a high degree of overall dysfunctioning, poor physical health, and previous psychiatric treatment are all characteristics associated with the concept of 'severe' attempted suicide/deliberate self-harm. The risk of repetition is greater in the severe type. In between, in the mixed type of attempted suicide/deliberate self-harm, the attempts and the attempters show mixed characteristics, which makes this type harder to distinguish in medical practice.

In order to refine further the classification of attempted suicide/deliberate self-harm, Arensman (32,) included psychological and personal history variables and these characteristics were studied in relation to recurrent non-fatal suicidal behaviour in a follow-up period of 1 year. She validated the mild type, approximately 40 per cent of the total sample, as being predominantly younger than 30 years of age, single, living alone or with parents, and having minor injuries because of the index attempt. The mean number of previous attempts was 3.7 attempts. The repetition rate in the follow-up period for this group was 27 per cent. In the older age group, two groups were distinguished: a moderate group, and a group with an extremely high risk for non-fatal repetition was identified. The high-risk group, consisting of approximately 28 per cent of the total sample, suffered more physical injury as a consequence of their attempted suicide/deliberate self-harm. The high-risk group consisted predominantly of females in the age group 30 to 49 years who were divorced or separated, living alone, and who were economically inactive. Most had made previous attempts (mean number of five previous attempts). They had histories of traumatic life events and experiences that mostly started early in life. A high percentage reported physical, sexual, and mental maltreatment by parents in childhood and early adolescence, followed by physical and mental maltreatment by partners later in life. The females in this group more often were divorced and the total number of times they were divorced or had cohabited with a partner was significantly higher. The high-risk group had highest scores on depression, hopelessness, and expression of state-anger. Two thirds of this high-risk group could be diagnosed as having borderline personality disorder, which accounts for the patterns of unstable personal relationships and affective instability. In the follow-up at least 75 per cent engaged in repeated non-fatal suicidal behaviours.

The moderate group was characterized by low levels of physical injury following their non-fatal suicidal behaviour, they were predominantly aged at least 30 years and married, and scored intermediate on measures of depression, hopelessness, and anger. The mean number of previous attempts was 2.3, and 33 per cent made one or more repeated attempt in the follow-up. Surprisingly, this classification into three types of non-fatal suicidal behaviours did not correspond to the levels of reported suicide intent nor to the levels of the different motivations reported (to die, to appeal, to lose consciousness, revenge), underlining the difficulty of classifying attempted suicide according to intentions.

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

Get My Free Ebook


Post a comment