Introduction

Attempted suicide and deliberate self-harm are terms used to describe behaviours through which people inflict acute harm upon themselves, poison themselves, or try do so, with non-fatal outcome. These behaviours are somehow linked to, but do not result in, death. Common to these behaviours is that they occur in conditions of emotional turmoil. In former days attempted suicides were often regarded as failed suicides. However, this view did not appear to be correct, and the great majority of patients in fact do not try to kill themselves. Therefore the term deliberate self-harm was introduced to describe the behaviour without implying any specific motive. (!) But this too has some disadvantages because there is a temporal association between non-fatal and fatal suicidal behaviour; many people who kill themselves have attempted suicide before or have displayed deliberate self-harm. Thus Kreitman et al.(2) introduced the concept of parasuicide to describe behaviour that, mostly without the intention to kill oneself, communicates a degree of suicidal intent. However, both terms, deliberate self-harm and parasuicide, are still somewhat confusing, because in practice they include people who really have the intent of killing oneself but survive the attempt. The difficulty of finding a good terminology for these behaviours is reflected in differences in research populations in empirical studies: some studies are limited to self-poisoning only (overdose), a few studies are restricted to self-injury (wrist cutting) only, some to self-poisoning and self-injury combined, and some studies include behaviours in which due to last-moment intervention from others, there was no actual self-harm inflicted at all.

In this chapter we will use the terms attempted suicide and deliberate self-harm interchangeably to refer to non-fatal suicidal behaviours in which there may have been an intention to die, however ambiguous this intention may have been, and irrespective of other intentions that may have been operating at the same time. It should be stressed that in attempted suicide/deliberate self-harm many motives may play a role simultaneously, even contradictory motives such as the hope of being rescued and the wish to continue living. Intentions may vary from attention seeking or communication of despair, appeal for help, to a means for stress reduction. Common to these behaviours is that they are motivated by change: people want to bring about changes in their present situation through the actual or intended harm or unconsciousness inflicted upon the body. Attempted suicide/deliberate self-harm may be defined as follows. (3)

An act with non-fatal outcome, in which an individual deliberately initiates a non-habitual behaviour that, without intervention from others, will cause self-harm, or deliberately ingests a substance in excess of the prescribed or generally recognised therapeutic dosage, and which is aimed at realising changes which the subject desired via the actual or expected physical consequences.

This definition covers deliberate non-fatal suicidal behaviours. Not included are accidental cases of self-poisoning, accidental overdoses of opiates, or self-harmful acts by persons who do not anticipate the consequences of their actions. It does not include automutilation, which is a habitual, often obsessive act of inflicting (minor) self-harm, mostly without a conscious intent of changing the present situation, as with certain persons with learning disability.

Eliminating Stress and Anxiety From Your Life

Eliminating Stress and Anxiety From Your Life

It seems like you hear it all the time from nearly every one you know I'm SO stressed out!? Pressures abound in this world today. Those pressures cause stress and anxiety, and often we are ill-equipped to deal with those stressors that trigger anxiety and other feelings that can make us sick. Literally, sick.

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