Suicidal phenomena

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Suicidal Phenomena

Suicidal gestures and attempts

Sometimes, a person will carry out an act resembling a suicide attempt without being fully committed to ending his or her life. This is called a suicidal gesture. Prototypical methods might be a non-lethal method of self-harm that leaves obvious signs of the attempt or simply a potentially lethal action at a time when the person considers it likely that he/she will be rescued or prevented from completing the attempt.

On the other hand, a person who genuinely wishes to die may survive due to lack of knowledge, unwillingness to try methods that may end in permanent damage to herself/himself (in the event of an attempt which does not result in death), unwillingness to try methods that may harm others, or an unanticipated rescue, among other reasons. There may be conflict, whereby a genuinely suicidal person can be desperate enough to want to kill themselves but, at the same time, too afraid to go through with the extreme measures that are needed to guarantee death. It may be incorrect to state that a person who survived an overdose was issuing a "cry for help" when, in reality, it may have been a genuine suicide attempt that simply did not result in death. This highlights a basic fact that it is not easy to kill oneself in a way that is not traumatic or painful, hence the phenomenon of assisted suicides. This is referred to as a suicide attempt.

Distinguishing between a suicide attempt and a suicidal gesture may be difficult. Intent and motivation are not always fully discernible, as many people who find themselves in a suicidal state are genuinely conflicted over whether or not they wish to end their lives. One approach, assuming that a sufficiently strong suicide intent will ensure death, considers all near-suicides to be suicidal gestures. This, however, does not explain why so many people whose suicide attempts do not result in death end up with severe injuries, often permanent, which are most likely undesirable to those who are making a suicidal gesture. Another possibility is those wishing merely to make a suicidal gesture may end up accidentally killing themselves, perhaps by underestimating the lethality of the method chosen or by overestimating the possibility of external intervention by others. Suicide-like acts should generally be treated as seriously as possible, because if there is an insufficiently strong reaction from loved ones from a suicidal gesture, this may motivate future and ultimately more committed attempts.

In the technical literature the use of the terms parasuicide, or deliberate self-harm (DSH) are preferred; both of these terms circumvent the question of the intent of the actions.

Nearly half of all suicides are preceded by an attempt at suicide that does not end in death. Those with a history of such attempts are 23 times more likely to eventually end their own lives than those without. Those who attempt to harm themselves are, as a group, quite different from those who actually die from suicide; females attempt suicide much more frequently than males, however males are four times more likely to die from their attempt.

Suicidal ideation

Main article: Suicidal ideation

Suicidal ideation is a medical term for thoughts about suicide, which may range from vague or unformed urges to meticulously detailed plans and posthumous instructions. The condition requires professional intervention to determine its extent, including the presence of a suicide plan and the patient's means to commit suicide. Severe suicidal ideation is a medical emergency requiring immediate treatment.

Suicide crisis

Main article: Suicide crisis

A suicide being attempted, or a situation in which a person is seriously contemplating suicide or has strong suicidal thoughts, is considered by public safety authorities to be a medical emergency requiring suicide intervention.

Suicide note

Main article: Suicide note

A suicide note is a written message left by someone who attempts, or dies by suicide, though a large number of people who complete suicide do not leave one. Studies give inconsistent results as to the proportion of people who leave suicide notes - with a range of approximately 12% to 37%. Motivations for leaving a note range widely, from seeking closure with loved ones to exacting revenge against others by blaming them for the decision. It may also contain a few sentences apologizing to those they have left behind.