Suicidal and selfinjurious behaviour
Suicidal behaviour is defined as a conscious, intentional act that aims at terminating one’s
Suicidal ideation is often trigged by feelings of hopelessness or social isolation.
Individuals who commit suicide have usually indicated their wish to die either directly or
indirectly prior to the suicide attempt.
Suicide attempts with terminal intent can be classified as desperate or impulsive. In a
minority of cases, suicide is altruistically motivated, and such behaviour may not necessarily
be associated with psychopathology.
Parasuicidal or deliberate selfinjurious behaviour usually has no terminal intent.
People who show parasuicial behaviour are usually younger, more often female, choose ‘soft’
methods of committing suicide more frequently, and act out interpersonal conflict more
overtly compared to people who commit suicide attempts with terminal intent.
Repeated selfinjury increases the risk that individuals become practiced and accustomed
regarding suicide and may eventually lose fear and engage in increasingly dangerous self
In 2001 about 850,000 people worldwide died from suicide. In developed countries, more
people die from suicide than do from car accidents.
Suicide rates vary with ethnicity and social background. In Europe suicide rate is 25 per
100,000 people. The suicide risk is higher in persons with high social status but a recent fall
in social status also increases the risk of suicide.
Suicide is the third leading cause of death in young adults, and among the ten leading causes
in developed countries.
In men, suicide rates peak after age 45, whereas in women the rate peaks after 55 years of
age. In Western societies, men commit suicide at least three times more often than women,
and more often choose ‘hard’ methods such as hanging, shooting, comapred to ‘soft’ methods
such as taking an overdose of psychoactive drugs or a poison.
The incidence of parasuicidal behaviour is probably 10 to 20 times as high as is the rate of
suicide attempts with terminal intent. Selfinjurious behaviour is common in psychiatric
patients with personality disorders and patients with substance dependence.
Repetitive cutting occurs about 50 times more often in psychiatric patients compared to the
Environmental risk factors
Factors which increase the risk for suicide include • aggression and violence towards others,
• feelings of hopelessness
• shame and humiliation
• chronic insomnia
• panic attacks
• previous suicide attempts
Other risk factors include
• childhood trauma
• sexual abuse
• recent traumatic experiences
• marital discord
Neglectful parents increased the risk of suicide in females.
Age is a risk factor for suicidal behaviour but probably mediated by psychosocial features
• lack of social support
• poor relationship with family
• cognitive characteristics such as
o reduced executive functioning
o loss of physical health
About 90% of completed suicides are associated with a diagnosable disorder at the time of
The risk for successful suicide is particularly increased in patients with affective disorders,
substance dependence, schizophrenia and Cluster B personality disorders.
For depression, bipolar affective disorder, alcohol dependence and schizophrenia have been
estimated around 10% to 20%.
In BPD, 50% of patients make at least one severe attempt and undertake repeated suicide
attempts or deliberately injure themselves.
Impulsivity, emotional dysregulation and aggression also convey elevated suicide risk in
antisocial personality disorder.
Suicide and selfinjurious behaviours are causally linked to life events, which may reactivate
traumatic experiences that happened in the past.
Infancy and childhood are certainly vulnerable periods of life during which the ground for the
ability to cope with interpersonal conflict is laid. Suicidal behaviour expresses the desire to reduce emotional pain or anger directed towards
self or others.
It is widely agreed that suicide assessment scales have low predictive value and do not
provide a reliable estimate of individual suicidality.
Poor reliability of suicide assessment scales could be that patients with persistent suicidal
intent might try to conceal their real intentions from the interviewer.
A patient may deny further suicidal intent, but the experienced clinician may recognize a
great deal of fidgety movements, frequent change of body posture, or avoidance of eye
contact, which may alarm the clinician to continue assessment and to seek thirdparty
information from family members or friends.
Individuals with childhood abuse or neglect are not only at an increased risk for suicide and
parasuicidal behaviour later in life, they are also vulnerable to acquiring insecure attachment
Individuals with a history of traumatization therefore have difficulties in acknowledging that
the clinician wants to offer help to escape the situation that has led to the suicidal behaviour.
Suicidal behaviour and deliberate selfharm may be the consequence of an individual’s wish
to terminate his or her life, or may be motivated by feelings of revenge. Instead of harming
their significant others, a person may turn his or her aggression inward > also known as
Suicidal or parasuicidal behaviour is often paralleled by altered serotonin turnover. Decrease
in serotonin availability is associated with heightened levels of aggression, impulsivity and
risktaking behaviour, as well as suicidal behaviour and selfharm.
Carriers of alleles associated with greater serotonin efficiency seem to be protect