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Parasuicide and Self Harm

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Parasuicide 'Risk' Factors   Misconceptions & 'False Beliefs' regarding 'Self Harming' behaviours   Suicide 'Risk' Prediction

Deliberate self harm & attempted suicide are other terms used for the phenomenon known as ‘Parasuicide’. A more accurate definition would be ‘an apparent attempt at suicide, commonly called a suicidal gesture, in which the aim is not death’. For example: a sub-lethal overdose of medication or slashing or cutting of the wrist. These ‘non-fatal’ suicide attempts or actions vary in their risk to life and the individuals themselves have different levels of sincerity in their wish to die.  


A suicide attempt of a ‘non-fatal’ nature may be the result of an attempt to end unbearable psychological & emotional anguish. The person is so distressed they are incapable of seeing any other option but to end their life. It may also be a ‘cry for help’; unable, unwilling or unsure of how to seek assistance or adequately express their feelings, they resort to a demonstrative manner of showing how distressed they are. The individual in such a desperate situation may be, or feel, totally isolated, believing there is no-one to turn to; no-ne who can help.


Repeat suicide attempts are common in the context of ‘parasuicide’. Approximately 20% of those who deliberately self harm are re-admitted to hospital within a year of a previous attempt and those who have attempted suicide are at a significantly higher risk of eventually dying by suicide.


Factors such as social deprivation & isolation, history of abuse (particularly physical or sexual), alcohol &/or drug abuse, unemployment, marital status (single, divorced, widowed), relationship difficulties, child custody issues are common amongst those who attempt suicide.


Those at most risk of parasuicide are women; particularly younger women under the age of 45, but more specifically between 15 & 25. Parasuicide is extremely distressing for those close to the individual; family, friends and also those who have witnessed an apparent attempted suicide.


One cannot definitively state how suicidal an individual is or how intent they are in their suicidality. Certain statistics and historical information can assist, along with the presentation and severity of a suicide attempt. For example, a history of parasuicide or attempted suicide increases the risk of eventual suicide to 40 times that of the general population. As it may also be as a result of, or connected to, a mental health disorder requiring treatment in a hospital, the risk of suicide is highest in the first months after psychiatric care and the risk of repetition & ultimate suicide is highest also 1 to 2 years after an episode of parasuicide.


The severity of the attempt is a sound indicator of the level of suicidal intent. Lethal doses of drugs, hanging attempts, carbon monoxide poisoning, ingestion of poisons, serious self inflicted wounds etc. should be taken into account, along with the isolation of the individual and factors relating to having been found, prior to achieving success in their apparent suicide attempt.





Parasuicide Risk Factors




  • Depression  
  • Alcoholism & Drug addiction  
  • Personality disorder (particularly ‘Borderline Personality Disorder)  
  • Relationship difficulties & problems  
  • Physical illness or disability (especially chronic conditions)  
  • Death of a parent when at a young age  
  • Neglect & abuse by parents or parental identities  
  • Intellectually handicapped or disabled  
  • Trouble with the law and legal system  
  • Unemployment, retrenchment, redundancy etc.  
  • Financial losses  
  • Coping with a loved one’s illness or disability  



These are but some of the possible and more common situations that might lead to parasuicide and by no means should be considered the only factors involved.




Misconceptions & False beliefs regarding ‘self harming’ behaviour.





  • Self harming or self injury is NOT necessarily a suicide attempt.  
  • Many of those who self harm cannot explain why they do so.  
  • Self harming behaviour can be a means of ‘coping’ with underlying psychological & emotional problems, rather than a wish to die, despite many expressing or contemplating suicide.  
  • Self harming is NOT solely attention seeking behaviour. Many self-harmers do so privately, or use areas of their body that are not clearly visible. They may even resort to wearing long sleeved shirts to hide the scars of previous self harm or current self injury.  
  • The severity of the self harming injury inflicted is not consistent with, or an indicator of, the level of distress or the intensity of the psychological trauma.  
  • Self injury is not a mental illness. It may be a sign of another disorder or illness but the act of self-harm is not a condition in its own right.  




Suicide ‘risk’ prediction




1.   Previous suicide attempts are the most accurate predictive tool as to the

probability of suicide in the future. Estimates of 10 to 15% of people in contact with health care services & facilities following a suicide attempt will ultimately take their own lives.



  1. A family history of suicide, depression or mental illness.  


  1. Changes in behaviour such as increasing social withdrawal & difficulty with interpersonal interactions & relationships, low mood, deterioration or neglect of personal appearance, hygiene etc. They may appear irritable or tearful; have difficulty concentrating; appearing preoccupied and vague. One might also note a lack of energy and poor appetite or dietary intake. A potentially serious indicator can be a sudden & incongruous cheerfulness & contented mood. Often this is as a result of the individual having made up their mind as to the course of action (suicide) & having reconciled that within their mind.  


  1. People who express feelings of hopelessness, worthlessness, loneliness, failure and view the future as bleak, negative or irrelevant. They may even talk of suicide quite openly; if not a little blasé.  


  1. There are those who suddenly begin organizing their affairs, such as making or changing their will, financial arrangements & even funeral arrangements.  


  1. People with poor, inadequate or inappropriate coping skills and/or who display poor impulse control.  




Despite these predictors or indicators for the risk of suicide, parasuicide & deliberate self-harm, suicide continues to occur, at even greater numbers and at younger ages. The value of one’s life appears to have diminished; not only to society, but within themselves. Suicide is seen as an ‘option’ for coping with problems that cause distress. Where this originates is open for philosophical debate though the reality and nature of the problem NEEDS to be addressed in a serious and sincere manner & with significant urgency.


The role of alcohol & drugs in the ‘inexplicable’, spontaneous suicide of younger adolescents is worrying. Its capacity to reduce impulse control, exacerbate & intensify internal emotions & feelings, distort thinking to a point of irrational behaviour is intrinsically linked to many of the unfortunate cases of juvenile suicide and those in their 20’s. Remember, many of our league players fall into this age group and are indicated by some of these risk factors.


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