Sandbox:Vindhya
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Vindhya BellamKonda, M.B.B.S [2]
Classification of suicidal ideation
| Classification | Definition | Examples |
|---|---|---|
| Suicidal events
Completed suicide |
A self-injurious behavior that resulted in fatality and
was associated with at least some intent to die as a result of the act.
|
example:1) After a long argument with his girlfriend, which resulted in the end of their relationship, the patient collected a rope and rode his bike to an isolated area where he fatally hanged himself. A suicide note was later found. 2) After four documented attempts at suicide, the patient stole his uncle’s gun and shot himself and was fatally injured |
| Suicide attempt | A potentially self-injurious behavior, associated with
at least some intent to die, as a result of the act. Evidence that the individual intended to kill him/ herself, at least to some degree, can be explicit or inferred from the behavior or circumstance. A suicide attempt may or may not result in actual injury
|
Example:fter a fight with her friends at school, in which they discontinued
speaking with her, the patient ingested approximately 16 aspirin and eight other pills of different types on the school grounds. She said that she deserved to die, which was why she swallowed the pills. 2) The patient used a razor blade to lacerate his wrists, his antecubital fossae, and his back bilaterally. He told his therapist that the “the main objective was to stop feeling like that,” and he knew that he could die but didn’t care. According to the patient, he also ingested a bottle of rubbing alcohol because in his health class he heard “that the medulla will get more suppressed that way,” thereby increasing y increasing the chances that he would be “successful” and die |
| [Preparatory acts
towards imminent suicidal behavior |
The individual takes steps to injure him- or herself,
but is stopped by self or others from starting the self-injurious act before the potential for harm has begun
|
her had gone to school and retrieved a recent “bad” report card. He was fearful of his father’s reaction. Upon his return home, a 5- to 6-hour argument with his parents ensued, and he took a vegetable (broad, sharp) knife and went to his room. He reported putting the knife to his wrist but never puncturing the skin. 2) The patient stated that he “couldn’t stand being depressed anymore” and “wanted to die.” He decided to hang himself. He tied a telephone cord to the door knob and placed the cord loosely around his neck. Then, he stopped himself and did not follow through with the attempt. |
| Suicidal ideation | Passive thoughts about wanting to be dead or active
thoughts about killing oneself, not accompanied by preparatory behavior.a |
about hanging himself in the closet. He was taken to the hospital and admitted.
to be dead but denied acting on these feelings.
|
Classification of suicidal ideation
| Classification | Definition | Examples |
|---|---|---|
| Non-Suicidal events
Self-injurious behavior, no suicidal intent |
Self-injurious behavior associated with no intent to
die. The behavior is intended purely for other reasons, either to relieve distress (often referred to as “self-mutilation,” e.g., superficial cuts or scratches, hitting/banging, or burns) or to effect change in others or the environment
|
The patient was feeling ignored. She went into the family kitchen where her mother and sister were talking. She took a knife out of the drawer and made a cut on her arm. She denied that she wanted to die at all (“not even a little”), but she just wanted them to pay attention to her. 2) The patient reported feeling agitated and anxious after a fight with her parents. She went into her room, locked the door, and made several superficial cuts on the inside of her arms. She stated that she felt relieved after cutting herself and that she did not want to die. She reported that she had done this before at times of distress and that it usually helped her feel better. 3) The patient was in class, where a test was about to begin, and stabbed himself with a pencil in order to be taken to the nurse’s office. 4) A 14-year-old girl wrote her name on her arm with a penknife and said that she often does so in order to reduce her anxiety. 5) The patient was noted to have multiple superficial burns on his arms. Upon questioning, he denied trying to kill himself |
| Other, no
deliberate self-harm |
No evidence of any suicidality or deliberate self-injurious
behavior associated with the event. The event is characterized as an accidental injury, psychiatric or behavioral symptoms only, or medical symptoms or procedure only |
1) The patient had a cut on the neck from shaving. 2) The patient
was hospitalized for worsening of OCD or depressive symptoms with no suicidal thoughts or actions or 3) aggressive behavior. 4) Hospitalization was because of an infection, rhinoplasty, or pregnancy |
Classification of suicidal ideation
| Classification | Definition | Examples |
|---|---|---|
| Indeterminate or
potentially suicidal events Self-injurious behavior, suicidal intent unknown |
Self-injurious behavior where associated intent to
die is unknown and cannot be inferred. The injury or potential for injury is clear, but why the individual engaged in that behavior is unclear.
|
1) The patient cut her wrists after an argument with her boyfriend.
2) The patient was angry at her husband. She took 10 to 15 diazepam tablets and flushed the rest down the toilet. Her husband called the police for help, and she was taken to the hospital. She was groggy and stayed overnight in the hospital. 3) A 9-year-old patient had spoken about suicide frequently. After learning that his baseball coach was retiring, he began scratching his arm with a pencil. |
| Not enough
information |
Insufficient information to determine whether the
event involved deliberate suicidal behavior or ideation. There is reason to suspect the possibility of suicidality but not enough to be confident that the event was not something other, such as an accident or psychiatric symptom. An injury sustained on a place on the body consistent with deliberate self-harm or suicidal behavior (e.g., wrists), without any information as to how the injury was received, would warrant placement in this category |
1) A child who “stabbed himself in [the] neck with a pencil.” The
event may have been deliberate as opposed to accidental, as suggested by “stabbed,” but not enough information was provided to determine whether the event was deliberate. 2) A cut on the neck.
|
References
Posner K, Melvin GA, Stanley B, Oquendo MA, Gould M: Factors in the assessment of suicidality in youth. CNS Spectr 2007; 12: 156–162