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Many suicidal people participate in suicidal activities which do not result in death. These activities fall under the designation of attempted suicide. Generally, those with a history of such attempts are almost 23 times more likely to eventually end their own lives than those without.
Parasuicide
In the technical literature the use of the terms parasuicide or deliberate self-harm (DSH) are preferred – both of these terms avoid the question of the intent of the action.
Those who self-harm are, as a group, quite different from those who attempt to die from suicide. It is of utmost importance to note that self-harm is not a suicide attempt and should never be construed as such. There is a non-causal correlation between self-harm and suicide; individuals who suffer from depression or other mental health issues are also more likely to choose suicide. DSH is far more common than suicide, and the majority of DSH participants are females aged under 35. They are usually not physically ill and while psychological factors are highly significant, they are rarely clinically ill and severe depression is uncommon.
Social issues are key: DSH is most common among those living in overcrowded conditions, in conflict with their families, with disrupted childhoods and history of drinking, criminal behavior, and violence. Individuals under these stresses become anxious and depressed and then, usually in reaction to a single particular crisis, they attempt to harm themselves. The motivation may be a desire for relief from emotional pain or to communicate feelings, although the motivation will often be complex and confused. DSH may also result from an inner conflict between the desire to end life and the desire to continue living. See the article on self-harm for an in depth discussion.
Suicidal gesture
Sometimes, a person will make actions resembling suicide attempts while not being fully committed, or in a deliberate attempt to have others notice. This is called a suicidal gesture (also known as a "cry for help"). Prototypical methods might be a non-lethal method of self-harm that leaves obvious signs of the attempt, or simply a lethal action at a time when the person considers it likely that they will be rescued or prevented from fully carrying it out.
On the other hand, a person who genuinely wishes to die may fail, due to lack of knowledge about what they are doing; unwillingness to try methods that may end in permanent damage if they fail or harm to others; or an unanticipated rescue, among other reasons. This is referred to as a suicidal attempt.
Distinguishing between a suicidal attempt and a suicidal gesture may be difficult. Intent and motivation are not always fully discernible since so many people in a suicidal state are genuinely conflicted over whether they wish to end their lives. One approach, assuming that a sufficiently strong intent will ensure success, considers all near-suicides to be suicidal gestures. This however does not explain why so many people who fail at suicide 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 since if there is an insufficiently strong reaction from loved ones from a suicidal gesture, this may motivate future, more committed attempts.
An important distinction has also been made (see Erwin Stengel, 'Suicide and Attempted Suicide') between those who kill themselves and did not mean to, and those who did not kill themselves but did mean to. Thus a 'Suicide' (noun) may either succeed or fail in his/her goal (ie. succeed in killing himself/herself or not) and an 'Attempted Suicide' (noun) may either succeed or fail in his/her goal (e.g., succeed in 'making a cry for help' or fail and, in doing so, probably die).
This distinction, if correctly drawn, can have important ramifications for the treatment of people who are suicidal.
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