Suicide Research: Addressing the Motivational Differences in Self-Injury
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Suicide research does not consistently differentiate between self-injuring patients who wanted to die from their injury and those who wanted to live, when defining a “suicidal act” (Silverman, Berman, Sanddal, O'Carroll P, & Joiner, 2007a). This lack of standard categorization creates significant barriers to the generalizability of findings (Silverman, et al., 2007a). In addition, the need to distinguish between various groups of self-injurers stems from the concern that patients who injure themselves without the intent to die have different reasons for the self-injurious behavior than patients who intended to die via the act (Cholbi, 2007). Thus, each group may require differing medical treatment (Freedenthal, 2007). To begin to characterize the impact of these definitional discrepancies, the current study uses a research protocol with scales for assessing intent, lethality, and motive in a U.S. population to determine motivational differences between samples of self-mutilating patients, patients attempting suicide, and those who were ambivalent about dying. The study replicated methods used during the World Health Organization Region of Europe (WHO/EURO) Multicentre Study on Suicidal Behavior as applied in the Oxford, England cohort (Hawton, Fagg, Simkin, Bale, & Bond, 1997; Hjelmeland, et al., 2002). Deliberate self-injury patients admitted to Parkland Hospital were interviewed to determine their specific motives and the level of suicidal intent present during the self-injurious behaviors. This investigation identifies an important difference between suicidal patients and self-mutilating patients in terms of their motives for self-injurious behavior. While suicidal and nonsuicidal self-injurers demonstrated no significant difference in number of motives endorsed, the nature of motives endorsed by suicidal and non-suicidal patients differed significantly. On average, those who wanted to die from the injury endorsed intrapersonal motives while those who wanted to live endorsed interpersonal motives for their self-injury.