So many different types of behaviors are sometimes referred to as suicide attempts that when we read in the medical record that someone had a “suicide attempt,” we can’t be sure what actually happened. The lack of clarity and agreement about what to call different types of suicidal behaviors has been a significant problem clinically and in clinical research. Without agreement in the field about terminology, miscommunication occurs. Can we please agree on the terminology for suicidal behaviors?
With regard to the terminology for different types of suicidal behaviors, what are some mistakes that you have seen others make? Please do share them by posting a comment at the bottom of this page (under “Leave a Reply”).
Do you know exactly what the following terms mean?
“Actual Attempt”
“Interrupted Event”
“Aborted Attempt”
“Preparatory Acts/Behavior”
For explanations, examples, and suggested questions to ask the person who had these suicidal behaviors, please continue to read below.
The Columbia Suicide History Form did us a valuable service by providing definitions of different behaviors (Oquendo et al., 2013). These definitions are also used in the Columbia – Suicide Severity Rating Scale (C-SSRS), which is now routinely used in antidepressant clinical trials.
Actual Attempt
When should a suicidal behavior be referred to as an “actual attempt”? An actual attempt is defined as a:
1. Potentially self-injurious act
2. Committed with at least some intent to die as a result of the act
Note: The intent to die does not have to be explicit.
I might as well say upfront that I don’t like this term, “actual” attempt. It could be taken to imply that if a person starts a suicidal behavior but is, thankfully, stopped by someone (“interrupted attempt,” see below), that this was not an “actual” attempt. From the viewpoint of the serious clinical implications of the behavior, an interrupted attempt may have the same significance as an “actual” attempt. But since actual attempt is the term used by the sources I am using, which have become standard in the field, I use it in this article and elsewhere.
Important clarifications:
In real-life situations, the mental state of persons who exhibit suicidal behavior and the circumstances in which the suicidal behavior occurs mean that there are many gray areas. To avoid uncertainty, several clarifications have been provided regarding situations in which we would call the behavior an actual attempt.
1. To be called an actual attempt, there does not need to be a 100% intent to kill oneself. Even a partial thought that this act will or may kill oneself means that this act was an “actual attempt.” So, please remember: if there is any intent or desire to die as a result of the act, then it can be considered an “actual” suicide attempt.
2. To be called an actual attempt, it is not a requirement that injury or harm should have occurred as a result of the act. The C-SSRS gives the example that if a person puts a gun in his or her mouth and pulls the trigger, but the gun is broken and no injury occurs, this is still considered an actual attempt.
3. After an actual attempt, even if the person denies that they wanted to die or intended to die as a result of the behavior, the intent to die could be inferred from the circumstances. For example, if the person does a behavior that obviously could be very lethal (for example, jumping from a considerable height) and for which no reasonable alternative explanation is possible, the clinician can assume that there was suicidal intent even if the person denies that it was a suicide attempt.
4. Similarly, if persons who exhibited suicidal behavior say that they were not trying to kill themselves, but admit that they did think that they could die, we can conclude that there was suicidal intent and that this was an actual attempt.
Interrupted Attempt
If a person intends to start a suicidal behavior, but someone or something stops the person from STARTING the act, this should be called an interrupted attempt. What this means is that if someone or something had not stopped the person, an Actual Attempt would have occurred.
Clarification: If the person starts the suicidal act (for example, takes a single pill in an attempt to overdose) and is then stopped by someone, this should be called an actual attempt and not an interrupted attempt.
Here are some examples of what would constitute an interrupted attempt:
– A person opens a bottle of pills and is ready to take them in order to kill herself, but someone comes into the room.
– A person is standing at the edge of the roof with the intention to jump, but someone grabs him and prevents him from jumping.
The C-SSRS suggests the following question to ask about interrupted attempts:
Has there been a time when you started to do something to end your life but someone or something stopped you before you actually did anything?
Important! We must keep in mind that some persons who have an interrupted attempt are known to take precautions in a subsequent suicide attempt to not be interrupted and die by suicide in that subsequent event.
Aborted Attempt
If a person starts to engage in suicidal behavior, but stops themselves before starting to carry out any potentially lethal behavior, this should be called an aborted attempt.
Clarifications regarding aborted attempts:
– If a person has suicidal ideation with a specific plan and intent, but does not take any step to carry out the plan, this should not be called an aborted attempt unless the person actually took some step that started the suicidal act. For example, if the person opens a bottle of pills and takes some pills out into his or her hand, but immediately before taking the pills, changes his or her mind, this would be called an aborted attempt.
– The difference between an interrupted attempt and an aborted attempt is that in an interrupted attempt, it is another person or external circumstances that stop the person from continuing the suicide attempt.
The C-SSRS suggests the following question to ask about any aborted attempts:
Has there been a time when you started to do something to try to end your life but you stopped yourself before you actually did anything?
Preparatory Acts or Behavior
These are any acts that are directly in preparation for making a suicide attempt, for example, buying pills, writing a suicide note, or giving one’s belongings away.
The C-SSRS suggests the following question to ask about preparatory acts or behavior:
Have you taken any steps towards making a suicide attempt or preparing to kill yourself (such as collecting pills, getting a gun, giving valuables away or writing a suicide note)?
Related Pages
Suicidality: General articles
Five horrifying statistics about suicide we should all know
Suicide trends
How NOT to talk about suicide
Suicidality: Evaluation
The Three-Step Ladder: A better, easier way to start to ask about suicidal ideation
How to evaluate and categorize the type of suicidal ideation
Types of suicidal behaviors
Why and how to monitor and evaluate for suicide risk after bariatric surgery
Quick tips in suicide assessment: Interview with Jack Krasuski, MD
Suicidality: Resources
Practice guidelines for suicidality and self-harm
BEST books on suicide risk assessment and management
Suicidality: Medications that may increase the risk
In whom can antidepressants increase the risk of suicidality?
What can we do about suicidality associated with antidepressants?
Can isotretinoin (Accutane®, Roaccutane®) cause depression or suicidality?
What do published studies on isotretinoin and depression/ suicidality show?
Suicidality: Management
Tips on reducing the risk of death by suicide
Call 988, the “Suicide & Crisis Lifeline”
In suicidal patients, avoid 90-day prescriptions of these medications
Which psychiatric medications are particularly lethal in overdose?
Is ADHD associated with increased suicidality and does treatment reduce that risk?
Suicide: A New Conceptualization, A Neglected Question, and Specific Medications (Interview with David Sheehan, MD)
TED talk: The bridge between suicide and life
References
1. Columbia – Suicide Severity Rating Scale (CSSRS)
2. Oquendo MA, Halberstam B, Mann JJ. Risk factors of suicidal behavior: the utility and limitations of research instruments. In: First MB, editor. Standardized Evaluation in Clinical Practice. Washington, DC: American Psychiatric Publishing; 2003. pp. 103–130.
Copyright © 2016 to 2025, Simple and Practical Medical Education, LLC. All rights reserved. The content on this website may not be reproduced in any form without express written permission.
Disclaimer: The material on this website is provided as general education for medical professionals. It is not intended for patients or other laypersons, nor is it a substitute for medical advice, diagnosis, or treatment. Patients must always consult a qualified healthcare professional regarding their diagnosis and treatment. Healthcare professionals should always check this website for the most up-to-date information.
Leave a Reply