The difficulty of differentiating between suicidal and non-suicidal overdoses

Drug overdoses are a relatively common way to attempt suicide. There are also many overdose cases where the intent is to cause self-harm but not death. Usually, when people commit intentional self-harm the act is considered to be either suicidal or non-suicidal self-injurious behavior (SIB). However, due to an unresolved debate about definitions, non-fatal overdoses are traditionally not classified as being self-injurious at all.

Researchers Kathryn Fox, Alexander Millner and Joseph Franklin recognized this deficiency as a barrier to developing effective treatment methods, and designed an empirical study to help develop a better system for classifying overdoses.

Participants in this investigation, published online in the academic journal Psychology Research, were recruited from online forums related to self-injury and associated psychopathologies. In total 183 young people were included in the analysis. All subjects met the condition that they had experienced 5 SIB incidents, one suicide attempt or one overdose without suicidal intentions within the past year. Surveys were completed to measure the frequency of SIBs, including overdoses, along with intentions (desire to die and belief that they would die) during these events.

Several applicable results were observed following a host of statistical comparisons. Non-suicidal overdoses were found to be more similar to suicide attempts than other SIB incidents in the average age of onset, as both tend to occur when older. In contrast, they were more closely related to non-suicidal SIBs when comparing averaged ratings of the desire for death. Beliefs in the likelihood of death were highest in suicide attempts, followed by non-suicidal overdoses and were lowest in other SIBs. Additionally, it was discovered that many SIBs without overtly deadly purposes (including non-suicidal overdoses) still carry a measurable amount of suicidal intent.

The failure to develop consistent definitions of SIBs (like overdoses) is a problem that undoubtedly restricts the effectiveness of related studies and the methods derived from them. This investigation, while being limited by a mostly-female and small sample size, provides evidence that non-suicidal overdoses require some form of recognized classification alongside suicide attempts and other SIBs.

A particularly stubborn issue with past definitions was the fact that intent is very hard to decipher in overdoses that resemble suicide attempts, but this new research shows that most other forms of SIB are also based on an observable amount of suicidal ambivalence. With this barrier overcome it may now be possible to develop useful and consistent definitions of overdoses and other SIBs.