• Definition:
o Any act of self-poisoning or self-injury, regardless of intent.
o May be non-suicidal (emotional regulation, cry for help) or suicidal (intent to die).
• Assessment essentials:
o Determine intent: was it an attempt to end life or to relieve distress?
o Evaluate lethality: method used, planning, precautions against discovery.
o Access to means: ongoing availability of pills, sharp objects, firearms.
• Psychiatric comorbidity:
o High association with mood disorders, personality disorders (especially borderline), substance misuse.
• Key risk factors (SAD PERSONS mnemonic):
o Sex (male higher completion risk)
o Age (>45 men, >55 women)
o Depression or hopelessness
o Previous attempts
o Ethanol/substance abuse
o Rational thinking loss (psychosis)
o Social supports lacking
o Organised plan
o No spouse (single/divorced/widowed)
o Sickness (chronic illness)
• High-risk markers:
o Recent serious attempt or high-lethality method.
o Ongoing strong suicidal ideation, expressed plan.
o Active psychosis, severe depression, recent major losses.
• Immediate priorities:
o Medical stabilisation (if overdose, physical injury).
o Remove access to lethal means.
o Maintain safe environment.
• Psychiatric management:
o Risk assessment: structured, document thoroughly.
o Safety planning: identify warning signs, coping strategies, contacts for crisis.
o Crisis team or community support for moderate risk.
• Admission indications:
o Persistent high risk of suicide.
o Severe psychiatric illness needing intensive treatment.
o Lack of social support, unable to ensure safety at home.
Extra Revision Pearls
• Men are more likely to die by suicide, but women make more attempts.
• Previous suicide attempt is the strongest single predictor of future completed suicide.
• SSRIs may increase suicidal ideation in young adults early in treatment — close monitoring is crucial.
• In borderline personality disorder, self-harm is often non-suicidal but still requires careful assessment.
• Always evaluate protective factors: children, family ties, religious beliefs, therapeutic alliance.
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Author & Educational Disclaimer
Author:
Dr Phillip Cockrell BM FRCP DipClinEd
Dr Phillip Cockrell is a UK Consultant Physician in Internal Medicine, currently working at Queen Alexandra Hospital, Portsmouth University Hospitals NHS Trust. He has previously worked as a registrar across Intensive Care Medicine, Gastroenterology, Cardiology, Stroke Medicine, Acute Medicine, and Respiratory Medicine.
He has held senior leadership roles including Associate Clinical Director of the Acute Medical Unit, Clinical Director of Internal Medicine, and Chief of Medicine. Dr Cockrell has over 15 years’ experience in postgraduate medical education, having lectured extensively across the MRCP syllabus and contributed to MRCP revision teaching and course development.
Dr Cockrell holds a Bachelor of Medicine (BM), Fellowship of the Royal College of Physicians (FRCP), and a Diploma in Clinical Education (DipClinEd). His teaching approach is based on structured consolidation of complex medical topics to support efficient and effective revision for postgraduate examinations.
Purpose of this content:
The material on this page is intended solely for educational purposes to support revision for the MRCP (UK) Part 1 examination. It reflects examination-relevant principles of internal medicine and is designed to aid learning and pattern recognition.
Medical disclaimer:
This content is designed for postgraduate medical examination revision and does not constitute medical advice, diagnosis, or treatment guidance and must not be used as a substitute for professional clinical judgement, local guidelines, or specialist consultation. Clinical decisions should always be made in the context of individual patient circumstances and current national guidance.
