Suicide by unusual methods: a rare case of complex suicide

Genital Self-Mutilation (GSM) is usually associated with mental illness. It is considered as the most brutal form of self-harm. Many cases of such self-harm have been described by various authors in different times. However, its existence in absence of any mental illness and using it as a method of suicide is a matter of question. Although, some cases are reported; its incidence is very low. Its association with complex suicide is even much lower. Usually, in complex suicide, the victim chooses some methods which are less painful. Such a complicated case of complex suicide was brought to the tertiary care center of Dibrugarh, Assam for post mortem examination. The deceased, a 36 years old male was brought with history of cutting his external genitalia followed by hanging. The case has been described in this paper with relevant review literature.

Suicidal Ideation and Behavior Rethinking: The Mindsponge Approach

Within the literature related to suicidal ideation, several theories have been proposed. However, given the complexity and dynamics in the formation of suicidal ideation and behavior, I propose a new approach - Mindsponge mechanism - that considers suicidal ideation and behaviors as a result of an individual’s information processing. The approach is expected to make sense of previous literature’s inconsistencies and help comprehend complex suicide-related phenomena, such as suicide contagion, etc.

Complex and complicated suicides in Friuli (1993–2017)

Complex suicides involve more than one suicide method. According to the intention of the victim, they are classified as ‘planned’ when the use of more than one suicide technique has been previously devised by the victim and ‘unplanned’ when the first method turns out to be too painful or insufficient to cause death, and the individual then resorts to other means of suicide. Complicated suicide, on the other hand, is a term that was introduced by Töro and Pollak, in which a failed act of suicide is followed by traumatisation, which has a fatal outcome. This type of death must be distinguished from complex suicides. From a sample of 1160 fatalities (837 males) between 1993 and 2017, we identified 20 (1.72%) cases of complex suicide and three (0.26%) cases of complicated suicide. We considered age, sex, psychiatric history, previous suicide attempts, suicide methods and eventual secondary traumatisation. We also compared planned and unplanned complex suicides. The results show a higher number of planned complex suicides (16 vs. 4), a prevalence of males ( n = 17) and adults (median age = 48 years, range 21–74 range). Plastic bag suffocation and gas inhalation ( n = 8) were the most commonly used methods. Firearms ( n = 4) were used exclusively by males in planned complex suicides. Wrist and forearm cuts ( n = 5) were found in four unplanned and one planned complex suicides, and all of the cases with known previous suicidal attempts ( n = 3) involved planned complex suicides. Complicated suicides concerned three male victims in two failed attempts of hanging and an unforeseen carbon monoxide intoxication following a non-fatal gunshot to the mouth, confirming the rarity of these fatalities.