Parasuicidal behavior

Remember that it is important to assess for suicidality when working with any client with a history of suicidal and parasuicidal behavior. Not only ideations should be assessed, but also plans, lethality of plans, means to carry out those plans, and proximity of means. You would surprised at how often such clients carry lethal doses of pills, razor blades, or even guns in their purses, pockets, or backpacks during such an assessment interview with intentions to use these items. (Please see the extended discussion about suicide assessment in Chapter 3.)... 

Parasuicidal. Behavior that involves self-harm without necessarily the intent to die. 

If a person is having suicidal thoughts presently, then you should assess for any plans that he or she may have for carrying out a suicidal act. One way to be attuned to clients preferred plans is to ask them about means used in past suicide attempts or parasuicidal behavior. For example, if a person tells you that he attempted suicide by swallowing a handful of pills in the past, then you can ask if that idea has reoccurred to him recendy or if a client tells you she has burned herself in the past with a cigarette, you can ask if she has been thinking about doing that recendy. You also want to look for how specific the plan is to determine its... 

This discussion brings us to the function of suicidal behavior. For some people, the function of suicidal behavior is to die, but not for everyone. Clearly the most lethal attempts represent a clear intent to die, especially if done in secrecy. However, many other times self-harm behavior is found to have a function besides death after a comprehensive behavioral analysis is completed with a client. For example, some clients have told me that cutting and burning themselves was related to boredom, anger, sadness, shame, uncertainty how to solve a problem, or even revenge toward someone who had hurt them. Parasuicidal... 

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