Suicide attempt: one diagnosis, multiple disorders

Patients who intentionally injure themselves are a varied group, ranging from those who are unthinkingly agitated to those who are calculatingly manipulative to those who are truly suicidal; these patients require very different forms of management. If a manipulator is able to exploit the hospital in trying to solve life's problems, he is likely to repeat such behavior when inevitable problems occur in the future. The truly suicidal patient, however, must be recognized and safeguarded while his underlying problems are treated. Suicidal behavior is the outcome of the dynamic interaction of the patient's personality, affective state, and social circumstances. The question commonly asked initially, "Will he try to hurt himself again?" addresses the wrong issue, as outcome is of little diagnostic relevance.