Self-inflicted injuries: suicidal, self-harm and fabricated
- Finding
Some injuries are made by the person on themselves, to die, to relieve distress, or to support a false account; the pattern helps recognise them.
What it is
Self-inflicted injuries have three main settings. In suicide attempts, cuts are usually on the front of the wrists, the neck or the inside of the elbow, often with hesitation marks: shallow, parallel trial cuts beside the main wound. In self-harm without intent to die, repeated superficial cuts or burns on accessible areas (forearms, thighs) appear in different stages of healing. In fabricated injury, a person injures themselves to support a false complaint of assault or for gain: the injuries are superficial, avoid sensitive areas, are within reach of the dominant hand and do not match the story. All self-inflicted injury needs a respectful, non-judgemental approach; it is a sign of distress or of a mental disorder, and the doctor's first duty is safety and care.
How to tell it apart
- Defence wounds suggest assault, hesitation marks suggest self-infliction; neither settles the manner alone (see defence wounds).
- Hesitation-like cuts have been reported in homicides staged to look like suicide.
- Fabricated injury and factitious disorder are different: in factitious disorder the person seeks the role of patient without obvious external gain.
- Do not label an injury «self-inflicted» in the record without the evidence: describe and record the account.
How to recognise it
- Suicidal cuts: wrist flexor surface, neck, elbow crease; several shallow cuts and one or more deeper ones.
- Self-harm: linear parallel cuts, cigarette or other burns, picked wounds; old scars in rows.
- Fabricated injury: shallow scratches or cuts of the same depth, often parallel, on the face, front of the chest or the non-dominant arm.
- Associated: other signs of previous attempts, notes, medicines nearby.
How it forms
- Hesitation marks reflect trial attempts before a decisive cut.
- Self-harm relieves emotional pain or tension; it is repetitive.
- Fabrication seeks a gain or supports a story, so the person avoids pain and danger.
- The dominant hand usually makes the cuts on the opposite side, running from far to near.
Step by step
- Examine the whole body, including scars of earlier injuries.
- Describe each wound: site, number, length, depth, direction, parallel grouping and stage of healing.
- Compare the injuries with the clothing: cut or intact over the wounds.
- Note the dominant hand and whether the sites are within its reach.
Next step: what to do and document
- Assess suicide risk in every person with self-inflicted injury before discharge, and arrange mental-health care.
- Describe the wounds without labelling them; record the account in the person's words.
- Examine and keep the clothing if an assault is reported; note if it is undamaged over the wounds.
- If the person alleges assault, the case goes to the justice system; the doctor documents and does not decide.
- Notify a suicide attempt: in Colombia it is a public-health surveillance event of the Instituto Nacional de Salud; in a minor, also follow the child-protection route.
Common mistakes
- Discharging a person with hesitation marks without assessing suicide risk.
- Writing «self-inflicted» or «false» in the record instead of describing.
- Ignoring old scars that show a pattern of self-harm.
- Taking hesitation marks as proof of suicide at a death scene.
Test yourself
Think of the answer, then tap the question to see it.
What are hesitation marks?
Shallow, parallel, grouped trial cuts beside a deeper wound on accessible sites such as wrists or neck; they suggest self-infliction.
Which features suggest a fabricated injury?
Superficial, uniform injuries on accessible areas, avoiding sensitive parts, within reach of the dominant hand, with undamaged clothing, not matching the story.
Do hesitation marks prove suicide?
No. They also occur in self-harm without suicidal intent and have been seen in staged homicides; the whole investigation decides.
Elsewhere in DurgiPedia
- Mandatory reporting: public health, violence and abuse
- The limits of confidentiality: duty to warn and legal disclosure
Connections
Educational content on forensic and legal medicine; not legal advice and no substitute for the technical guides of Colombia's National Institute of Legal Medicine and Forensic Sciences. Laws change: each page links the official text and says when it was last checked. For a real case, follow the guide in force and ask the competent authority.
Sources: A singular case of complex suicide by hanging with hesitation marks by axe (Forensic Science, Medicine and Pathology (PMC), 2025); Factitious Disorder Overview (StatPearls Publishing (NCBI Bookshelf), 2025); Suicide: Assessment and Management (StatPearls Publishing (NCBI Bookshelf), 2026); Fichas y Protocolos (Instituto Nacional de Salud (INS), Colombia, 2026).
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Representative model, for educational purposes only.