[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Forensic medicine](https://durgical.com/en/forensic-medicine/) › [Mechanical injuries](https://durgical.com/en/forensic-medicine/areas/injuries/) › Self-inflicted injuries: suicidal, self-harm and fabricated

# 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.

Updated Nov 13, 2026

## Key points

- Hesitation marks: shallow, parallel, grouped trial cuts beside the main wound, on accessible sites.
- Self-harm: repeated superficial cuts or burns of different ages on forearms or thighs, often with scars.
- Fabricated injury: superficial, uniform, avoids eyes, lips and nipples, within reach of the dominant hand, and the clothing is often undamaged.
- Self-inflicted cuts are usually made under the clothing or after moving it aside.
- Hesitation marks point to self-infliction but are not proof; they also occur in self-harm without suicidal intent.

On this page

- The basics Key points
- What it is
- How to tell it apart
- How to recognise it
- How it forms
- Step by step
- Next step: what to do and document
- Common mistakes
- Elsewhere in DurgiPedia

- Study Test yourself

- Connections Connections

## 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.

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## Elsewhere in DurgiPedia

- [Mandatory reporting: public health, violence and abuse](https://durgical.com/en/medical-ethics/mandatory-reporting-public-health-violence-and-abuse/)
- [The limits of confidentiality: duty to warn and legal disclosure](https://durgical.com/en/medical-ethics/the-limits-of-confidentiality-duty-to-warn-and-legal-disclosure/)

## Connections

## Related 5

- [Suicide or homicide? Reading the scene and the wounds](https://durgical.com/en/forensic-medicine/suicide-or-homicide-reading-the-scene-and-the-wounds/)
- [Defence wounds and hesitation marks](https://durgical.com/en/forensic-medicine/defence-wounds-and-hesitation-marks/)
- [Incised wounds](https://durgical.com/en/forensic-medicine/incised-wounds/)
- [Malingering in forensic settings](https://durgical.com/en/forensic-medicine/malingering-in-forensic-settings/)
- [Cause, mechanism and manner of death](https://durgical.com/en/forensic-medicine/cause-mechanism-and-manner-of-death/)

## Related conditions 3

- [Suicidal behaviour and suicide risk](https://durgical.com/en/conditions/suicidal-behaviour-and-suicide-risk/)
- [Factitious disorder and malingering](https://durgical.com/en/conditions/factitious-disorder-and-malingering/)
- [Major depressive disorder](https://durgical.com/en/conditions/major-depressive-disorder/)

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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](https://pmc.ncbi.nlm.nih.gov/articles/PMC12491108/) (Forensic Science, Medicine and Pathology (PMC), 2025); [Factitious Disorder Overview](https://www.ncbi.nlm.nih.gov/books/NBK518999/) (StatPearls Publishing (NCBI Bookshelf), 2025); [Suicide: Assessment and Management](https://www.ncbi.nlm.nih.gov/books/NBK617057/) (StatPearls Publishing (NCBI Bookshelf), 2026); [Fichas y Protocolos](https://www.ins.gov.co/buscador-eventos/Paginas/Fichas-y-Protocolos.aspx) (Instituto Nacional de Salud (INS), Colombia, 2026).

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Source: https://durgical.com/en/forensic-medicine/self-inflicted-injuries-suicidal-self-harm-and-fabricated/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/forensic-medicine/self-inflicted-injuries-suicidal-self-harm-and-fabricated/