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Part of the book series: Forensic Pathology Reviews ((FPR,volume 2))

Abstract

The term “complex suicide” refers to suicides in which more than one suicide method is applied. In this context, a distinction can be made between planned and unplanned complex suicides. In planned complex suicides, two or more methods are employed simultaneously in order to make sure that death will occur even if one method fails. In unplanned complex suicides, several other methods of suicide are tried after the first method chosen failed to gain one’s end or when it proved to be too painful. In planned complex suicides, typically two of the generally common methods of suicide (e.g., ingestion of hypnotics or other medicaments, hanging, use of firearms, drowning, jumping from a height) are combined. However, unusual combinations have been described also, such as the simultaneous firing of several guns, self-immolation, jumping from a height, or shooting oneself while driving a car. In unplanned complex suicides, injuries by sharp force, especially cutting the wrists, are often found as the primary act of suicide. In some cases, the suicidal changes from the infliction of cut wounds to the infliction of stab wounds (most often located in the heart region). Other frequently used methods after failure of the first method are hanging and jumping from a height. A further characteristic feature of unplanned complex suicides is the application of more than two methods of suicide. The literature has reported the use of up to five suicide methods applied one after the other. From the criminological point of view, the presence of several injuries of different origin strongly suggests infliction by another person. Differentiation is possible only if autopsy including toxicological analysis is performed and the traces at the death scene are thoroughly investigated, so that the sequel of events can be reconstructed.

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References

  1. Karger B. Penetrating gunshots to the head and lack of immediate incapacitation. II. Review of case reports. Int J Legal Med 1995;108:117–126.

    Article  PubMed  CAS  Google Scholar 

  2. Karger B. Penetrating gunshots to the head and lack of immediate incapacitation. I. Wound ballistics and mechanisms of incapacitation. Int J Legal Med 1995;108:53–61.

    Article  PubMed  CAS  Google Scholar 

  3. Karger B, Banaschak S, Brinkmann B. Erhaltene Handlungsfähigkeit bei Gehirnschußverletzung. Arch Kriminol 1997;199:159–166.

    PubMed  CAS  Google Scholar 

  4. Karger B, Brinkmann B. Multiple gunshot suicides: potential for physical activity and medicolegal aspects. Int J Legal Med 1997;110:188–192.

    Article  PubMed  CAS  Google Scholar 

  5. Missliwetz J. Phänomenologie von Selbsttötungen mit mehrfachen Schußverletzungen. Arch Kriminol 1983;171:143–150.

    PubMed  CAS  Google Scholar 

  6. Bohnert M, Ropohl D, Pollak S. Suizidale Stichbeibringung durch die Kleidung. Arch Kriminol 1997; 200:31–38.

    PubMed  CAS  Google Scholar 

  7. Karger B, Niemeyer J, Brinkmann B. Physical activity following fatal injury from sharp pointed weapons. Int J Legal Med 1999;112:188–191.

    Article  PubMed  CAS  Google Scholar 

  8. Lieske K, Püschel K, Bußmann E. Suizid durch 120 Bruststichverletzungen? Arch Kriminol 1987; 180:143–149.

    PubMed  CAS  Google Scholar 

  9. Thoresen SO, Rognum TO. Survival time and acting capability after fatal injury by sharp weapons. Forensic Sci Int 1986;31:181–187.

    Article  PubMed  CAS  Google Scholar 

  10. Wiese J, Maxeiner H. Zweifacher suizidaler Herzstich mit Koronarverletzung. In: Schütz H, Kaatsch H-J, Thomsen H, eds. Medizinrecht—Psychopathologie—Rechtsmedizin. Springer, Berlin, Heidelberg, 1991, pp. 631–639.

    Google Scholar 

  11. Zimmer G, Miltner E, Mattern R. Zur Handlungsfähigkeit nach Stich-und Schnittverletzung. Arch Kriminol 1994;194:95–104.

    PubMed  CAS  Google Scholar 

  12. Schwarz F. Der aussergewöhnliche Todesfall. Erste Feststellungen am Ort des Geschehens. Enke, Stuttgart, 1970.

    Google Scholar 

  13. Holzer FJ. Der kombinierte Selbstmord. In: Schäfer H, ed. Grundlagen der Kriminalistik. Steintor, Hamburg, 1971, pp. 321–352.

    Google Scholar 

  14. Pollak S. Statistik und Phänomenologie kombinierter Selbsttötungen und anderer suizidaler Mehrfachschädigungen im urbanen Bereich. Arch Kriminol 1978;161:20–30, 68-81.

    PubMed  CAS  Google Scholar 

  15. Hofmann V, Herber F. Über kombinierte und protrahierte Suizide. Kriminal forens Wiss 1984; 53/54:83–88.

    Google Scholar 

  16. Marcinkowski T, Pukacka-Sokolowska L, Wojciechowski T. Planned complex suicide. Forensic Sci 1974; 3:95–100.

    Article  PubMed  CAS  Google Scholar 

  17. Fatteh A, Gore SB, Mann GT, Garvin K. Suicide with two guns: a unique case. J Forensic Sci 1980; 25:883–885.

    PubMed  CAS  Google Scholar 

  18. Hudson P. Multishot firearm suicide. Am J Forensic Med Pathol 1981;2:239–242.

    PubMed  CAS  Google Scholar 

  19. Lutz FU, Lins G. Kombinierter Suizid—Zwei Falldarstellungen. Z Rechtsmed 1981;86:145–148.

    Article  PubMed  CAS  Google Scholar 

  20. Hudson P. Suicide with two guns fired simultaneously. J Forensic Sci 1982;27:6,7.

    PubMed  CAS  Google Scholar 

  21. Lunghi F. Un caso eccezionale di suicidio con due armi da fuoco. Quad Med Leg 1982;4:109–117.

    Google Scholar 

  22. Graham MA, Poklis A, Mackell MA, Gantner GE. A case of suicide involving the concomitant intravenous injection of barbital and oral ingestion of arsenic. J Forensic Sci 1983;28:251–254.

    PubMed  CAS  Google Scholar 

  23. Marchiori A. Eccezionale caso di suicidio mediante il contemporaneo uso di due pistole. Zacchia 1983; 56:409–414.

    Google Scholar 

  24. Danto BL, Taff ML, Mirchandani HG. Cases of self-destructive behavior involving multiple methods during a single episode. Am J Forensic Psych 1985;6:38–45.

    Google Scholar 

  25. Lucchini G. Su di un caso di suicido mediante due colpi d’arma da fuoco al capo, esplosi da armi diverse. Arch Med Leg Assoc 1985;7:22–28.

    Google Scholar 

  26. Lunetta Q, Chiarelli G. Suicidio per esplosione contemporanea di due colpi d’ arma da fuoco (con armi diverse) alle regioni temporali. Riv Ital Med Leg 1985;7:1268–1272.

    Google Scholar 

  27. Lignitz E, Strauch H. Kombinierter Suizid durch Verbrennen und Sturz aus der Höhe. Arch Kriminol 1986;178:51–53.

    PubMed  CAS  Google Scholar 

  28. Markwalder C, Bänziger F. Der protrahierte Suizid als kriminalistisches Problem. Arch Kriminol 1987;180:79–87.

    PubMed  CAS  Google Scholar 

  29. Wehr K, Schäfer A. Eine ungewöhnliche Kohlenmonoxid-Intoxikation. Arch Kriminol 1987; 180:155–160.

    PubMed  CAS  Google Scholar 

  30. Gerling I, Pribilla O. Ungewöhnlicher Tod im Wasser. Arch Kriminol 1989;183:163–167.

    PubMed  CAS  Google Scholar 

  31. Murphy GK. Suicide by gunshot while driving an automobile. Am J Forensic Med Pathol 1989;10: 285–288.

    PubMed  CAS  Google Scholar 

  32. Rogers DR. Simultaneous temporal and frontal suicidal gunshots. Am J Forensic Med Pathol 1989;10: 338,339.

    PubMed  CAS  Google Scholar 

  33. Gentilomo A, Bogoni A. Duplice colpo d’ arma da fuoco al capo. Arch Med Leg Assoc 1991;13: 1–6.

    Google Scholar 

  34. Schmidt P, Haarhoff K, Hoffmann E. Sekundär kombinierter Suizid unter den Augen der Ehefrau. Arch Kriminol 1991;188:65–71.

    PubMed  CAS  Google Scholar 

  35. Avis SP, Archibald JT. Asphyxial suicide by propane inhalation and plastic bag suffocation. J Forensic Sci 1994;39:253–256.

    PubMed  CAS  Google Scholar 

  36. Cina SJ, Raso DS, Conradi SE. Suicidal cyanide ingestion as detailed in Final Exit. J Forensic Sci 1994;39:1568–1570.

    PubMed  CAS  Google Scholar 

  37. Lichtenwalner M, Tully R. A fatality involving zolpidem. J Anal Toxicol 1997;21:567–569.

    PubMed  CAS  Google Scholar 

  38. Murphy GK. Suicide by gunshot while driving a motor vehicle. Two additional cases. Am J Forensic Med Pathol 1997;18:295–298.

    Article  PubMed  CAS  Google Scholar 

  39. Grimm U, Sigrist T. Verbrennen im Freien. Arch Kriminol 1998;201:137–145.

    PubMed  CAS  Google Scholar 

  40. Kernbach-Wighton G, Pohlmann K, Sprung R. Zur Phänomenologie bei Ether-Applikation. Arch Kriminol 1998;202:87–94.

    PubMed  CAS  Google Scholar 

  41. Lasczkowski G, Röhrich J, Bratzke H. Suizidexzeß—Darstellung eines ungewöhnlichen Falles. Arch Kriminol 1998;202:100–108.

    PubMed  CAS  Google Scholar 

  42. Musshoff F, Dettmeyer R, Madea B. Tod in der Badewanne—Rektale Medikamentenbeibringung. Arch Kriminol 1998;201:80–86.

    PubMed  CAS  Google Scholar 

  43. Nadjem H, Logemann E. Zur Kasuistik der suizidalen Chloroformintoxikation. Arch Kriminol 1998;202: 29–37.

    PubMed  CAS  Google Scholar 

  44. Pollak S. Zur Typologie der Suizide mit mehr als einer Schußverletzung. In: Strauch H, Pragst F, eds. Rechtsmedizin. Festschrift für Gunther Geserick anläßlich seines 60. Geburtstags. Verlag Dr. Dieter Helm, Heppenheim, 1998, pp. 102–120.

    Google Scholar 

  45. Taff ML, Boglioli LR, Danto BL. Planned complex suicide [comment]. Am J Forensic Med Pathol 1998; 19:194.

    Article  PubMed  CAS  Google Scholar 

  46. Blanco-Pampin JM, Suarez-Penaranda JM, Rico-Boquete R, Concheiro-Carro L. Planned complex suicide. An unusual suicide by hanging and gunshot. Am J Forensic Med Pathol 1999;18:104–106.

    Article  Google Scholar 

  47. Giroud C, Augsburger M, Horisberger B, Lucchini P, Rivier L, Mangin P. Exit association-mediated suicide: toxicological and forensic aspects. Am J Forensic Med Pathol 1999;20:40–44.

    Article  PubMed  CAS  Google Scholar 

  48. Nowers MP. Suicide by drowning in the bath. Med Sci Law 1999;39:349–353.

    PubMed  CAS  Google Scholar 

  49. Cingolani M, Tsakri D. Planned complex suicide. Report of three cases. Am J Forensic Med Pathol 2000; 21:255–260.

    Article  PubMed  CAS  Google Scholar 

  50. Faller-Marquardt M, Bohnert M, Logemann E, Pollak S. Kombinierte Suizide durch Einnahme von Essigsäure mit nachfolgendem Erhängen. Arch Kriminol 2000;206:140–149.

    PubMed  CAS  Google Scholar 

  51. Athanaselis S, Stefanidou M, Karakoukis N, Koutselinis A. Asphyxial death by ether inhalation and plastic-bag suffocation instructed by the press and the Internet. J Med Internet Res 2002;4:E18.

    Article  PubMed  Google Scholar 

  52. Bohnert M, Schmidt U, Große Perdekamp M, Pollak S. Diagnosis of a captive-bolt injury in a skull extremely destroyed by fire. Forensic Sci Int 2002;127:192–197.

    Article  PubMed  Google Scholar 

  53. Grellner W, Anders S, Tsokos M, Wilske J. Suizide mit EXIT Bags: Umstände und besondere Problemlagen bei Sterbebegleitung. Arch Kriminol 2002;209:65–75.

    PubMed  Google Scholar 

  54. Parroni E, Caringi C, Ciallella C. Suicide with two guns represents a special type of combined suicide. Am J Forensic Med Pathol 2002;23:329–333.

    Article  PubMed  Google Scholar 

  55. Schmidt P, Driever F, Lock M, Madea B. Zur Bewertung atypischer Stich-und Schnittverletzungen bei einem kombinierten Suizid. Arch Kriminol 2002;210:28–38.

    PubMed  Google Scholar 

  56. Bohnert M, Rothschild MA. Complex suicides by self-incineration. Forensic Sci Int 2003;131: 197–201.

    Article  PubMed  Google Scholar 

  57. Pollak S, Saukko PJ. Atlas of Forensic Medicine. CD-ROM, Elsevier, Amsterdam, 2003.

    Google Scholar 

  58. Türk EE, Anders S, Tsokos M. Planned complex suicide. Report of two autopsy cases of suicidal shot injury and subsequent self-immolation. Forensic Sci Int 2003;139:35–38.

    Article  Google Scholar 

  59. Dotzauer G, Goebels H, Legewie H. Selbstmord und Selbstmordversuch. MMW 1963;105:973–975.

    Google Scholar 

  60. Lindeman SM, Hirvonen JI, Hakko HH, Lonnqvist JK. Use of the National Register of medico-legal autopsies in epidemiological suicide research. Int J Legal Med 1995;107:306–309.

    Article  PubMed  CAS  Google Scholar 

  61. Rogde S, Hougen HP, Poulsen K. Suicides in two Scandinavian capitals—a comparative study. Forensic Sci Int 1996;80:211–219.

    Article  PubMed  CAS  Google Scholar 

  62. Osuna E, Perez-Carceles MD, Conejero J, Abenza JM, Luna A. Epidemiology of suicide in elderly people in Madrid, Spain (1990–1994). Forensic Sci Int 1997;87:73–80.

    Article  PubMed  CAS  Google Scholar 

  63. Grellner W, Kukuk M, Glenewinkel F. Zur Suizidmethode von Ärzten, medizinischem Personal und verwandten Berufsgruppen. Arch Kriminol 1998;201:65–72.

    PubMed  CAS  Google Scholar 

  64. Lee CJ, Collins KA, Burgess SE. Suicide under the age of eighteen: a 10-year retrospective study. Am J Forensic Med Pathol 1999;20:27–30.

    Article  PubMed  CAS  Google Scholar 

  65. Bennett AT, Collins KA. Suicide: a ten-year retrospective study. J Forensic Sci 2000;45: 1256–1258.

    PubMed  CAS  Google Scholar 

  66. Fieguth A, Grimm U, Kleemann WJ, Tröger H-D. Suizidmethoden im Sektionsgut des Instituts für Rechtsmedizin der Medizinischen Hochschule Hannover. Arch Kriminol 1997;199:13–20.

    PubMed  CAS  Google Scholar 

  67. Scheib K. Kriminologie des Suizids. Selbstverlag, Groß-Gerau, 2000.

    Google Scholar 

  68. Haddix TL, Harruff RC, Reay DT, Haglund WD. Asphyxial suicides using plastic bags. Am J Forensic Med Pathol 1996;17:308–311.

    Article  PubMed  CAS  Google Scholar 

  69. Bullock MJ, Diniz D. Suffocation using plastic bags: a retrospective study of suicides in Ontario, Canada. J Forensic Sci 2000;45:608–613.

    PubMed  CAS  Google Scholar 

  70. Humphry D. Final exit. The practicalities of self-deliverance and assisted suicides using plastic bags. Bantam Doubleday, New York 1991.

    Google Scholar 

  71. Marzuk PM, Tardiff K, Hirsch CS, et al. Increase in suicide by asphyxiation in New York City after the publication of Final Exit. N Engl J Med 1993;329:1508–1510.

    Article  PubMed  CAS  Google Scholar 

  72. Bosshard G, Ulrich E, Bär W. 748 cases of suicide assisted by a Swiss right-to-die organisation. Swiss Medical Weekly 2003;133:310–317.

    PubMed  Google Scholar 

  73. Druid H. Site of entrance wound and direction of bullet path in firearm fatalities as indicators of homicide versus suicide. Forensic Sci Int 1997;88:147–162.

    Article  PubMed  CAS  Google Scholar 

  74. Eisele JW, Reay DT, Cook A. Sites of suicidal gunshot wounds. J Forensic Sci 1981;26:480–485.

    PubMed  CAS  Google Scholar 

  75. Koops E, Flüs K, Lockemann U, Püschel K. Tödliche Schußverletzungen in Hamburg 1966–1991. Arch Kriminol 1994;193:14–22.

    PubMed  CAS  Google Scholar 

  76. Ropohl D, Koberne F. Tödlicher Schußwaffengebrauch in Friedenszeiten. Beitr Gerichtl Med 1990;48:339–348.

    PubMed  CAS  Google Scholar 

  77. Schmeling A, Strauch H, Rothschild MA. Female suicides in Berlin with the use of firearms. Forensic Sci Int 2001;124:178–181.

    Article  PubMed  CAS  Google Scholar 

  78. Müller E. Verkehrsunfall und Selbstmord. Arch Kriminol 1965;135:61–69.

    Google Scholar 

  79. Wirth E, Markert K, Strauch H. Ungewöhnliche Suicide mit Viehbetäubungsapparaten. Z Rechtsmed 1983;90:53–59.

    Article  PubMed  CAS  Google Scholar 

  80. Koops E, Püschel K, Kleiber M, Janssen W, Möller MR. Todesfälle durch sogenannte Bolzenschußgeräte. Beitr Gerichtl Med 1987;45:103–107.

    PubMed  CAS  Google Scholar 

  81. Pollak S, Maurer H. Zur klinischen Bedeutung der Imprimate bei Verletzungen durch Schlachtschußapparate. Acta Chir Austriaca 1987;19:29–37.

    Article  Google Scholar 

  82. Lignitz E, Koops E, Püschel K. Tod durch Bolzenschußgeräte—eine retrospektive Analyse von 34 Fällen aus Berlin und Hamburg. Arch Kriminol 1988;182:83–93.

    PubMed  CAS  Google Scholar 

  83. Nadjem H, Pollak S. Kombinierte Suizide unter Verwendung von Viehbetäubungsapparaten. Med Sachverst 1993;89:29–33.

    Google Scholar 

  84. Watanabe-Suzuki K, Suzuki O, Kosugi I, Seno H, Ishii A. A curious autopsy case of a car crash in which self-strangulation and lung collapse were found: a case report. Med Sci Law 2002;42: 261–264.

    PubMed  CAS  Google Scholar 

  85. Ohberg A, Penttilä A, Lonnqvist J. Driver suicides. Brit J Psychiat 1997;171:468–472.

    Article  PubMed  CAS  Google Scholar 

  86. Canale M. L’ impiego dell’ automobile come mezzo suicidario; considerazioni su un caso singolare di suicidio combinato. Zbl Rechtsmed 1971;2:348.

    Google Scholar 

  87. Betz P. Immunohistochemical parameters for the age estimation of human skin wounds. Am J Forensic Med Pathol 1995;16:203–209.

    Article  PubMed  CAS  Google Scholar 

  88. Petersohn E. Über die Aktions-und Handlungsfähigkeit bei schweren Schädeltraumen. Dtsch Z ges Gerichtl Med 1967;59:259–270.

    Article  CAS  Google Scholar 

  89. Staak M, König HG. Handlungsfähigkeit und Verletzungsmuster bei Opfern von tödlichen Schuß-und Stichverletzungen. Beitr Gerichtl Med 1976;35:273–280.

    Google Scholar 

  90. Missliwetz J. Ungewöhnliche Handlungsfähigkeit bei Herzdurchschuß durch Schrotgarbe. Arch Kriminol 1990;185:129–135.

    PubMed  CAS  Google Scholar 

  91. Große Perdekamp M, Riede UN, Pollak S. Penetrierende Herzstichverletzung mit ungewöhnlich langer Überlebenszeit. Arch Kriminol 2000;206:102–109.

    Google Scholar 

  92. Kampmann H, Bode G. Traumatischer Infarkt nach Stichverletzung des Herzens. Z Rechtsmed 1982;88: 159–164.

    Article  PubMed  CAS  Google Scholar 

  93. Vock R, Magerl H, Lange O, et al. Handlungsfähigkeit bei tödlichen oralen Intoxikationen mit Cyan-Verbindungen. Rechtsmedizin 1999;9:56–61.

    Article  Google Scholar 

  94. Lignitz E, Strauch H. Tod durch Plastbeutel—Beitrag zum akzidentellen und suizidalen Ersticken. Kriminal forens Wiss 1986;63:36–49.

    Google Scholar 

  95. Große Perdekamp M, Nadjem H, Weinmann W, Pollak S. Plastikbeutel als Mittel der Selbst-und Fremdtötung. Arch Kriminol 2001;207:33–41.

    Google Scholar 

  96. Schmidt V, Guggolz M, du Bois R. Ertrinken in der Badewanne nach Drosseln: Fremdtötung, Unfall oder Suizid? Arch Kriminol 1991;187:163–172.

    PubMed  CAS  Google Scholar 

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Bohnert, M. (2005). Complex Suicides. In: Tsokos, M. (eds) Forensic Pathology Reviews. Forensic Pathology Reviews, vol 2. Humana Press. https://doi.org/10.1385/1-59259-872-2:127

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