Not only is suicidal behavior strongly predicted by its past occurrence, but the risk for recurrence appears to increase with each subsequent attempt. The current paper discusses a potential explanation for this phenomenon, that suicide attempts may leave a residual psychological scar that heightens risk for future attempts. This possibility is evaluated against two alternatives: (i) risk for first and subsequent suicide attempts is accounted for by a shared diathesis pre-existing the first lifetime attempt, and (ii) different rates of developmental decline in risk factors account for differences in prospective number of attempts. In this discussion, a formalized conceptual framework of psychological scarring is presented, along with considerations of particular relevance to its study. Finally, the clinical implications of determining the processes underlying the association between suicide attempts and heightened risk for recurrence are discussed.

自杀行为不仅可以根据过去的发生强烈预测，而且随着随后的每次尝试，复发的风险似乎也会增加。目前的论文讨论了这种现象的一个可能的解释，即自杀企图可能会留下残余的心理创伤，从而增加未来尝试的风险。这种可能性是根据两种选择进行评估的：（i）第一次和随后的自杀企图的风险是由第一次自杀尝试之前存在的共同素质来解释的，以及（ii）风险因素中不同的发育下降率导致了预期的差异尝试次数。在这次讨论中，提出了心理创伤的正式概念框架，以及与其研究特别相关的考虑因素。最后，讨论了确定自杀企图与复发风险增加之间关联的潜在过程的临床意义。