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Parasomnia Pseudo-Suicide

NCJ Number
203134
Journal
Journal of Forensic Sciences Volume: 48 Issue: 5 Dated: September 2003 Pages: 1158-1162
Author(s)
Mark W. Mahowald M.D.; Carlos H. Schenck M.D.; Mari Goldner M.D.; Vance Bachelder M.D.; Michel Cramer-Bornemann M.D.
Date Published
September 2003
Length
5 pages
Annotation
This review of case examples and the pertinent literature shows that some apparent "suicides" are the consequence of sleep-related complex behaviors, which are without conscious awareness, premeditation, or personal responsibility.
Abstract
Violence and injurious behaviors that occur during sleep have been well-documented and may be due to one of a number of conditions; these include disorders of arousal (sleepwalking/sleep terrors), REM sleep behavior disorder (RBD), nocturnal seizures, psychogenic dissociative states, and malingering. Those cases that come to legal or medical attention typically involve injuries or death to others or to the victim of the disorder. When the victim of the disorder dies from sleep behaviors, the death may be misclassified as intentional suicide. Three case studies labeled in this paper as "possible parasomnia-related suicides" involved a college student killed by a semi-trailer truck at 4:30 am while he was clad only in boxer shorts; a policeman who shot himself absent any indications of suicidal tendency but with a history of complex sleepwalking that dated back to early childhood; and an elderly man who shot himself while lying in bed. Two cases classified in this report as "near-miss for suicide" involved a young man who ran from his bed after falling asleep, crashing into a desk and then through a patio-level window, sustaining severe lacerations that required surgery; and a male university student who was found comatose in critical condition at 4:30 am on the ground below his open third-story dormitory window. In the latter case, the man was amnestic for the time between entering the dormitory at 2 am and awakening in the hospital the next day. A careful analysis of questionable cases of death, particularly during sleep periods and with people having a history of sleep disorders, may provide strong evidence of accidental death. A correct determination of cause of death is particularly important because of the social, religious, and insurance implications for surviving friends and family members. 1 figure and 33 references