A person attempting or contemplating suicide with a sharp knife or implement may make repetitive marks on an area of accessible skin.


Theories for hesitation marks:

(1) The person's resolve fails ("hesitates") while making a cut.

(2) The person is trying to decide how much a cut will hurt.

(3) The person is acting out and is not serious about committing suicide.


General features:

(1) The person has a history of depression or previous suicide attempts.

(2) There are multiple parallel cuts, often relatively shallow. On the wrist these are typically horizontal.

(3) The type of wound depends on the implement and the manner of cutting. If a blade was drawn back and forth across the skin then the edges may show several sharp angles. An irregular piece of glass or metal may cause an irregular wound.

(4) The most common sites are the wrist, forearm and neck, but cuts may occur in other sites, especially if the person is psychotic or intoxicated.

(5) A person may or may not cut deep enough to hit a major artery, after which the person may or may not bleed to death.

(6) Although a person can bleed significantly from hesitation marks, these may not be the cause of death.


Both wrists may be scarred, or only the wrist of the nondominant hand.


The wounds may be of different ages, depending on the number of attempts.


Differential diagnosis:

(1) A murderer trying to mask a homicide.

(2) Torture or taunting of a victim.

(3) Multiple slashes made by a deranged killer.

(4) Struggling by the victim.


If there is little evidence of bleeding from deeper incisions, then the wounds may have been made after death.


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