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Suicide attempts and completions by individuals while naked remain unexplored, both by clinicians and in the professional literature.

Nakedness at the time of the incident conveys important information about an individual's mental state. Motivations for attempting or completing suicide while naked are discussed. Nakedness during a suicide attempt is presumptive evidence of high risk for suicide completion. Deliberate self-harm, without intent to die, is not usually inflicted while naked. The clinical and forensic implications of naked suicide are explored. In completed suicides, the state of dress, including partial undress and nakedness may provide important clues in a psychological autopsy.

Forensic psychiatrists and treating clinicians who encounter naked suicides are afforded a unique opportunity to advance our knowledge. Letters to the editor and case reports would stimulate discourse about this little understood phenomenon. Naked came I out of my mother's womb, and naked I shall return.

Autoerotic asphyxia or naked suicide?

Marilyn Monroe was found lying nude, face down, with a sheet pulled over her dead body. The controversy about the cause of her death continues to this day. The naked body of Robert Maxwell, billionaire British tycoon, was found floating some distance from his yacht in the waters off Grand Canary Island. Maxwell was facing a scandal on his return to England involving the disappearance of corporate assets and pension fund monies.

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Although his death was ruled an accidental drowning, there was much doubt about the cause of his death. Theories of his demise included murder, suicide, heart attack, and accident. Cleopatra completed suicide shortly after Mark Antony fell on his sword. The legend is that she committed suicide by allowing herself to be bitten by a poisonous snake, an asp.

The psychiatric and forensic literature is mostly silent on the topic of naked suicide. A PubMed search found no information on naked suicide. The author interviewed forensic psychiatrists, general psychiatrists, coroners, and forensic pathologists. A review of textbooks on suicide and forensic pathology was conducted.

Little or no information was found from any source about naked suicide. The author's review of suicide cases in litigation revealed that an estimated five to eight percent had completed suicide while naked.

The percentage of all suicides that are completed while naked is unknown. Given the dearth of information available about naked suicide, this article is offered as an initial exploration of this topic. It is hoped that letters to the editor and case reports in response will stimulate discourse about this little understood phenomenon.

Autoerotic asphyxia is the use of strangulation to enhance the pleasure of masturbation.

The bodies are often found naked or in various states of undress. Props such as sexual aids, pornographic magazines, or women's clothing are present. Transvestism occurs in a minority of cases.

Strangulation death occurs when a rigged self-safety release mechanism fails. The purpose of autoerotic asphyxia is to achieve a more powerful orgasm, but not to die. Autoerotic asphyxia is also practiced by women, although less commonly than men.

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A study of fatal and near-fatal autoerotic asphyxia revealed that homicide, suicide, and accidental death were erroneously suspected initially. Most of the bodies were found completely naked. The authors underscored the subtle features of this practice in women and the underdiagnosis and confusion with nonaccidental death. Nonetheless, autoerotic asphyxia may be the route that a person takes who intends to commit suicide. A naked strangulation with all the indicia of autoerotic asphyxia may still be a suicide, not an accident.

Conventional wisdom has it that a woman found hanging naked is most likely a homicide or a staged suicide. Nonetheless, women do hang themselves or induce asphyxia by other means while naked. Wedin et al.

The cases usually occurred on open land during the winter months. Arteriosclerosis and chronic alcoholism were associated illnesses. The authors hypothesized that the paradoxical undressing could be explained by peripheral vasoconstriction in severely hypothermic individuals. Just before losing consciousness and death, these individuals feel overheated and discard their clothing.

There is no suicidal intent. Clothes may be partially or completely removed to facilitate the method of suicide. For example, the individual may remove or reposition clothing to expose the wound site. Individuals who engage in autoerotic asphyxia may partially disrobe, sometimes causing confusion about the type of death suicide or accidentalespecially in the absence of erotic paraphernalia.

The disposition of clothing found at the site of a naked suicide attempt or completion can yield valuable clues to the individual's mental state. Clothes that are neatly arranged point to a planned suicide. Clothes strewn about raise the question of impulsivity or mental disorganization secondary to a severe psychiatric condition, substance abuse, or sexual homicide. Nakedness in suicide attempts or completions in a tub or shower may seem incidental, since people take their clothes off to enter a tub or shower.

Nonetheless, knowing that one's body will be found naked and taking the trouble to remove clothing has psychological import. The state of an individual's clothing, including partial undress and nakedness, can provide important clues in a psychological autopsy.

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Naked suicide can be associated with any method of suicide; however, anecdotal evidence indicates that it occurs more frequently with hanging, overdose, or drowning, but to a lesser extent in jumping deaths. With the exception of jumping, most naked suicides occur indoors.

Naked suicide appears to be less common in suicides by gas asphyxiation. Still, the act may be associated with asphyxiation, especially if it is sexualized.

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For example, a couple may decide to complete suicide by carbon monoxide and engage in sexual activity before death ensues. However, a naked couple engaged in sex may die accidentally from a gas leakā€”for example, in a car with closed windows. Naked drowning, as occurred with Robert Maxwell, occurs infrequently, except when drowning takes place in a bathtub. Suicidal drowning in a bathtub or pool tends to be achieved when individuals are partially or totally naked. Encumbering clothes are doffed before immersion. A recent spate of individuals who jumped to their deaths when naked has been reported in the media.

Auditory hallucinations may command the individual to attempt suicide by jumping while naked. Most firearm suicides occur by gunshots to the head. In such cases, disrobing is unusual. Individuals may also disrobe to avoid leaving bloody clothes. Tidy suicides take place mostly in a bathroom, usually in a tub or shower. Impulsivity may be a factor in naked suicides. Most individuals spend at least some part of each day naked. An impulse to commit suicide may strike while the individual is naked. In their study of suicides, Simon et al.

Little is known about the reasons why individuals attempt or complete suicide while naked.

Suicide notes rarely indicate a reason for a naked suicide. Knowledge gained from the treatment of patients, however, can shed light on the motivation for naked suicide. As mentioned earlier, individuals who have made suicide attempts while naked are the best source of information. Table 1 lists some psychological themes that may be associated with naked suicide.

Approximately 95 percent of completed suicides are associated with mental illness.

As noted above, individuals who jump to their deaths naked may be psychotic. The psychodynamics of a naked suicide often remain opaque. Naked suicide suggests a variety of psychological themes. The shedding of clothes may symbolize a new beginning, a rebirth and cleansing, or a sloughing off of the world.

In the biblical description of Christ's resurrection, his clothes, a symbol of an unregenerate world, were left behind as he ascended into heaven. Anger and vengeance can be expressed by completing suicide while naked, especially when it is intended to traumatize a survivor.

The shock of discovering a naked suicide inflicts an indelible, traumatic memory that can haunt a survivor for a lifetime. In severely depressed individuals, a naked suicide may be an expression of vulnerability, utter despair, desolation, and worthlessness. Psychotic patients may be responding to delusions or auditory hallucinations commanding them to commit suicide while naked as a self-abasement.

In an illustrative case example, a suicidal psychiatric inpatient with a psychotic depression case disguised believed that he was the cause of the world's calamities. Marilyn Monroe, an American sex idol, was admired by many for a physical beauty that defined her life. Her naked death led to speculation of foul play with erotic overtones. Was it a naked suicide? Was her nakedness caused by disorientation from a drug overdose? To complicate matters, Monroe slept naked.

Naked suicide may represent an eroticized submission to life's exigencies. Rixens' portrait of a naked Cleopatra depicts her suicide as a surrender to fate. The sexual symbolism of completing suicide by being bitten by an asp while lying naked in bed is obvious. It is as if Cleopatra's beauty and sexual charisma were incorporated into her suicide, an example of death imitating life.

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