A systematic study of 50 adolescent self-poisoners aged from 13 to 18 demonstrated considerable discrepancies between the reasons chosen by the subjects to explain the overdoses and those chosen by clinical assessors. Most adolescents indicated that they had been feeling lonely or unwanted, or angry with someone, and had taken the overdose to alleviate or demonstrate this distress. A third said they had wanted to die. In contrast, clinical assessors tended to attribute the overdose to punitive or manipulative reasons and suggested that only seven out of the 50 had wished to die. The adolescents rarely indicated that they had taken the overdose to get help; this may explain the resistance that may be shown to psychiatric intervention, that casts doubt on the possible effectiveness of preventive agencies. Modification of attitudes to both self-poisoning and early help-seeking may be a more effective means of prevention.

In a consecutive sample of 50 adolescents aged 13-18 admitted to hospital after taking overdoses, 90 per cent were girls. There were other clear differences between this sample and adolescents in general. Twenty-four per cent had visited their general practitioners in the previous week, and 50 per cent during the previous month. The most common difficulties preceding the overdoses were problems with parents, boys or girlfriends, and with school or work, including unemployment. A substantial proportion of the subjects had recent recurrent physical ill health. In the majority of cases the problems appeared to be transient so that one month later two-thirds of the adolescents had shown considerable general improvement. However, 14 per cent were referred to hospital for further self-poisoning or self-injury in the following year. The recent increase in the incidence of self-poisoning among adolescents suggests that more attention must be paid to this group in terms of both primary and secondary prevention.

A simple method of classifying adolescent self-poisoners into three sub-groups on the basis of the duration of their problems and the presence or absence of behavioural disturbance is described. The three groups differed markedly in terms of factors concerning their families, especially their relationships with their parents, and in their medical and psychiatric histories, the nature of their overdoses and the problems they were facing at the time. The treatment offered to members of the three groups also differed. The method of classification may offer a useful means of distinguishing between subjects in terms of outcome, including subsequent adjustment and repeat attempts.