When suicide mimics homicide: a forensic analysis of three cases involving multiple sharp-force injuries

Suicide by multiple sharp-force injuries represents an uncommon and diagnostically complex occurrence in forensic pathology. The presence of numerous stab or incised wounds can mimic homicidal patterns, especially when typical self-inflicted indicators are absent or unclear. Differentiating between suicide and homicide in such cases requires a multidisciplinary assessment involving autopsy findings, scene investigation, and psychological history. We report three rare cases of suicide involving multiple sharp-force injuries. Case 1: A 44-year-old man with a history of depression and alcohol abuse was found in an advanced state of decomposition at home. Twelve stab wounds were located on the precordial and epigastric regions, with hesitation marks on the forearm and no evidence of third-party involvement. Case 2: A 32-year-old woman with bulimia nervosa was discovered supine in her kitchen, with a blood-stained kitchen knife nearby. Twelve parallel stab wounds were observed in the precordial region and left breast, with pulmonary artery transection and massive haemothorax. No hesitation or defensive wounds were noted. Case 3: A 39-year-old man, recently affected by bereavement-related depression, was found in his garage gripping a kitchen knife. He sustained 25 sharp-force injuries across the neck and abdomen, including jugular vein transection and tracheal perforation. Hesitation wounds were present on the palmar aspects of the fingers. Despite the high number of wounds, several factors (anatomical accessibility, presence of hesitation marks, lack of defence injuries, and psychiatric histories) supported a suicidal manner of death. These cases emphasise the critical need for integrated forensic evaluations in distinguishing suicides from potential homicides.