Self-Harm and Suicide

Self-harm is the deliberate action of causing physical harm to oneself and is a very dangerous sign of emotional distress. According to the Statistical and Diagnostic Manual of Mental Disorders, Fifth Edition (DSM-5), self-harm is formally known as nonsuicidal self-injury disorder (NSSID) as these self-destructive behaviors are carried out without any intention of suicide. Adolescents are at the highest risk for self-harm injury as many studies state that roughly 15% of teenagers and 17-35% of college students have inflicted self-harmful behaviors on themselves. Males and females have comparable rates of self-harm behavior. Cutting, skin carving, extreme scratching, or burning oneself as well as punching or hitting walls to induce pain are examples of self-injurious behavior. Other examples include ingesting toxic chemicals, extreme skin picking, hair pulling and deliberate interference with wound healing. The individual gains a superficial sense of emotional and mental relief after the harmful act is completed followed by feelings of shame or guilt resulting in even more negative emotions until this cycle continues.

Why do individuals engage in NSSID?

Studies have shown that there are four main reasons why individuals engage in self-harm behavior:

  • To reduce negative emotions
  • To feel “something” besides numbness or emptiness
  • To avoid certain social situations
  • To receive social support

Self-harm is often misconstrued as being directly linked with suicide but this is not the case as the two are drastically different. Since suicide and self-harm are inflictions of pain, they often get grouped together under the same subject. Although it sometimes is true that individuals who engage in self-harm may later commit suicide, generally individuals who engage in self-harm do not wish to end their life but rather engage in self-harm as a way to cope with their life. Individuals who attempt suicide do so with the intent to end their life due to their suffering.

The difference between self-harm and suicide is intent

The most significant difference between suicide and self-harm is the intent. Individuals who are suicidal are experiencing severe life stressors and/or mental health disorders that are causing unbearable pain and suicide is their way to end this pain. Suicide attempts usually come from a place of despair, hopelessness, and worthlessness. On the contrary, individuals who engage in self-harm do so as a way to cope with their feelings and stressors. For some, the pain from self-injury reassures them that they are still in fact, alive especially when they are experiencing emotional numbness or a disconnect from the world. The physical act of cutting or burning induces pain receptors in the body that triggers the brain to feel an adrenaline “rush” which can easily become addictive and highly dangerous.

Similar risk factors

Despite the different intentions associated with self-injury and suicidal thoughts and behaviors, it is important to note that they share common risk factors, which include the following:

  • History of trauma, abuse, or chronic stress
  • High emotional perception and sensitivity
  • Few effective mechanisms for dealing with emotional stress
  • Feelings of isolation (this can be true even for people who seem to have many friends/connections)
  • History of alcohol or substance abuse
  • Presence of depression or anxiety
  • Feelings of worthlessness
  • Because of these and other risk factors, the presence of non-suicidal self-injury is, in and of itself, a risk factor for suicidal thoughts and behaviors.

Non-suicidal self-injury is typically used as a coping strategy for preserving and enhancing life, not ending one’s life. However, since self-injury and suicide both indicate underlying distress it is important to assess whether self-injurious individuals are also suicidal and provide the necessary treatment for individuals in both of these categories.