Suicide is the leading cause of death for individuals between the ages of 15 and 29. Every year, more than 800,000 people die from suicidal behavior, (Mesi, et.al., 2021). The majority of self-harming behavior is done without the intent to die, but the overlap between NSSI and suicide attempts is noteworthy. Let’s review the definitions and key characteristics of these behaviors and compare them. 

Self-Harm 

Self-harm, or non-suicidal self-injury, is the act of harming your body intentionally without the purpose of dying. Two of the most common self-injurious behaviors are cutting and burning. Self-harm is impulsively done when under intense emotional duress. These behaviors are most common among adolescents.

Many of those that self-injure will tell you it is not suicidal behavior. While that is normally true, it is considered a risk factor for future suicidal behavior. Impulsivity and the habitual act of self-harming significantly correlate to suicide. In addition to that, self-harm is often linked to emotional issues and mental health issues that increase the risk of suicide. 

Causes

There is no single cause of self-harming behavior. Some risk factors include traumatic life experiences, family problems, mental health issues, substance use, and friends who self-injure, (Mayo Clinic, n.d.). The most common causes cited for self-injury include the following. 

• Lack of Coping Skills
• Poor Emotional Management
• Reduced Support / Communication
• Negative Self-Image
• Loss of Sense / Dissociation

Effects

When a friend or family member self-harms, it affects their loved ones and personal mental health. It can put a strain on interpersonal relationships and alienate, or confuse loved ones. The following are the personal effects of self-injurious behavior. 

• Increased Feelings of Shame and Guilt
• Diminished Self-Esteem
• Physical Infection
• Permanent / Temporary Scaring
• Accidental Death

Suicide Ideation 

Personally, I look at suicide ideation as a spectrum. Definitively, the term is used to describe the most fleeting thought of wanting to die to actively planning a suicide attempt. Mental health professionals differentiate between passive and active suicidal ideation. Passive SI is typically used to describe thoughts and feelings of wanting to die, or not caring if you die. Active SI refers to specific thoughts including how, where, and when you will take your own life. 

I prefer to think of it as a spectrum because there are stages even within these two categories. When people become suicidal, they appear somewhere on the below spectrum, but that doesn’t mean that they start at the beginning. While suicidal, they can move back and forth on the spectrum, fall off the spectrum and feel better, or eventually follow through with a suicide attempt. 

Passive SI 

Passive suicide ideation is often downplayed and overlooked. It is characterized by a wish or contemplation of death without a plan. For some people, this could be romanticizing death, or seeing it as the answer to all of their problems. For others, it’s simply not caring whether they’re alive. In addition to the examples listed on the above spectrum, passive suicide ideation includes the following thoughts. 

• “I wish I were never born.”
• “I wish I could never wake up.”
• “I can’t do this anymore, (life).”

Active SI

When people imagine a suicidal person, they picture someone experiencing active suicide ideation. This category is characterized by actively planning and working towards suicide. Individuals experiencing active suicide ideation no longer wish to be dead, they plan to make it a reality. The following list includes the many ways someone would prepare to take their own life. 

• Preparing, or telling, their loved ones
• Researching and considering different methods
• Obtaining the necessary equipment
• Deciding on a plan
• Attempting to follow through with the plan (Suicide Attempt)

Suicide

For this article we will include suicide attempts in this category. Suicide typically occurs when individuals feel intense hopelessness and despair. In some cases, there are warning signs, while other times loved ones may be left wondering what happened. Individuals considering suicide may never tell their friends and family. Suicide is often ‘triggered,’ not ‘caused, by a painful event, negative life change, or loss of something/someone. Watch for abrupt changes in behavior or the development of new, possibly unhealthy, behaviors. 

Risk Factors

Suicide is typically performed under extreme duress and can be an impulsive decision, so it can be entirely unrelated to these risk factors. But, the presence of these risk factors make suicide more likely, (AFSP, 2022). 

• Mental Illness, especially pertaining to depressive episodes and symptoms
• Major Physical Illness, especially those including chronic or intense pain
• Ongoing stress, including bullying, relationship problems, and unemployment
• Access to firearms, drugs, or sensationalized suicide accounts
• History of self-harming or suicidal behavior
• Family history of substance abuse, suicide, or suicidal behavior
• Presence of adverse childhood experiences

Warning Signs

Most warning signs of suicide involve moods and feelings. Depression, anxiety, irritability and lethargy are all worrisome signs. But, individuals who exhibit these symptoms than abruptly feel better are also exhibiting a warning sign. When someone is suicidal, they often experience relief once they’ve decided and accepting taking their own life as a solution. Other warning signs include the following, (AFSP, 2022). 

• Conversations involving feelings of hopelessness, feel trapped, or burdening others
• Expression of crushing or all-consuming pain or unhappiness
• Expressing an intent to kill themselves or lack of reason not to
• Withdrawal from friends, family, and social activities
• Changes in substance use, sleep, eating, or mood
• Preparations; saying goodbye, researching, or planning

How They All Relate

Now that we understand all of the interacting parts of self-harm, suicide ideation, and suicide, let’s examine how these three behaviors relate. 

From the venn diagram above, we can see several ways that these behaviors overlap. Suicide, SI, and self-harm all relate to loneliness and feelings of hopelessness. Each of these behaviors intends to end mental, emotional, or physical pain and they all share the common risk factor of the presence of mental illness. 

Suicide ideation and self-harm may lack suicidal intentions, but they both act as a risk factor for suicide. The presence of either of these behaviors in the past or present indicates an increased risk of suicide when the individual is in emotional duress. Self-harm and suicide are both conducted when experiencing intense feelings. These feelings may be acted upon impulsively, or they may lead to thoughts, or plans of suicide, (suicide ideation). 

References

American Foundation for Suicide Prevention. (2022, March 30). Risk factors, protective factors, and warning signs. American Foundation for Suicide Prevention. Retrieved March 22, 2023, from https://afsp.org/risk-factors-protective-factors-and-warning-signs 

Masi, G., Lupetti, I., D’Acunto, G., Milone, A., Fabiani, D., Madonia, U., Berloffa, S., Lenzi, F., & Mucci, M. (2021, June 15). A comparison between severe suicidality and nonsuicidal self-injury behaviors in bipolar adolescents referred to a psychiatric emergency unit. MDPI. Retrieved March 21, 2023, from https://www.mdpi.com/2076-3425/11/6/790 

Mayo Foundation for Medical Education and Research. (2022, November 10). Self-injury/cutting. Mayo Clinic. Retrieved March 21, 2023, from https://www.mayoclinic.org/diseases-conditions/self-injury/symptoms-causes/syc-20350950