It’s not unusual for young people who are struggling with painful feelings to engage in self-injury — things such as cutting, burning or scratching themselves until they bleed. Knowing that a child is intent on harming herself is very upsetting to parents, and many worry that self-injury is a sign that their child is suicidal.

Self-injury and suicidal behaviors — imagining, planning or attempting suicide — are related, but the relationship between the two is confusion

Differences

Self-injury and suicide differ in multiple ways, including:

The intent: The intent of self-injury is almost always to feel better, whereas for suicide it is to end feeling (and, hence, life) altogether.

The method used: Methods for self-injury typically cause damage to the surface of the body only. Suicide-related behaviors are much more lethal. Notably, it is very uncommon for individuals who practice self-injury and who are also suicidal to identify the same methods for each purpose.

Level of damage and lethality: Self-injury is often carried out using methods designed to damage the body but not to injure the body badly enough to require treatment or to end life. Suicide attempts are typically more lethal than standard NSSI methods.

Frequency: Self-injury is often used regularly or off-and-on to manage str. Suicide-related behaviors are much more rare.

Level of psychological pain: The level of psychological distress experienced in self-injury is often significantly lower than that which gives rise to suicidal thoughts and behaviors. Moreover, self-injury tends to reduce arousal for many of those who use it and, for many individuals who have considered suicide, is used as a way to avoid attempting suicide.

Presence of cognitive constriction: Cognitive constriction is black-and-white thinking — seeing things as all or nothing, good or bad, one way or the other. It allows for very little ambiguity. Individuals who are suicidal often experience high cognitive constriction. The intensity of cognitive constriction is less severe in individuals who use self-injury as a coping mechanism.

Aftermath: Although unintentional death does occur with self-injury, it is not common. The aftermath of a typical self-injury incident is short-term improvement in sense of well-being and functioning. The aftermath of a suicide-related gesture or attempt is precisely the opposite.

Common Risk Factors

Despite differences and intention, suicidal thoughts and behaviors and self-injury do share common risk factors. Some of these include:

• High emotional sensitivity
• A history of trauma, abuse, or chronic stress
• Extreme emotion or lack of emotion
• A tendency to suppress emotions coupled with few effective mechanisms for dealing with emotional stress
• Feelings of isolation (this can be invisible in people who seem to have many friends/connections)
• A history of alcohol and substance issue.

Because of these common risk factors, it is important for you to know that youth who self-injure are also at increased risk for suicidality. Our work shows that about 65 percent of youth who self-injure will also be suicidal at some point (though many will not go beyond having suicidal thoughts). For many, self-injury is used alone or in combination with other behaviors as a way to keep emotional distress or disconnectedness at a manageable level.