Self-injury and suicide: Is there a link?

Self-injury behavior is a growing concern in many schools across the country, especially in our adolescent girls.  It has even been known to occur as young as 5th grade.  We also know that suicide is the 3rd leading cause of death among youth, ages 15-24.  While self-injury and suicide are related in many ways, there are also very distinct differences in the intention, motivation, and goals of these behaviors.

According to the American Academy of Child and Adolescent Psychiatry (2009), self-injury is defined as "the act of deliberately destroying body tissue, at times to change a way of feeling."  They go on to say that this behavior includes:

  • carvings / scratching
  •  branding / marking
  • picking and pulling skin and hair
  • burning / abrasions
  • cutting / biting / head banging
  • bruising / hitting
  • tattooing / excessive body piercing

  • With no intent to commit suicide, it is often referred to as parasuicidal behavior.  When an adolescent begins to self-harm, the intent is about alleviating emotional pain.  These adolescents lack the ability to successfully regulate their emotions and, as a result, self-injury becomes a form of coping.  Many have shared how they enter a trancelike state while self-injuring.  It becomes a way of externalizing their internal emotional pain.  By seeing blood, they often feel a sense of relief.  In turn, when injured, the body reacts by releasing endorphins as a way of coping with the physical pain and anxiety.  Eventually, like drugs or alcohol, self-injury becomes an addiction.  However, like any addiction, it is short lived.  Cutters soon feel guilt and shame and the cycle continues.  To learn more, I suggest reading Cutting: Understanding and Overcoming Self-Mutilation by Steven Levenkron.  He does a terrific job of explaining it.

    Suicide, on the other hand, is less about externalizing pain and more about stopping the pain altogether.  It becomes a permanent solution to a temporary problem.  So what is the link?  Well, what we understand is this...self-injury and suicide have similarities in that both are forms of coping.  They are ways people use to escape pain.  However, they are distinctly different when you look at the person's motivation and intent.  A self-harmer attempts to alleviate internal pain while a person considering suicide wants to end the pain.

    We also know that self-harmers increase their threshold to pain as they become desensitized and at the same time, become more comfortable with injuring their bodies.  Adding guilt and shame to the cycle of self-harm behavior, these individuals become at a much greater risk for suicidal ideation and attempts.  In fact, it is estimated that about 1/2 of those that self-harm also attempt suicide.  Furthermore, self-injury can lead to death since many run the risk of cutting too deeply and/or failing to reach medical attention in time. Unfortunately, this makes it difficult to identify the true intent of his or her behavior.  Was it truly a suicide or was it self-injury gone wrong?  To add to our dilemma, there is little research among the professional community about non-suicidal self-injury.  As we continue to work with those at risk of self-injury or suicide, we have a strong need for continuing research to understand.  Let's hope more is being done.  It can only help save lives!!!

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