Links Between Self-Injury and the Risk of Suicide


Self-harming behaviors are generally considered a sign of increased risk for suicide. Many people who take their own lives have a history of self-harm. However, it is also true that many self-harming individuals are actually at low risk for suicide.

If you, someone you care about, or a client self-harms, is there a way to determine this person’s level of risk for suicide?

Human behavior, being forever unpredictable, makes determining the level of suicide risk with certainty impossible. Even so, there are factors that make it possible to assess this risk with increased accuracy.

What Is Self-Harm or NSSI?

In research circles, self-harming behaviors are often called non-suicidal self-injury (NSSI). NSSI is the deliberate, self-performed alteration or destruction of body tissue and includes burning, carving, cutting, and hitting one’s self without lethal intent.

According to clinical inpatient records, 30 to 40 percent of adolescents and up to 21 percent of adults engage in NSSI. Although this behavior can begin at any age, a large percentage of individuals start between the ages of 17 and 24. As this statistic indicates, NSSI is a significant health concern among college students.

Three Levels of NSSI Suicide Risk

Recent research has revealed three levels of suicide risk for those who self-harm. To determine this, researchers looked at individual self-reports of frequency, type, and intensity of self-injury, suicidal behavior (thoughts, planning, telling others), overall well-being (stress, mood, esteem, emotions, social engagement, behavior), quality of parent and friend relationships, and history of delinquency.

Group 1: Lowest Risk

Over two-thirds of young adults with NSSI behavior fit the low risk profile for suicidal behavior. Low risk is characterized by:

  1. A low frequency of engagement in self-injury behaviors.
  2. A lower level of suicidal behavior (thoughts, planning, telling others).
  3. Psychosocial risk factors (e.g., anxiety, depression) are about the same as for non-self-injurers.
  4. Experiencing less pain with NSSI than the moderate or high risk individuals.

Group 2: Moderate to Higher Risk

This group of individuals:

  1. Have higher psychosocial risk factors such as anxiety or depression than non-self-injurers.
  2. Have the highest frequency of NSSI behavior of the three groups.
  3. Greater variety or number of harming methods than low risk individuals.

Group 3: Highest Risk

The highest suicide risk indicators are:

  1. Frequently engage in NSSI behaviors.
  2. Have the highest psychosocial risk factors out of the three groups.
  3. Frequently engage in self-injury behaviors when alone.
  4. Have current suicidal behavior or ideation (thoughts, planning).

Although not everyone who engages in NSSI is at moderate or high risk for suicide, all self-injury includes the risk of infection and possible permanent nerve or tissue damage. Even infrequent self-harm indicates underlying problems related to belonging, self-esteem, anxiety, or other issues that can be addressed with the help of a qualified counselor.

Source: Hamza CA, Willoughby T (2013) Nonsuicidal Self-Injury and Suicidal Behavior: A Latent Class Analysis among Young Adults. PLoS ONE 8(3): e59955. doi:10.1371/journal.pone.0059955


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