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Important Differences Between Self Harm and Suicidal Ideation

What is Self-Harm?

Self-harm is a behavior used as a coping mechanism in response to severe psychological and emotional distress. Individuals can also experience suicidal ideation in response to this distress as well but it is important to understand the difference.


Self-Harm Behavior

Self-harm behavior is any behavior that the individual intends to cause physical harm to themselves. Suicidal ideation includes thoughts ranging from “wishing one were dead or would go to sleep and not wake up” to having a plan and intent to follow through with suicide. A suicide attempt always involves infliction of harm upon the self, however, not all self-harm is suicidal in nature.


Self-harm behavior ranges in the type of behavior as well as the severity and intensity of that behavior. Types of self-harm include cutting oneself, burning oneself, and hitting oneself. Severity and intensity of self-harm can range from superficial scratching of the skin to causing deep lacerations and severe bruising. Regardless of the result, all self-harm behavior should be evaluated. Although these behaviors could result in death depending on the severity and intensity, it is not uncommon for a person to engage in the self-harming behavior solely to redirect emotional and psychological pain. However, individuals who engage in self harming behaviors are at a higher risk for becoming suicidal. It is not uncommon for self-harm behavior to become repetitive and habitual. According to NAMI, “Sometimes, injuring yourself stimulates the body’s endorphins or pain-killing hormones, thus raising mood. Or if a person doesn’t feel many emotions, they might cause themself pain in order to feel something “real” to replace emotional numbness.” Regardless of the intended result, self-harm is a form of coping and the goal of therapy includes learning to replace self-harm behavior with other types of coping mechanisms.


Risk Factors

There are certain risk factors related to self-harm behavior. These include having a diagnosis of a mood disorder and experiencing a past traumatic event or events. Although self-injury is a risk factor for suicide, not everyone who engages in self harm behavior will complete suicide. Mental health professionals screen for both suicidal ideation and self-injury behavior in different ways and will ask differentiating questions such as, “Do you think about suicide while harming yourself?” or “Has any self-harm behavior ever resulted in a suicide attempt? It is also important to know how severe an individual’s injuries have been. This is important so the correct level of care can be recommended or so the person can get medical attention if needed.


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