Self-Harm and Suicide: Understanding and Prevention

This page discusses the important topic of self-harm and suicidality – why it happens and how to prevent it.

Introduction
Overview of Suicide Incidence and Prevention from the National Institute of Mental Health
Suicide Prevention Resources
Articles and Books about Suicide and Self-Harm Prevention

Introduction

There are few things more tragic than a person taking their own life.  Whether caused by seemingly insurmountable life stressors, impaired biochemistry, or a combination of both, suicide is something that we need to get better at preventing, both in the US and abroad.  Yes, life is hard, and sometimes extremely so for certain members of the population, but there is always hope.

“Self-harm” is a broad term that refers to any conscious and deliberate act of harm toward oneself.  While some people hurt themselves as a means of ending their life, there are others who engage in self-injurious behavior that doesn’t stem from a desire to die.  These types of behaviors directed toward oneself include cutting, burning, hitting, hair pulling and other acts of intentional self-injury.  The reasons people engage in acts of self-injury vary, but one of the most common ones is to try to help regulate overwhelmingly painful emotions, perhaps of deep sadness, intense fear, rage or self-loathing.  The act of something like self-cutting or hair pulling can provide a temporary emotional release, distraction from pain, or sense of greater aliveness by de-numbing.  But, this “remedy” obviously comes with great cost.

While the root causes of self-harm are complex, one common thread is exposure to trauma – an oft underlying source of anxiety, depression, substance abuse and other psychological conditions that increase the risk of self-injurious behavior and suicide.

Any thoughts of suicide or self-injurious behavior should be taken seriously.  Research actually shows that the more suicide is talked about in the open, the more likely lives will be saved.  This may run contrary to popular myth or cultural patterns that say talking about it will potentially exacerbate the problem.  Due to the challenging nature of life for all people, it’s likely that most have thought about suicide (or another form of self-harm) at one point or another (e.g., during periods of abnormal stress or melancholy).  But, most of those people will say they’d never seriously consider actually trying to harm themselves.  Tragically, however, there’s a large percentage of people around the world who think differently, with the CDC estimating that a life is taken by suicide every 13 minutes in the US (Centers for Disease Control) and every 40 seconds around the world (World Health Organization).

So, again, any thoughts of self-harm should always be taken seriously by oneself and those around them.  Help is available to prevent suicide and self-harm.  Seek help by contacting your doctor, local mental health professional, or call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. The service is available to anyone. All calls are confidential. http://www.suicidepreventionlifeline.org 

Overview of Suicide Incidence and Prevention from the National Institute of Mental Health

Suicide is a major public health concern. Over 41,000 people die by suicide each year in the United States; it is the 10th leading cause of death  overall. Suicide is tragic. But it is often preventable. Knowing the risk factors for suicide and who is at risk can help reduce the suicide rate.

Who is at risk for suicide?

Suicide does not discriminate. People of all genders, ages, and ethnicities can be at risk for suicide. But people most at risk tend to share certain characteristics. The main risk factors for suicide are:

  • Depression, other mental disorders, or substance abuse disorder
  • A prior suicide attempt
  • Family history of a mental disorder or substance abuse
  • Family history of suicide
  • Family violence, including physical or sexual abuse
  • Having guns or other firearms in the home
  • Incarceration, being in prison or jail
  • Being exposed to others’ suicidal behavior, such as that of family members, peers, or media figures.

The risk for suicidal behavior is complex. Research suggests that people who attempt suicide differ from others in many aspects of how they think, react to events, and make decisions. There are differences in aspects of memory, attention, planning, and emotion, for example. These differences often occur along with disorders like depression, substance use, anxiety, and psychosis. Sometimes suicidal behavior is triggered by events such as personal loss or violence.

In order to be able to detect those at risk and prevent suicide, it is crucial that we understand the role of both long-term factors—such as experiences in childhood—and more immediate factors like mental health and recent life events. Researchers are also looking at how genes can either increase risk or make someone more resilient to loss and hardships.

Many people have some of these risk factors but do not attempt suicide. Suicide is not a normal response to stress. It is however, a sign of extreme distress, not a harmless bid for attention.

What about gender?

Men are more likely to die by suicide than women, but women are more likely to attempt suicide. Men are more likely to use deadlier methods, such as firearms or suffocation. Women are more likely than men to attempt suicide by poisoning.

What about children?

Children and young people are at risk for suicide. Suicide is the second leading cause of death for young people ages 15 to 34.

Learn more:

Podcast on Warning Signs for Childhood Suicide

Podcast on Childhood Suicide and Keeping Kids Safe Online

What about older adults?

Older adults are at risk for suicide, too. While older adults were the demographic group with the highest suicide rates for decades, suicide rates for middle aged adults have increased to comparable levels (ages 24-62). Among those age 65+, white males comprise over 80% of all late life suicides.

What about different racial/ethnic groups?

Among racial and ethnic groups, American Indians and Alaska Natives tend to have the highest rate of suicides, followed by non-Hispanic Whites. Hispanics tend to have the lowest rate of suicides, while African Americans tend to have the second lowest rate.

How can suicide be prevented?

Effective suicide prevention is based on sound research. Programs that work take into account people’s risk factors and promote interventions that are appropriate to specific groups of people. For example, research has shown that mental and substance abuse disorders are risk factors for suicide. Therefore, many programs focus on treating these disorders in addition to addressing suicide risk specifically.

Psychotherapy, or “talk therapy,” can effectively reduce suicide risk. One type is called cognitive behavioral therapy (CBT). CBT can help people learn new ways of dealing with stressful experiences by training them to consider alternative actions when thoughts of suicide arise.

Another type of psychotherapy called dialectical behavior therapy (DBT) has been shown to reduce the rate of suicide among people with borderline personality disorder, a serious mental illness characterized by unstable moods, relationships, self-image, and behavior. A therapist trained in DBT helps a person recognize when his or her feelings or actions are disruptive or unhealthy, and teaches the skills needed to deal better with upsetting situations.

Medications may also help; promising medications and psychosocial treatments for suicidal people are being tested.

Still other research has found that many older adults and women who die by suicide saw their primary care providers in the year before death. Training doctors to recognize signs that a person may be considering suicide may help prevent even more suicides.

Suicide Prevention Resources

If you are in crisis
Call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. The service is available to anyone. All calls are confidential.http://www.suicidepreventionlifeline.org 

Additional Resources

End Source: NIMH – Suicide Prevention

Articles and Books about Suicide/Self-Harm Prevention

Waking Up Alive, by Richard A. Heckler, Ph.D.
The critically-acclaimed research & book about how people recover from the suicidal trance and go on to live happy, fulfilled and engaged lives.

How to Help Someone Who is Having Suicidal Thoughts
A short blog post written from the perspective of a family member.

Cutting and Self-Harm, from the HelpGuide.org

Self-Harm, from the National Alliance on Mental Illness

Suicide Risk Reduced After Talk Therapy, Study Suggests, from BBC health news

Preventing Suicide, A Toolkit for High Schools
From the Substance Abuse and Mental Health Services Administration (SAMHSA)

Preventing Suicide: A Global Imperative
From the World Health Organization (WHO), versions available in Arabic, Chinese, English, Finnish, French, Japanese, Russian, and Spanish

Suicide: Symptoms and Danger Signs
From SAVE.org (Suicide Awareness Voices of Education)