The Difference Between Self-Harm and Suicidal Ideation
Self-harm and suicidal ideation are often grouped together, but they differ. Why people self-harm, where the two overlap, and why the distinction matters.
Written by Pamela N. Barbagallo, MHC-LP
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The terms “self-harm” and “suicidal ideation” are commonly grouped together under a broad umbrella, leaving room for them to be misunderstood and classified as having the same meaning. However, it’s vital to identify the distinction between the terms, not only to continue destigmatizing mental health, but also to provide individuals with the proper support they need.
Engaging in self-harm is a behavior commonly displayed in individuals diagnosed with eating disorders, substance use disorder, and borderline personality disorder. According to Fuller (2021), approximately 4% of Americans self-harm, whereas 14% of adolescents inflict self-harm.
It is imperative to note that even though individuals who self-harm do not typically intend to commit suicide, suicide rates increase within a period of 6 months with this population once self-harm behaviors are initiated (Fuller, 2021).
What Is Self-Harm?
Clinical settings often refer to self-harm as Non-Suicidal Self-Injury (NSSI). This is defined as the deliberate, direct destruction of body tissue without any conscious intent to die. Methods of self-harm can include cutting, burning, scratching, wound picking, or hitting oneself (Fuller, 2021).
Individuals who engage in self-harm use it as a maladaptive coping mechanism that provides relief by regulating overwhelming emotional distress. Thus, individuals who self-harm are most often trying to relieve their emotional pain as opposed to ending their life (Fuller, 2021).
Individuals Engage in Self-Harm To:
Combat severe emotional numbness – past trauma can often exacerbate feelings of emotional numbness, so individuals substitute it with physical pain to feel a sense of emotion and reality again.
Self-punish – influenced by past trauma, individuals can experience feelings of guilt and unworthiness. Past encounters with abandonment, bullying, and trauma can decrease their self-worth. Overall, self-harm enables individuals to trade feeling guilty for punishing themselves in return.
Avoid unwanted feelings – used as an immediate distraction to escape intense, unwanted emotions such as anxiety, sadness, and anger, or to block out painful memories and flashbacks instead of confronting them with healthy coping skills.
Regulate emotions – this serves as a temporary emotional outlet that releases endorphins for fast relief. However, individuals experience feelings of guilt and shame shortly after, reinforcing the cycle.
What Is Suicidal Ideation?
Suicidal ideation refers to thoughts, feelings, or preoccupations about ending one’s own life. This can range from considering suicide to creating a plan to act on it. Suicidal ideation is divided into the following two categories:
Passive suicidal ideation: An individual experiences thoughts or a persistent desire about not wanting to be alive or wishing not to wake up, but lacks any specific plan or intent to act on them.
Active suicidal ideation: An individual experiences thoughts of suicide accompanied by a concrete plan and the conscious intention to carry it out.
Unlike self-harm, the basis for suicidal ideation is an individual’s desire to escape an unbearable existence. The intent is permanent cessation, where individuals plan to end all feelings, pain, and consciousness altogether (Orentas, 2021).
Where Self-Harm and Suicidal Ideation Overlap
Shared risk factors – Both behaviors derive from deep emotional distress, challenges with emotion regulation, trauma, and underlying mental health conditions such as depression or anxiety.
Escalation risk – Individuals who engage in chronic self-harm are at an elevated statistical risk for suicide over time. This can happen if self-harm eventually stops providing emotional relief, if the individual becomes desensitized to physical pain, or if feelings of shame and isolation intensify.
Considering this overlap between self-harm and suicidal ideation, any act of self-harm should be handled as a serious indicator of emotional distress requiring professional evaluation, including a formal suicide risk assessment (Orentas, 2021).
Why the Distinction Matters
Confusing self-harm with suicide attempts can lead to harmful responses that increase isolation, or to dismissing the behavior as a phase or attention seeking. This can further lead to missed opportunities for early intervention. Accurate distinction ensures appropriate support, matching empathy and coping strategies for self-harm with crisis intervention for suicidal ideation. Both behaviors demand compassion, active listening, and evidence-based therapeutic support (Orentas, 2021).
Recognizing the difference enables us to respond accurately: with empathy and healthy coping strategies for self-harm, and with immediate crisis intervention and safety planning for suicidal ideation (Orentas, 2021).
References
Fuller, K. (2021). Four reasons why individuals engage in self-harm: Understanding the motivations for self-harm is the key to overcoming it. Psychology Today. https://www.psychologytoday.com/us/blog/happiness-is-state-mind/202103/four-reasons-why-individuals-engage-in-self-harm
Orentas, G. (2021). What is suicidal ideation? PsychCentral. https://psychcentral.com/depression/what-is-suicidal-ideation
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