The Difference between Suicide Attempts and Non-Suicidal Self-Injury

What we looked at

Non-suicidal self-injury (NSSI) is deliberate bodily harm or disfigurement without suicidal intent and for purposes not socially sanctioned. NSSI and suicide attempts are often treated as the same behaviour in research and in practice, but there is some debate on whether they are different behaviours. We reviewed the literature to determine whether NSSI and suicide attempts are distinct behaviours.

What we found

There is strong evidence that suicide attempts and NSSI are distinct behaviours. Offenders who have made suicide attempts have different clinical presentations and histories than those who engaged in NSSI.

The reasons individuals give for engaging in NSSI and suicide attempts differ, although there is some overlap. As their names suggest, suicide attempts are undertaken with the intent of ending one’s life, while NSSI is not. One study found that NSSI is more often undertaken for reasons such as to express anger, punish oneself, generate feelings of normalcy, and distract oneself, whereas suicide attempts were more often reported as intended to make others better off. Both behaviours, however, were intended to escape or relieve negative emotions.

Certain personal characteristics distinguish between individuals who engage in NSSI and those who attempt suicide. Those who attempt suicide tend to have more symptoms of depression and display more anger and aggression. Individuals who engage primarily in NSSI tend to present with more emotional instability and volatility. Suicidal ideation is predictive of later suicide attempts, but not NSSI.

Suicide attempts and NSSI are correlated with each other. Those who engage in NSSI are at increased risk for suicide compared to individuals who do not self-injure, but the risk remains very low (i.e., about 3-7% of individuals who self-injure eventually die by suicide). The risk of death is higher for those with previous suicide attempts. It has been found that approximately half of offenders who died by suicide had made at least one previous suicide attempt.

What it means

NSSI and suicide attempts are distinct behaviours. In order to effectively treat and manage both of these behaviours, they should not be grouped together. Rather, their different characteristics, motivations and purposes suggest that different approaches may be needed.

References

Brown, M. Z., Comtois, K. A., & Linehan, M. M.(2002). Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder. Journal of Abnormal Psychology, 111(1), 198–202.

Fulwiler, C., Forbes, C., Santangelo, S. L., & Folstein, M. (1997). Self-mutilation and suicide attempt: distinguishing features in prisoners. Journal of the American Academy of Psychiatry and the Law, 25(1), 69-77.

Hawton, K., Zahl, D., & Weatherall, R. (2003). Suicide following deliberate self-harm: Long term follow-up of patients who presented to a general hospital. British Journal of Psychiatry, 182, 537-542.

Klonsky, E.D. & Muehlenkamp, J.J. (2007). Self-injury: A research review for the practitioner. Journal of Clinical Psychology: In Session, 63(11), 1045-1056.

Owens, D., Horrocks, J., & House, A. (2002). Fatal and non-fatal repetition of self-harm. British Journal of Psychiatry, 181, 193-199.

Wichstrom, L. (2009). Predictors of non-suicidal self-injury versus attempted suicide: Similar or different? Archives of Suicide Research, 13, 105-122.

Prepared by: Jenelle Power & Amelia Usher

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