How Is Self-Harm Related to Suicide?

The term self-harm encompasses a wide variety of behaviors and motivations. Some people inflict injuries upon themselves with the intent to cause pain and wounds, but not death. This is often considered nonlethal self-injurious behavior. These can include piercing, cutting, and even drug overdose.

Other actions, which overlap with nonlethal self-injurious behaviors, can be committed with the sole intent of causing serious injury or death. Sometimes these behaviors are the cause of suicide, and sometimes they are not. Understanding how self-harm is related to suicide could decrease the risk of suicide among those who engage in self-harming acts.

In an effort to get a clearer picture on this relationship, Matthew Miller of the Department of Health Policy and Management at the Injury Control Research Center at the Harvard School of Public Health in Boston recently conducted a follow-up to a previous study on 3,600 individuals. The participants were monitored immediately following their release from a hospital for nonlethal self-injury. Miller looked at the rate of completed and attempted suicides four years later and also at the methods used in first and subsequent self-injurious behaviors.

The results revealed that individuals who were first admitted due to cutting, drug overdose, or piercing had a higher risk of committing suicide after their release, but by means other than those they first employed. Surprisingly, the majority of suicides that occurred were among people with no history of either hospitalization or prior psychiatric episodes. This suggests that even though many people take their lives on their first attempt at self-injury, many do not.

Miller said, “Our findings suggest that preventing suicide among persons with a history of self-harm must account for the possibility that they will adopt methods with higher case-fatality ratios than they previously tried.” The fact that self-harmers were admitted to the hospital for serious injuries could provide a window of opportunity for clinicians and caregivers. If individuals with a history of self-harm, especially behaviors like cutting and drug overdose, are provided with tailored mental health care, this may lessen the likelihood of further more severe attempts at suicide.

Miller, Matthew, et al. (2013). Method choice in nonfatal self-harm as a predictor of subsequent episodes of self-harm and suicide: Implications for clinical practice. American Journal of Public Health 103.6 (2013): E61-8. ProQuest. Web.

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  • trey


    August 21st, 2013 at 11:12 AM

    Generally I would think that self harm is always some kind of cry for help, and if they are crying out by trying to hurt themselves, then eventually, even if it is not the intial intent, there will inevitably be that leap to suicidal tendencies.

  • glass bridge

    glass bridge

    August 21st, 2013 at 9:04 PM

    Even self harm that is not lethal cannot be should be treated as a sign for possible attempt to suicide and the person needs to be monitored Nd helped.there could be a variety of factors for such behavior Nd help can go a long way in mitigating the concerns or fears.

  • Kayleen


    August 22nd, 2013 at 3:56 AM

    I wonder why the method choices change. Do you think that when they are at frist self harming that they are trying things out, seeing what they could tolerate? Or maybe this is a way of premeditated throwing people off and having them look for one thing when really they are ultimately thinking of another in which they will do lasting harm?

  • bramlett


    August 24th, 2013 at 12:41 PM

    Let us assmue that harming oneself is, like I believe, a serious cry for help.
    It may be a way to say hey look, I need some attention. Or it may be a way of saying look, I am hurting and this is the only way that I know how to express what I am feeling.
    No matter what it is saying, the point is that this is someone who needs some intervention and we have to be willing to give before it reaches the stage where suicide looks like a viable option to them.
    Harming oneself intentionally should not be this cry for help that no one is taking very seriously It should be something that we are all on the lookout for because I am convinced that this is the first step toward things that are going to eventually spiral out of control in a horribly sad way.

  • mjw


    August 24th, 2013 at 9:45 PM

    as a cutter, i know this all too well. i agree that it’s often a cry for help. however, for myself, it’s a way to release pain that i can’t seem to release any other way. it is in NO WAY a suicidal thing and i have a feeling i am not the only person this way.

  • Carolee


    August 26th, 2013 at 4:01 AM

    mjw- you were so brave to write in here. I applaud you for trying to clear up some of the misconceptions. I too thought that harming yourself had to automatically mean that this was a pathway to suicide, that this would naturally be then next step. Obviuously for you this is not the case. For you it sounds to be more like a release from the pain in a way that feels a little safer for you, and while I know that there are safeer options out there I know that you just haven’t found one yet that allows you quite the same kind of release. Best of luck to you as you continue that search. And please be careful.

  • Armando favazza

    Armando favazza

    September 16th, 2013 at 12:07 PM

    The term self-injury can be used generically to cover all sorts of behavior but in the professional literature NSSI [non-suicidal self-injury] is totally distinct from drug overdose. The dynamics are quite different. People who engage in NSSI rarely, if ever, kill themselves. Chronic NSSI behavior places a person at high risk for a drug overdose, usually out of demoralization over not being able to control their NSSI. In England and Australia drug overdose is counted together with NSSI and this has distorted the research from those countries.
    Armando Favazza,MD

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