Teen Angst

Helping adolescents deal with anger and other emotions effectively

Understanding Suicide and Self-harm

Discovering the similarities and differences between self-harm and suicide.

Hayden’s Story:

Hayden sat at his desk hands shaking.  Tears splattered onto his papers and ink ran off of the pages.  Why wouldn't they stop?  "fag, worthless, good for nothing, stupid, sissy, ugly, dumbo."  Why do they hate him so much?  Why did he hate himself so much?  He was a disgrace, worthless, an utter disappointment.  These thoughts and more raced throughout his mind.  Reaching into his desk drawer he pulled out his faithful pair of scissors and pulled back the neck of his shirt.  Scarred pink welts told the story of past cuts.  With the blades of the sharp scissors he began to dig and carve into his flesh; creating a fresh wound on his youthful skin.

Colton’s Story:

Colton sat on the edge of his bed hands shaking.  He looked in his closet where a noose swung from the ceiling.  The time had arrived.  This is what he’d been planning for a while.  He had tried everything and nothing worked.  There was only one way to take care of it…to end it.  Numbness set into his body and a wave of nausea swept through him.  “It’s time” he thought.  He stood and made his last descent.  Each step was one step closer to ending the pain.

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Find out the endings to the stories below...

How similar are the two scenarios?  How different are they?  Both clearly have troubled individuals, who are hurting.  But in regards to the ending result, both scenarios are very different.  One scenario describes self-harm while the other involves the taking of one’s life. 

Self-harm is thought to be directly linked with suicide but this isn't the case.  The two are actually as different as night and day. Unfortunately the two oftentimes get grouped together because both are inflictions of pain and sometimes people who begin with self-harm may later commit suicide.  Generally people who self-harm do not wish to kill themselves; whereas suicide is a way of ending life. 

One significant difference between suicide and self-harm is intent.  Simply put, a suicidal person sees no other way out and wants to end his or her life.  People who are contemplating suicide are experiencing life stressors and possibly depression in which they don't have an escape.  Suicide is their attempt to escape pain and suffering, and not burdening loved ones any longer.  Suicidal acts usually come from a place of hopelessness, depression and worthlessness.The underlying mindset between someone who is suicidal and someone who self-harms is very different.

On the flip side, many people who self-harm view hurting themselves as a way of coping with life.  In fact, for some, the self-infliction of pain reassures them they are still alive. This is especially true when they are experiencing emotional numbness or feeling disconnected with the world around them. Plus, self-harming can cause changes in the brain chemistry, which gives the effects of a "rush" and can easily become addictive and highly dangerous.

Clear differences between the two:

Self-harm is a form of mutilation while suicide is the deliberate taking of one’s life. 

What is self-harm?

Self-harm is the intentional and deliberate hurting of oneself.  Most commonly it is done by:

  • Cutting
  • Burning
  • Hitting
  • Picking at the skin
  • Pulling hair
  • Biting
  • Carving

What are the warning signs of self-harm?

  • Many cuts/burns on the wrists, arms, legs, back, hips, or stomach
  • Wearing baggy or loose clothes (e.g., wearing hoodies or long sleeves during hot days to conceal the wounds)
  • Always making excuses for having cuts, marks or wounds on the body
  • Finding razors, scissors, lighters or knives in strange places (i.e., the nightstand drawer or under the bed)
  • Spending long periods locked in a bedroom or bathroom
  • Isolation and avoiding social situations

Why do people self-harm?

  • To escape their feelings
  • To cope with life stressors
  • To express their pain
  • To punish themselves (Some people mutilate their bodies to punish themselves for what's going on in their lives. They lack the appropriate coping skills and suffer from low self-esteem so they feel that they deserve what they are doing to themselves.)
  • To feel euphoria. (It's true. When we get hurt endorphins are released into the blood stream, resulting in a "natural high" or a feeling of euphoria. Self-harming behaviors can be addictive and habit forming.)

What is suicide?

Suicide is the voluntary and intentional act of taking of one’s life.  Suicide is commonly carried out through:

  • Firearms (number one method by men and women)
  • Hanging (most commonly done by men)
  • Drug Overdose (most commonly done by women)

Men are four times more likely to die from suicide than women, but women attempt suicide more often during their lifetime.  http://www.medicinenet.com/script/main/art.asp?articlekey=84760

The warning signs of suicide:

While some suicides may occur without any warning signs, most people who are suicidal do give warnings, such as:

  • Increasing their alcohol and/or other drug use
  • Taking unnecessary risks and impulsivity
  • Threatening suicide and/or expressing a strong wish to die
  • Exhibiting rage and/or anger
  • Talking about wanting to die or to kill oneself
  • Fascinating over or preoccupying oneself with death
  • Talking about feeling hopeless or having no reason to live
  • Talking about being a burden to others
  • Acting anxious or agitated; behaving recklessly
  • Isolating or withdrawing oneself
  • Displaying mood swings
  • Telling loved ones goodbye
  • Setting one's affairs in order
  • Giving things away, such as prized possessions
  • Referring to death via poetry, writings and drawings
  • Exhibiting dramatic changes in personality or appearance
  • Changing eating or sleeping patterns
  • Declining in performance

Why do people commit suicide?

Fellow PT blogger Alex Lickerman provides a detailed explanation in his blog “The Six Reasons People Attempt Suicide:  Suicide is far more understandable than people think.”

Here are the top six reasons:

  1. They're depressed
  2. They're psychotic
  3. They're impulsive
  4. They're crying out for help
  5. They have a philosophical desire to die
  6. They've made a mistake

The difference between the mindset of a self-harmer and a person contemplating suicide:

There's a difference in the mindset of a self-harmer and someone who is suicidal.  The major difference is that of “intent”.  With suicide the intent is to bring end to one’s life; to end pain and suffering.  Conversely, with self-harm the intent is one of trying to find relief and release from emotional pain and distress. 

Most people who engage in self-harming do so as a means to cope with their distress (avoid suicide) rather than escape it by committing suicide.  Self-harm is a response to painful emotions. Unfortunately self-harm may become a habitual way of coping with stress.

The injuries caused by self-harm may be serious or superficial, but any form of self-mutilationis a sign of emotional distress and should be taken seriously. Self-harm is oftentimes confused with suicidal behavior. A person who self-harms does not intend to commit suicide, but their self-injurious behavior may result in an accidental death.

Hayden’s story continued:

As the blood began to trickle down Hayden’s shoulder, he became disgusted with himself.  He threw the scissors across the room and cried out in anguish.  “Why can’t I stop?” he questioned.  Cutting felt good at the time but not afterwards.  After the fact, Hayden felt guilty and beat himself up for giving in to the powerful urge.  He was obsessed and addicted to the infliction of pain on his body. “I have to stop” he thought.  He got up, put things back in order and walked out of the room.  He walked into the family room and sat on the sofa next to his mom.  She hooked her arm around him and he broke down.  Hayden’s broken hearted secret began to pour out of his very soul.  For the first time in a long time he felt hope.

Colton’s story continued:

He checked to make sure the noose was secure.  He pulled out a small step stool from its hiding place and climbed each step.  Reaching the top he grabbed the noose and hooked it around his youthful neck.  Just before taking his final step he looked up and on the top shelf of his closet laid a baseball that he had caught with his dad at a major league game.  Tears streamed down his face.  “I can’t do this.  I don’t want to die.” he thought.  He slipped the noose from his neck and grabbed the ball.  He hugged the ball tightly to his chest and sobbed, dropping to his knees he let it all go.  His sobs echoed throughout the house.  His bedroom door opened.  "Son, are you okay?"   His father stepped into the room and the scene before him chilled him to the bone.  With his son, he dropped to his knees and embraced his broken child. "I am here, he said through strangled tears.  I am here."

If you or someone you know self-harms or shows warning signs for suicide, please seek help.  There are resources following this blog.

Click to a directory of therapists in your area. 

Resources:

Cornell University Research Center on Self-Injury:  http://www.crpsib.com/default.asp

Self Injury Foundation: this foundation promotes awareness for those who self-injure and works to provide funding for research, advocacy, and support for those who self-injure and their families.       1-800-334-HELP http://www.selfinjury.com/

Adolescent Self Injury Foundation: an organization that works to raise awareness about adolescent self-injury and provides education, prevention tips, and resources for self-injurious adolescents and their families.

National Suicide Prevention Hotline: 1-800-273-TALK (8255)

National Self-Injury Helpline: 1-800-DONT-CUT (366-8288)

24-hour Crisis Hotline: 1-800-273-TALK

Self-injury Help Guides: 

http://helpguide.org/mental/self_injury.htm

http://www.westminster.ac.uk/__data/assets/pdf_file/0009/45729/Self-Harm_Suicide-thoughts_Mind-Matter-Lflet-BACK-COVER--.pdf

http://www.mentalhealth.org.uk/content/assets/PDF/publications/truth_about_self_harm.pdf

Raychelle Cassada Lohmann, M.S., L.P.C., is the author of The Anger Workbook for Teens.

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