If you know someone who is self-harming or non-suicidal self-injury, how do you assess their risk of suicide? 
Self-harming behaviors and suicide attempts can look similar to an untrained eye. 
When you find out a loved one has been cutting their wrists, burning their inner thighs, or scratching themselves to the point of drawing blood it’s likely you’re going to be filled with overwhelming emotions, and an abundance of questions. 
One of those questions you may have pertains to whether your partner, sister or close friend has the desire to commit suicide. 
It can be an uncomfortable question to ask, but a crucial one, nonetheless. 
So, how do you address their risk of suicide? 
Unfortunately, there is no one-stop formula to determining whether or not someone who self-harms is going to take their own life - however, there are signs you can look out for that may signal risky potential. 
Defining ‘Self Harm’: 
In order for us to talk about the risk of suicide in those who engage in self harming behaviors, we need to talk about what the term ‘self-harm’ means. 
Self-harm is repeated intentional acts of injury done against a person’s own body in order to cope with emotional pain. Self-harm is an unhealthy method of turning an inner battle, outwards. 
Self-harm quite literally means hurting yourself on purpose. This is often a difficult concept for people who have never struggled with it, to understand. Why in the world would someone want to hurt themselves? The irony is, they’re already hurting. It’s just inside of them, and self-harm serves as a way to release those pent-up emotions. 
Common Methods of Self-Harm: 
● Cutting 
● Head Banging 
● Burning 
● Excessive Scratching 
● Punching Oneself 
● Intentionally Infecting Oneself 
● Drinking Chemicals 
● Breaking Bones 
Suicide and Self Harm Statistics: 
The relationship between suicide and self-harm is messy, as the intent is often the biggest determining factor. 
Many people who self-harm engage in what experts call, ‘Non-Suicidal Self Injury’ (NSSI). 
These people don’t want to kill themselves; they just want their pain to end. In most cases of NSSI, the emotional turmoil they’re experiencing has become too much to bear, and by self-harming, they can manage their emotions without taking their own life. 
However, there are those who do commit suicide after a period of self-harm. 
Let’s look at some statistics regarding self-harm and suicide: 
● 36% of Adults Who Self Harm Have Felt Suicidal While Doing So 
● Suicide Rate Per Year: 45,979 
○ Firearm: 24,292 
○ Suffocation: 12,495 
○ Poisoning: 5,528 
● Emergency Room Visits For Self-Injury: 312,000 
● 1 in 5 Females Engage In Self Harm 
● 1 in 7 Men Engage In Self Harm 
While the majority of those who self-harm don’t have suicidal thoughts, it’s important to remember there are some who do. In addition, self-harming behaviors can escalate over time into suicidal idealizations if not addressed. 
How To Assess The Risk Of Suicide In A Loved One Who Self Harms: 
While self-harm isn’t suicide, it could become suicide. It’s always best to reach out to someone who may be self-harming before it’s too late. 65% of youth that self-harm become suicide - however whether or not they act on these thoughts is unclear. 
Risk Factors: 
There are a few risk factors to keep in mind when assessing the chance of suicide: 
● High emotional sensitivity 
● A past history of abuse, trauma, or stress 
● Lack of emotions 
● Habit of suppressing emotions 
● Little or no healthy coping skills for handling emotions 
● Feelings of isolation 
● ‘Black or white’ way of thinking about negative events 
● Bullying 
● Substance abuse 
It’s important to understand these risk factors as a way to proactively keep an eye out. 
It’s always a good idea to understand the major differences between self-harm and suicide. This can prevent you from accusing a loved one of being suicidal, if they really aren’t. Or, on the other hand, this can keep you from ignoring possible warning signs that someone you know may be thinking of taking their own life. 
Frequency and severity of self-harm incidents can indicate a higher or lower level of risk of suicide. 
Warning Signs: 
If you feel as though a loved one who is self-injuring may be suicidal, stay alert for these warning signs. These are incredibly common among victims of suicide and can save their life if caught in time. 
● Severe sadness or hopelessness 
● Extended sleeping problems 
● Withdrawal 
● Sudden calmness 
● Risky behaviors 
● Sudden changes in appearance or behavior 
● Recent trauma or major life change 
● Talks of suicide 
How To Approach Someone About Their Risk Of Suicide: 
If you know someone that struggles with self-harm and has any of the traits or risk factors listed above, it’s recommended to approach them in a loving, non judgmental way. Talking about thoughts of suicide can be intimidating and uncomfortable for some but try to get on their level and express patience and empathy. 
First and foremost, always remember to give the other person space to talk. It’s important to allow them to express whatever they may be feeling, without interruption. Someone contemplating suicide is often feeling overwhelmed by mental despair, so by allowing them room to talk about their struggles may just be exactly what they need. 
Here are a few ways to start a conversation: 
● “Hey, I’ve noticed you haven’t been acting like yourself lately, are you doing alright?” 
● “I’m worried about you. I saw your Facebook post and I’m wondering if we could talk about what’s going on?” 
● “You seem really (insert emotion word) lately. If you feel comfortable opening up, I would love to talk about this together.” 
In addition, using specific examples such as, “I’ve noticed you haven’t been eating much lately. Is everything okay?” can help clarify your worries and gives the other person less room to deny any struggles they may be dealing with. 
Being Proactive Is Key: 
Let’s circle back to what we’ve learned. Not all people who struggle with self-harm want to commit suicide, so it’s important to educate yourself before making accusations. 
However, suicidal thoughts can stem from long term self-injury, so staying vigilant and proactive if you notice any significant changes in someone can stop things from progressing too far. One of the most important aspects of recovering from self-harm or suicidal thoughts is feeling heard and connected to others. 
Be sure to always approach with an open mind, without the intent to “fix” the situation for the other person. As long as you go about it the right way, it never hurts to reach out to someone you may suspect is struggling with either self-harm, or suicidal thoughts. 
You never know, you could just save a life. 
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