Suicidality and Self-Injury

What it is: Suicidality involves the thoughts, urges, and behaviors associated with a wish or plan to take one’s own life. Suicide is a major public health problem: it is the second leading cause of death in young people, and it is in the top 10 leading causes of death for adults in the US. Moreover, the CDC recently released a report showing that suicide rates are on the rise nationwide (CDC, 2018). The pattern of chronic suicidality is similar to any other chronic condition. For some with chronic suicidality, the suicidal thoughts may increase in intensity and when they subside it is only temporary and then the thoughts return. For others,they may experience suicidal thoughts on a daily basis. Warning signs for suicide are not always obvious and can vary from person to person.

Some warning signs can include:

Making statements about suicide such as
- “I am going to kill myself”
- “I wish I were dead”
- “Everyone would be better off if I were dead”
Obtaining means to end your own life, i.e. hoarding pills, buying a weapon
Searching online for ways to end your own life
Preoccupied with death, dying or violence
Increase in hopelessness about the future
Engaging in high-risk behaviors such as drug use, risky driving
Withdrawing from social contact and increasing in isolative behaviors

A similar yet distinct behavior is called non-suicidal self-injury and includes any behavior that causes damage to the physical self without the intent to die (e.g., cutting, burning). People engage in self-injury for a variety of reasons, including self-punishment, distraction, or to reduce feelings of numbness or detachment.

Fortunately, treatments are available that target both suicidal and non-suicidal self-injurious behavior. These treatments include both short-term and long-term goals. In the short-term, treatment involves learning more effective and less damaging coping skills for managing intense emotional distress. Over the long-term, treatment is focused on creating a life worth living.

Associated concerns: Suicidality and self-injury often co-occur with mood disturbance, anxiety and stress, perfectionism and shame, or traumatic experiences. When individuals have trouble coping with these symptoms, they may also develop difficulties with substance abuse or anger management.

Evidence Based Treatments offered: DBT. DBT has been shown to be the most effective form of psychotherapy to treat chronic suicidality. The individual treatment component of DBT focuses primarily on building a Life Worth Living and working to increase the client’s motivation to live and to continue treatment. Along with individual therapy, group therapy is part of the treatment that teaches the client the skills needed to change and move toward acceptance of self and others. Research studies performed by Marsha Linehan, treatment developer, and other researchers found that DBT can significantly decrease suicide attempts in people learning DBT skills.