Self-Injury and Suicidal Behavior

Self-injury and suicidal behavior in adolescents span non-suicidal self-injury, suicidal ideation, suicide attempts, and death by suicide. Self-harm typically rises during adolescence, and suicide is among the leading causes of death in young people, making this one of the most consequential topics in adolescent mental health.

Definition

Self-injurious behavior comprises acts in which a person deliberately harms their own body; non-suicidal self-injury denotes such acts performed without intent to die, while suicidal behavior encompasses suicidal ideation, suicide attempts, and suicide, defined by some degree of intent to end one's life.

Scope

This entry covers the spectrum of self-injurious and suicidal behavior in adolescents: definitions and the distinction between non-suicidal self-injury and suicidal behavior, epidemiology, associated risk factors, and the psychological models used to understand suicidality. It is reference-educational and does not provide clinical risk-assessment or crisis guidance.

Core questions

• How is non-suicidal self-injury distinguished from suicidal behavior, and how are they related?
• How common are self-harm and suicidal behavior in adolescents, and how do they vary by sex and method?
• What factors and psychological models help explain the emergence of suicidal behavior in adolescence?

Key concepts

• Non-suicidal self-injury
• Suicidal ideation, attempt, and suicide
• Self-harm as a risk marker for later suicide
• Emotion regulation functions of self-injury
• Ideation-to-action frameworks of suicide
• Method and means in adolescent suicide

Mechanisms

Non-suicidal self-injury is often understood as serving emotion-regulation or interpersonal functions, while contemporary models of suicide distinguish the development of suicidal ideation from the transition to suicidal action, emphasizing factors such as hopelessness, capability for self-harm, and acute distress. Self-harm and suicidal behavior frequently co-occur with depression, and a history of self-harm is among the strongest markers of later suicide risk. These accounts summarize prevailing psychological frameworks rather than a deterministic pathway.

Clinical relevance

Self-harm in adolescence is a major marker of subsequent suicide risk and of underlying mental distress, and suicide is among the leading causes of adolescent death. This entry describes the epidemiology and explanatory models as background; it is not a crisis resource and provides no clinical risk-assessment, safety-planning, or treatment guidance.

Epidemiology

Non-suicidal self-injury commonly begins in early-to-mid adolescence, with meta-analytic lifetime prevalence in non-clinical samples in the order of one in six adolescents. Suicide is consistently among the leading causes of death in adolescents and young adults worldwide; self-harm is more frequently reported in females, whereas death by suicide is often higher in males, partly reflecting differences in method.

History

Adolescent self-harm and suicide moved from relative clinical neglect to a recognized public-health priority over recent decades, supported by large cohort and survey studies. Conceptual work increasingly separated non-suicidal self-injury from suicidal behavior and advanced ideation-to-action frameworks, articulated by O'Connor, Nock, and others, to explain why some adolescents move from suicidal thoughts to acts.

Debates

Relationship between non-suicidal self-injury and suicide

Whether non-suicidal self-injury is best seen as distinct from suicidal behavior or as part of a continuum is debated; it is clearly associated with increased later suicide risk, but the nature and mechanisms of that link remain under study.

Key figures

• Keith Hawton
• Rory O'Connor
• Matthew Nock
• Sarah Swannell

Seminal works

• hawton-2012
• oconnor-2014
• swannell-2014

Frequently asked questions

What is the difference between non-suicidal self-injury and suicidal behavior?

Non-suicidal self-injury is deliberate self-harm performed without intent to die, often serving emotion-regulation functions, whereas suicidal behavior involves some degree of intent to end one's life; they are distinct but related, and self-injury raises later suicide risk.

How common is self-harm in adolescents?

Meta-analytic estimates put the lifetime prevalence of non-suicidal self-injury in non-clinical adolescent samples at roughly one in six, with onset typically in early-to-mid adolescence.