Is non-suicidal self-injury (NSSI) the same as suicide?

Non-suicidal self-injury (NSSI), also known as self-harm, self-mutilation, or cutting, is the deliberate, self-inflicted destruction of body tissue, done without suicidal intent. Although NSSI is done without suicidal intent, the behaviors can escalate to suicide. The average age of onset for NSSI is between 12 and 14 years old; it is most common with adolescents and young adults, but there are very young children who self-injure. NSSI often co-occurs with another mental health disorder, such as anxiety or depression.

NSSI is a powerful communicator of emotional pain. It is sometimes used to cope with overwhelming emotions such as anger, guilt, or sadness or to express feelings too difficult to put into words. Other reasons people give as to why they self-harm is that it helps them have control over past pain and trauma, to punish themselves, distract them from their life, or to feel alive. It can be a learned behavior or a way to “fit in,” but use caution in assuming that is the case, as it still can be a way of asking for help. Some adolescents who self-harm explain the motive to self-harm by using the Novocain analogy. They say it (the Novocain injection) hurts initially, but then the pain (of the toothache) goes away, temporarily.

Stress may lead to increased use of NSSI behavior as a coping skill to manage overwhelming emotions. Self-harming behavior increases the adult risk of long-term behavioral health issues, risk-taking behaviors, and suicidal behavior. There is some research which shows NSSI can be an important risk factor for suicide.

Questions about any marks or injuries should be nonthreatening; remain calm and avoid overreacting or panicking, as negative reactions will minimize your child asking for help or talking with you about their behavior.

Suicidal youth will not typically seek out assistance on their own, so observing these warning signs and acting immediately are key steps in the prevention of youth suicide.

What are districts required to do?

School districts must identify methods for addressing the needs of students for suicide prevention, including a parental notification procedure. Districts must also include strategies and methods for suicide prevention in campus and district improvement plans.

Curriculum and awareness

Suicide prevention has been added to the mental health curriculum. School Health Advisory Councils (SHACs), which now include school counselors, advise and are charged with strategies and policies to raise parental awareness of warning signs for suicide, mental health disorders, and substance use disorders. By law, SHACs must now advise on curriculum for elementary, middle school, and, if applicable, high school health. Additionally, physical health and mental health are integrated in the health curriculum.

What should I know?

It is important to talk about all aspects of health with your children, including behavioral health. Communicate in a simple and straightforward manner. They are looking to you for how they should react, so if you appear to be uncomfortable, they may see it as a taboo topic, or one they should feel ashamed of. Have conversations beyond asking about their teacher, school day, or homework, and ask open-ended questions (questions that cannot be answered simply by saying yes or no.) Examples of open-ended questions include:

• What are three things I don’t know about you?
• If you could change something in your life, what would it be?
• What do you like about your friends?” or “What was the best (or worst) part of your week?

Sometimes children are so used to answering “I don’t know” to a question that it may take a few seconds or minutes for them to think about an answer. Be patient and let them know that you care about them and that you will wait for an answer other than “I don’t know,” or “I’m fine.”

If you notice that your child is overwhelmed, stressed, sad, anxious, or not acting like themselves, ask your child about it. Talk with your child about what is going on in their world, whether they have anything that is concerning them, how they are feeling, and that you care about them and want to hear what is weighing on their heart or mind. You can begin these conversations by simply asking them, “You look (sad) today. What is going on?” or “You look (sad) today. What happened?”

Do not ignore, minimize, or dismiss your observations. If they say they are okay, but you do not believe them, continue to talk with them, encouraging them to open up by talking about what you are noticing.

Be sure to listen to your child and avoid judgment, threats, or ultimatums. Children and adolescents are keen observers of the behaviors of adults in their lives, noticing whether the adult (you, teachers, coaches, etc.) keeps their word, can be trusted, and whether they are genuine. Are your actions consistent with what you tell your child? If you tell your child that you care about them, but you rarely talk with them, or when they come to you with a problem, you do not look up from your phone or computer, they will believe you do not care. This is also true with how you react. If you are quick to minimize, dismiss, or talk poorly about their friends, relationships, problems, or experiences, they will believe you do not care about them.

Model healthy behaviors, both for physical health and for mental health, including talking about mental health openly, learning from your mistakes, taking care of your health, and seeking therapy when it is needed.

Assure your child that you are on their side and that you are a team. They can tell you anything, and you will work through any problems together.

If you have a family history of, or your child has a history of mental or behavioral illness, especially depression, anxiety, substance use, suicide attempts, suicidal thoughts, or self-harm, this should be monitored closely by a mental health professional.

It may be helpful to ask, “Do you want me to just listen, or do you want me to fix it?” When your child talks about something they are going through, it can be hard to listen to their experience and not want to fix it. Resist the urge to offer solutions. From your child’s perspective, offering solutions may feel like you do not care about them or that you are not truly listening to them, but that you just want to fix it.