When parents, teachers, or loved ones discover that someone they care about is engaging in some kind of self-harm, their natural response is one of fear. And usually it’s a specific fear: Does this mean s/he is going to commit suicide? Almost every family that we treat asks this question, and for good reason. The mere idea of self-harm brings with it a host of misunderstandings and misconceptions, especially when the self-harm comes in the form of cutting. A laceration on the underside of the arm, close to the wrist and major arteries (the most common presentation), sure looks a lot like suicide. It makes sense that families and loved ones would worry about this.
The question is a good one. Can NSSI lead to suicide? The answer is complicated. On one hand, no. Of course not. NSSI stands for “non-suicidal self-injury” and the answer is in the question. Something that is non-suicidal is, by definition, not likely to lead to suicide. Self-harm is actually better understood as a coping mechanism, and as controversial as this may seem, as long as someone is coping, they’re fighting. In this way, self-harm is a statement of survival. Someone who is coping has made an active decision to see a problem through to the other side. It’s the opposite that scares us: Someone who has stopped coping has given up. This is a suicidal person.
However, on the other hand, yes. Self-harm can lead to suicide. But pay attention to the rationale here. Self-harm can lead to suicide in the same way that anything can lead to suicide. An eating disorder can lead to suicide. A drug addiction can lead to suicide. A divorce can lead to suicide. Death of a loved one can lead to suicide. The list goes on and on, and after a moment of simple logic, you’ll find that anything in life can lead to suicide.
The problem with seeing self-harm (or any problematic behavior) this way is the phrasing: It’s not so much that self-injury leads to suicide, just as eating disorders and drug addictions themselves don’t lead to suicide. It’s the underlying problem that leads to suicide. Self-injury, like an eating disorder or a drug addiction or any other problematic coping, is simply that—coping. You have to ask the cutter (or burner or carver) what it is they’re coping with. The issue isn’t the coping, rather it’s the problem the person is attempting to cope with. If the problem isn’t addressed, and the coping stops working after a while, then yes, a person could become suicidal. Anyone can.
The moral of the story here is simple: If someone is self-injuring, there’s a problem that needs solving. The trick is to shift your focus from the self-harm itself to the underlying problem (which can be incredibly hard!). And often, this takes a professional’s help. A cutter isn’t always open about what’s really at the core. Mental health professionals, especially family therapists, are trained to get to the bottom of it. That’s what we’re here for.
-Angela Kahn is the Founder and Director of KISI