7 Common Self-Harm Conditions Linked to Suicide

What makes a mental health condition more perilous than others? Among the most common self-harm conditions are those associated with self-injury or suicide, which can stem from untreated mental health issues. And it is more common than you might imagine.

According to the National Institute of Mental Health, 20% of adults in the U.S. have a mental disorder of some type. This means almost 53 million Americans are struggling with mental health issues that have a wide array of symptoms ranging from mild to severe that may include self-injury.

It is crucial to address the underlying mental health conditions that drive these behaviors and seek help from a mental health provider. Could you or a loved one be at risk?

Understanding Self-Injury

Self-injury, also known as self-harm or non-suicidal self-injury (NSSI), involves deliberately hurting oneself without the intention of causing a lethal injury. This behavior can take many forms, including cutting, burning, biting, carving, scratching the skin, or hitting oneself.

Although these actions may provide temporary relief from stress, painful memories, and difficult emotions, they are maladaptive coping mechanisms that can lead to more severe mental health issues.

People who self-injure often do so to express emotions they cannot verbalize, to regain a sense of control, or to distract themselves from emotional pain. However, self-injury is not a sustainable or healthy way to manage emotions.

It is crucial to address the underlying mental health conditions that drive these behaviors and seek help from a mental health professional.

How Self-Harm Differs from Suicide

When a person deliberately hurts the surface of their body without intending to cause a lethal injury, it is referred to as self-harm or non-suicidal self-injury (NSSI), which are common self-harm behaviors. Repeatedly cutting, burning, biting, carving, and scratching the skin or hitting oneself are common forms of NSSI.

Although these are maladaptive coping mechanisms, such behaviors can temporarily provide a sense of relief from stress, painful memories, and difficult emotions—or even give someone a sense of control when faced with uncertain circumstances. For some people, it may also be a way to express suicidal thoughts to avert the possibility of acting on them.

Unfortunately, the symptoms of some mental health disorders can feel intolerable to those suffering from them and suicide might feel like the only way out.

In 2019, the CDC reported that suicide was the 10th leading cause of death in the U.S., and for individuals between the ages of 10 and 34, it was the 2nd highest cause of mortality. Research has also found that people who engage in NSSI are at a much higher risk for suicide compared with the general population.

Why People Self-Harm

People self-harm for a variety of reasons, including:

• To cope with emotional pain or distress
• To regain a sense of control in their lives
• To express feelings that they cannot verbalize
• To punish themselves for perceived wrongdoings
• To distract themselves from emotional pain
• To feel something physical when they are numb emotionally

Self-harm can be a way for individuals to deal with negative feelings, such as low self-esteem, anxiety, or depression. However, self-harm is not a sustainable or healthy way to manage emotions.

Seeking help from a mental health professional is essential for recovery, as they can provide the necessary support and treatment to address the underlying issues and develop healthier coping strategies.

7 Mental Health Conditions Most at Risk for Self-Harm and/or Suicide

The potential for severe symptoms in common self-harm conditions makes individuals more vulnerable to engaging in self-injury or even suicidal behaviors. Understanding these conditions is crucial for effective intervention.

While not an exhaustive list, here are seven of the most common disorders that have an increased risk for these behaviors:

1. Bipolar Disorder

Approximately half of the people with bipolar disorder engage in NSSI at least once in their life, according to a study published in the Journal of Nervous and Mental Disease.

Because symptoms in this condition can be very severe, the lifetime risk for suicidal behavior is believed to be about 20 to 30 times greater for those who have it. Sadly, 5-6% will intentionally end their life.

Females with bipolar disorder tend to make more suicide attempts, but males are more likely to have fatal results. While some factors influence suicidality in this condition, research has found that the most prominent one is a depressed mood state—which, in bipolar disorder, can be debilitating.

2. Borderline Personality Disorder

Characterized by impulsivity and instability in many areas of life, the Diagnostic and Statistical Manual for Mental Disorders (DSM-5TR) also includes repeated self-harming behavior as well as suicidal thoughts, threats, and attempts as one of the criteria for a diagnosis of this condition.

Repeated incidents of NSSI are common in borderline personality disorder and may be used to help manage the intense emotions they experience, offset feelings of unhappiness, or cope with distress. Self-harm may also occur during dissociative states.

Suicidal behavior is prevalent too. While some threats may be attempts to avoid abandonment or for other manipulative purposes, the risk of completed suicide for those with borderline personality is as high as 6%.

3. Depression and Anxiety Disorders

The previously referenced research from the Journal of Nervous and Mental Disease also found that 37% of people with unipolar depression (as opposed to bipolar depression) had engaged in NSSI at least once.

What’s even more concerning, however, is that some of the symptoms inherent in this disorder—especially hopelessness and an inability to experience joy or pleasure in life—are known to increase the chances of making a suicide attempt. Overall, people suffering from major depressive disorder have a 17-fold greater risk of taking their own life.

Depression often co-occurs with anxiety disorders, such as generalized anxiety disorder, panic disorder, and social anxiety disorder, which can significantly contribute to self-injury behaviors. Individuals with these conditions often experience overwhelming feelings of fear, worry, and apprehension.

In an attempt to cope with these intense emotions, they may turn to self-injury as a temporary relief. However, this behavior can exacerbate the underlying anxiety disorder, creating a vicious cycle of distress and self-harm.

Mental health professionals play a crucial role in helping individuals with anxiety disorders develop healthier coping mechanisms. Through helpful forms of therapy and, in some cases, medication, they can address the root causes of anxiety and reduce the reliance on self-injury as a coping strategy.

4. Early Trauma and Post-Traumatic Stress Disorder (PTSD)

Early trauma, such as physical or emotional abuse, neglect, or bullying, can have a profound impact on an individual’s mental health. Those who experience early trauma may develop negative coping mechanisms, including self-injury, to deal with their emotions. Although self-injury may provide temporary relief from emotional pain, it can perpetuate a cycle of negative behaviors and further harm mental health.

A study published in the International Journal of Environmental Research and Public Health found that individuals with four or more adverse childhood experiences (ACEs) were more likely to repeatedly engage in NSSI and had a 12 times greater risk of committing suicide.

Mental health professionals can help individuals who have experienced early trauma by providing therapy and support to develop healthier coping mechanisms. Addressing the underlying mental health conditions is crucial for breaking the cycle of self-injury and promoting long-term recovery.

Some people who experience trauma can develop post-traumatic stress disorder (PTSD), a severe mental health condition. Individuals with PTSD often suffer from flashbacks, nightmares, and severe anxiety, which can lead them to engage in self-injury behaviors. For some, self-injury becomes a way to cope with overwhelming emotions and regain a sense of control over their lives.

However, self-injury can worsen PTSD symptoms and increase the risk of suicidal behaviors. Individuals with PTSD need to seek professional treatment, such as cognitive-behavioral therapy (CBT) and medication, to manage their symptoms and develop healthier coping mechanisms.

5. Eating Disorders

Self-harming behaviors often accompany this group of mental health conditions—especially anorexia and bulimia—which most frequently affect adolescents. A study that analyzed the relationship between NSSI and eating disorders found up to 42% of people with anorexia and as much as 55% of those with bulimia engaged in self-harming behaviors.

According to the DSM-5TR, 25-33% of people with bulimia struggle with suicidal thoughts and attempts, while suicide is the second leading cause of death for those suffering from anorexia.

6. Schizophrenia

Self-harm is not unusual for people who have this severe mental illness. In fact, researchers studying NSSI in those with schizophrenia found that when they had a co-occurring substance use disorder (mostly cannabis), the prevalence of self-harm was 43.6%.

Suicidal ideation is also very common in this condition and 20% of people who are schizophrenic will attempt suicide at least once. Sometimes the decision to do so is the result of delusions or demands that come from their hallucinations. There is a high lifetime risk for suicide and 5-6% of people with this condition will intentionally end their life.

7. Substance Abuse/Alcohol Use Disorders

Addictions are often linked to untreated mental health problems, including all the ones listed above. Therefore, it is not surprising that self-harming behaviors are also found in some people who struggle with alcohol or substance abuse, which by their inherent nature, exacerbate underlying psychiatric symptoms.

Even outside the presence of addiction, it is well-established that alcohol and illicit drugs diminish a person’s judgment and impulse control, which can increase the possibility that an act of intentional self-harm will accidentally cause a fatal injury.

Furthermore, disinhibition combined with the intensity of painful emotions can elevate the chance of someone becoming suicidal. Research that examined the suicide risk in people with alcohol and opiate use disorders found that at the time they took their own life, 22% had used alcohol, 20% had used opioids, and 10.2% had used marijuana.

Co-Occurring Mental Health Problems are Common

Many people who struggle with these conditions have more than one type of mental health problem, thus increasing the risk of self-harm and suicide.

For example, about 50% of those with bipolar disorder also have alcohol use disorder, which can significantly worsen symptoms, especially during a depressed or psychotic state. Many people with borderline personality have co-occurring depression or bipolar disorder, substance abuse, an eating disorder, or other mental health conditions.

Understand that spotting the warning signs of self-injury can be challenging. For instance, in hot weather, children may conceal self-harm injuries by wearing long sleeves or jewelry, making it challenging to recognize the signs of self-harm.

These complex problems illustrate the critical importance of getting correctly diagnosed and receiving effective treatment as soon as possible to help stop the consequences of self-harming behaviors and offset the potential for a tragic ending.

***PLEASE NOTE:***If you observe warning signs of self-harm on a loved one (i.e. otherwise unexplainable scars, cuts, and bruises), talk with them about what is going on in their life—without judging or shaming—and encourage them to accept the need for professional help.

If you notice someone making statements about not wanting to be alive, it is a cry for help and should be taken seriously. Or, if a loved one is giving away their belongings, finalizing business matters, or purchasing a weapon or other lethal means, consider it an urgent situation that needs to be addressed immediately by a mental health professional. Call 911 or take the person to the nearest emergency room if you believe they are in crisis.

If you have concerns for yourself or someone you know, put the National Suicide Prevention Lifeline numbers in your phone directory: 800-273-8255 and 988. It is staffed 24/7 by trained counselors who provide compassionate and knowledgeable support as well as connections to helpful resources.

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Reviewed by Amen Clinics Inc. Clinicians