RISK OF IMMINENT HARM THROUGH SELF-INJURIOUS BEHAVIORS
Nonsuicidal self-injuries (NSSI) are defined as “behaviors engaged in with the purposeful intention of hurting oneself without intentionally trying to kill oneself” (Sadek, 2019). Other terms used are self-injurious behavior, self-mutilation, cutting, deliberate self-harm, delicate self-cutting, self-
inflicted violence, parasuicide , and auto aggression (Sadek, 2019). Forms of NSSI include scratching, plucking hair, interfering with wound healing, cutting, burning, and hitting (Sadek, 2019).
Evaluating between nonsuicidal self-injury and a suicide attempt Evidence-based practice!
behaviors. Moreover, NSSI tends to reduce arousal for many of those who use it and, for many individuals who have considered suicide, it is used as a way to avoid attempting suicide. ● Presence of cognitive constriction : Cognitive constriction is black-and-white thinking—seeing things as all or nothing, good or bad, one way or another. It allows for little ambiguity. Individuals who are suicidal often experience high cognitive constriction; the intensity of cognitive constriction is less severe in individuals who use NSSI as a coping mechanism. ● Aftermath : The aftermath of NSSI and suicide can be strikingly different. Although unintentional death does occur with NSSI, it is not common. After a typical NSSI incident, well-being and functioning improve for a short amount of time. The aftermath of a suicide-related gesture or attempt is precisely the opposite. Despite the different intentions associated with NSSI and suicidal thoughts and behaviors, it is important to note that they share common risk factors. These include (Whitlock et al., n.d.): ● History of trauma, abuse, or chronic stress. ● High emotional perception and sensitivity. ● Few effective mechanisms for dealing with emotional stress. ● Feelings of isolation (this can be true even for people who seem to have many friends or connections). ● History of alcohol or substance abuse. ● Presence of depression or anxiety. ● Feelings of worthlessness. Health care professionals are in a unique position to prevent suicide due to their frequent contact with patients, and they should use a multifactorial approach to screen patients for suicidality to assess their risk level, conduct a thorough assessment, and appropriately refer patients to services. ○ Zero Suicide . This organization has created a toolkit to help transition individuals through care. Website: https://zerosuicide.edc.org/toolkit/ transition#quicktabs-transition=1 ○ Zero Suicide, Universal Health Services Inc., Behavioral Health Division has a detailed suicide care management plan template for inpatient hospital settings. Website: https://zerosuicide.edc.org/sites/default/ files/UHS%20Inpatient%20Suicide%20Care%20 Management%20Plan%20Template.pdf
A review of 22 empirical studies found that the adolescent lifetime prevalence of self-injury is 13% to 23% (Sadek, 2019). The typical age of onset is between 12 and 14 years of age (Sadek, 2019). Risk factors for NSSI include a history of sexual abuse, a higher number of adverse childhood events (ACEs), depression, anxiety, eating disorders, alexithymia, hostility, low self-esteem, antisocial behavior, smoking, and emotional reactivity (Sadek, 2019). While self-injury is a risk factor for suicide, they differ in several important ways, including (Whitlock et al., n.d.): ● Expressed intent : The expressed intent of NSSI is almost always to feel better, whereas for suicide, it is to end feeling (and subsequently, life) altogether. ● Method used : Methods for NSSI typically cause damage to the surface of the body only; suicide-related behaviors are potentially lethal. Notably, it is uncommon for individuals who engage in NSSI and who are also suicidal to identify the same methods for each purpose. ● Level of damage and lethality : NSSI is often carried out using methods designed to damage the body, but not to injure the body sufficiently enough to require medical intervention or to end life. Suicide attempts are always more lethal than standard NSSI methods. ● Frequency : NSSI can vary in frequency and is often contingent on the experience of stress and other difficult emotions; suicide-related behaviors are much rarer. ● Level of psychological pain : The amount of distress experienced when engaging in NSSI is often significantly lower than that which gives rise to suicidal thoughts and Conclusion Death by suicide is one of the top 10 leading causes of death in the U.S. for people ages 10–65 (CDC, 2022). Suicidal behavior takes an emotional toll on family and friends and an economic toll on society. Therefore, suicide prevention and treatment must be addressed throughout the healthcare community to prevent the further loss of life. Resources Below is an extensive resource list borrowed from the National Action Alliance for Suicide Prevention (2019) of suicide-related resources filtered by topic. ● Suicide Care ○ National Action Alliance for Suicide Prevention . This organization lists recommended standard care practices for people with suicide risk. Website : https://theactionalliance.org/sites/default/ files/action_alliance_recommended_standard_care_ final.pdf ○ U.S. Department of Veterans Affairs (VA)/U.S. Department of Defense (DoD) . The VA and DoD have created their own guidelines for the assessment and management of patients at risk for suicide. Website: https://www.healthquality.va.gov/ guidelines/MH/srb/
● Suicide-Specific Therapy Approaches ○ Dialectical behavioral therapy (DBT) . Website: https://behavioraltech.org/ ○ Cognitive-behavioral therapy (CBT).
Website : https://www.sprc.org/resources-programs/ cognitive-therapy-suicide-prevention ○ Collaborative Assessment and Management of Suicidality (CAMS). Website : https://cams-care.com/
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Book Code: SWPA1525
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