Self-Harm and Suicidal Thoughts and Behaviors

What Are Self-Harm And Suicide?

Signs And Symptoms Associated with Self-Harm and Suicide

Psychological Models and Theory of Self-Harm and Suicidal Thoughts and Behaviors

• Dialectical Behavior Therapy (DBT), which views suicide and self-harm as the product of emotional dysregulation. Linehan views emotional dysregulation (the inability to change or regulate emotional cues, experiences, actions, verbal or nonverbal responses) as a product of an interaction between biological vulnerability and an invalidating environment (Linehan, 2014).

• Joiner’s Interpersonal Theory of Suicidal Behavior (Joiner, 2005; Van Orden et al., 2010), which proposes that suicidal desire is caused by “thwarted belongingness” and “perceived burdensomeness” (and hopelessness about these states). The model also proposes that the desire to engage in suicidal behavior is separate from the capacity to engage in suicidal behavior—capability is said to emerge in response to repeated exposures to physically painful and/​or fear-inducing experiences.

• The Experiential Avoidance Model of deliberate self-harm (Chapman, Gratz, & Brown, 2006) proposes that deliberate self-harm is maintained by negative reinforcement in the form of escape from or avoidance of negative emotional experiences.

• The hopelessness theory of suicidality (Abramson et al., 1989 / 2002) proposes a causal chain in which life events are perceived as negative, stable (i.e., unlikely to change), global (i.e., affect many outcomes), likely to lead to other negative outcomes or consequences, and seen as implying that the individual concerned is flawed, unworthy, or deficient. The result of this chain is hopeless depression and suicidality.

Evidence-Based Psychological Approaches for Working with Self-Harm and Suicidal Thoughts and Behaviors

• DBT, which targets the development of emotional regulation skills;

• trauma-focused therapies, which target the experiences which can trigger self-harm;

• cognitive behavioral treatments for depression and suicidal thinking.

Resources for Working with Self-Harm and Suicidal Thoughts and Behaviors

• psychological models of self-harm and suicidal thoughts and behaviors

• information handouts for self-harm and suicidal thoughts and behaviors

• exercises for self-harm and suicidal thoughts and behaviors

• CBT worksheets for self-harm and suicidal thoughts and behaviors

• self-help programs for self-harm and suicidal thoughts and behaviors

References

• Abramson, L. Y., Metalsky, G. J., & Alloy, L. B. (1989). Hopelessness depression: A theory-based subtype of depression. Psychological Review, 96(2), 358–372.

• Abramson, L. Y., Alloy, L. B., Hogan, M. E., Whitehouse, W. G., Gibb, B. E., Hankin, B. L., & Cornette, M. M. (2000). In T. E. Joiner & M. D. Rudd (Eds.), Suicide science: Expanding the boundaries(pp. 17–32). New York: Springer.

• Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self-harm: The experiential avoidance model.Behaviour Research and Therapy, 44(3), 371–394.

• Joiner, T. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.

• Kessler, R. C., Borges, G., & Walters, E. E. (1999). Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Archives of General Psychiatry, 56(7), 617–626.

• Kreitman, N. (1977). Parasuicide. New York: Wiley.

• Linehan, M. M. (2014). DBT skills training manual(2nd ed.). New York: Guilford Press.

• Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. E. Jr. (2010). The interpersonal theory of suicide. Psychological Review, 117(2), 575–600.

• Velamoor, V. R., & Cernovsky, Z. Z. (1992). Suicide with the motive ‘to die’ or ‘not to die’ and its socioanamnestic correlates. Social Behavior and Personality,20(3), 193–198.