Students Experiencing Self-Injurious Thoughts and Behaviors

SITBs can generally be grouped into two main categories: non-suicidal self-injury (NSSI) and suicidal thoughts and behaviors. NSSI refers to intentional harm to one’s own body without the intent to die. The most commonly used methods of NSSI are cutting, scratching, and burning oneself—often on the arms, legs, or torso. NSSI is uncommon among young children and increases with age during adolescence (typically starting with the onset of puberty at around at age 12). Approximately 6% of children report engaging in NSSI, with this rate increasing to approximately 20% of high school students reporting engagement in NSSI at least once in the past year (Liu et al., 2022; Swannell et al., 2014).

Suicidal thoughts (or ideation) and behaviors are thoughts and/or self-injurious behaviors a person engages in with the intent of ending their own life. Suicidal thoughts and behaviors are relatively rare among young children, but increase dramatically beginning in middle school (at around age 12). By the time students are in high school, 22% of students report seriously considering suicide in the past 12 months, 18% make a plan to kill themselves, and 10% actually attempt to kill themselves (3% making a suicide attempt requiring medical treatment) (Centers for Disease Control, 2024b). Of note, girls experience suicidal thoughts and behaviors at approximately twice the rate of boys.

We spend a lot of our time as humans trying to stay healthy and prolong our lives: eating well, exercising, taking medicine, and so on. So why, in some cases, do people intentionally hurt themselves and try to end their lives? This question has confused many people, and can lead some individuals to not want to even talk or think about SITBs. Understanding, however, why youth engage in these behaviors can help teachers and other adults be in a much better position to aid youth struggling with these problems.

NSSI: Research in the past few decades has made meaningful progress in helping us to understand why people hurt themselves. In short, people engage in NSSI because it temporarily decreases their negative thoughts and feelings. For instance, if someone is having very intense negative feelings or memories, intentionally hurting themselves may make them seem to go away for a while. It is not yet clear how exactly this works (e.g., distraction, a biological process, social support from others afterwards, a combination of factors). Research has shown that people report a significant reduction in negative thoughts and feelings immediately after engaging in NSSI (Nock, 2010). Treatments for NSSI that have proven to be most effective are those that teach people how to tolerate negative thoughts and feelings without engaging in harmful behaviors, as well as how to more effectively communicate with others and obtain social support without resorting to NSSI (Nock, 2010). Like a lot of risky and potentially harmful behaviors (e.g., alcohol and drug use), NSSI increases during adolescence and decreases later into adulthood. Furthermore, like other risky behaviors, it is concerning because NSSI is associated with increased risk of harm and potentially death. In addition to the risk of serious injury that comes with NSSI, it is a significant predictor of subsequently making a suicide attempt.

Suicidal behavior: Suicidal thoughts and behaviors differ from NSSI in that they involve some intention of dying as a result of self-harm. Suicidal thoughts and behaviors, however, are similar to NSSI because they are also motivated by a desire to decrease negative thoughts and feelings. A consistent primary motivation for suicidal behavior is to escape from seemingly unbearable psychological life circumstances. Researchers have done studies in which they interview people who tried to kill themselves, but survived, and a consistent primary motivation for suicidal behavior is to escape from seemingly unbearable psychological life circumstances (Nock et al., 2024). That is, people who try to kill themselves do not necessarily want to be dead, they just want relief from what appears to be inescapable psychological pain. This pain can come from the experience of intense depression, school or social pressures, chronic physical pain, family problems, or other stressors. Treatments for suicidal thoughts and behaviors that have proven to be most effective are those that teach people how to tolerate negative thoughts and feelings, and then let them dissipate without hurting themselves as a means of relief. The most helpful and important things that teachers and other school staff can do in this regard is to recognize the warning signs for suicide and take steps to get suicidal youth connected with a mental health professional.

NSSI: In addition to youth talking or writing about NSSI, those engaging in the behavior(s) can sometimes be identified by the resulting markings on their skin. Most youth who injure themselves do so on their arms (followed by their legs and torso), and injuries or scarring can sometimes be observed in these locations.

Suicide: Two-thirds of people who die by suicide told someone that they were thinking about death or suicide. The clearest warning sign for suicide is a person talking about wanting to be dead or expressing that they are having thoughts of suicide (Rudd et al., 2006). Having a suicide plan and taking steps toward implementing that plan should increase concerns about the person’s risk. For these reasons, all mentions of suicide, and all engagement in self-injurious behaviors, should be taken seriously.