The Differences between Self-Harm and Suicide

Self-harm and suicide are often talked about as if they were the same thing, and sometimes as if one did not matter as much as the other. Both are signs that a person is in real pain and needs support. Understanding how they differ, and how they are connected, can help you respond with care rather than fear or judgement, whether you are worried about yourself or about someone you love.

What is self-harm?

Self-harm means a person hurts their own body on purpose. Many people who self-harm describe it as a way of coping with feelings that seem unbearable, such as overwhelming sadness, anger, shame, loneliness or numbness. Others use it to punish themselves, or to feel something when they feel empty. Self-harm can happen at any age, but it often starts in adolescence.

Self-harm is not “just attention-seeking”, it is not a trend, and it is not something a person can simply be told to stop. It is a signal that someone is struggling and has not yet found a safer way to cope or to be heard.

What is suicide?

Suicide is death caused by a person ending their own life. Suicidal thoughts can range from feeling that life is not worth living, to thinking about dying, to making plans. These thoughts often grow out of intense hopelessness and the feeling that the pain will never end. They can come with depression and other mental health conditions, but also after a crisis such as a loss, a breakup, bullying, debt or abuse. Suicidal crises can also develop quickly.

According to the World Health Organization, more than 720,000 people die by suicide every year, and suicide is the third leading cause of death among 15 to 29-year-olds (WHO suicide fact sheet). Suicide is preventable, and help makes a difference.

How are self-harm and suicide different?

The main difference is intention. A person who self-harms is often trying to get through an overwhelming moment, not to die. A person who is suicidal wants the pain to end and may see death as the only way out. But the line between them is not always clear, and it can change over time:

• Someone who self-harms can also have suicidal thoughts, at the same time or later on.
• Injuries from self-harm can be serious and can need medical care, even when the person did not intend to die.
• It is not possible to judge how much danger someone is in from the kind or size of an injury. Only a careful conversation, and ideally a professional assessment, can do that.

Self-harm is a serious risk factor for suicide

It is a myth that self-harm is “not serious” because the person did not want to die. Clinical guidance from the UK’s National Institute for Health and Care Excellence states that people who have self-harmed are at greatly increased risk of suicide, especially in the year after they come to hospital for self-harm (NICE guideline NG225, 2022). The WHO also identifies a previous suicide attempt as an important risk factor for suicide.

This is why every episode of self-harm deserves to be taken seriously, met with compassion and followed up with proper support, without panic and without punishment.

Signs that someone may be struggling

There is no single sign, and many people hide their pain well. Things that may suggest someone needs support include:

• Unexplained injuries, or covering up their body even in hot weather
• Talking about feeling hopeless, worthless, trapped or like a burden to others
• Talking or writing about death, dying or wanting to disappear
• Withdrawing from family, friends and things they used to enjoy
• Big changes in sleep, eating or mood, or seeming unusually calm after a period of distress
• Drinking more or using drugs
• Giving away belongings or saying goodbye in unusual ways

How to respond if someone tells you they self-harm

• Stay calm and listen. Shock, anger or disgust can make the person feel more ashamed. Thank them for trusting you.
• Focus on the feelings, not the injury. Ask what has been going on for them and how you can help.
• Avoid ultimatums. Demanding that they “just stop” or making promises you cannot keep often pushes self-harm out of sight rather than reducing it.
• Make sure injuries are cared for. If an injury looks serious, get medical help straight away.
• Encourage professional support and offer to help them find it, for example by sitting with them while they call or make an appointment.

How to talk about suicide safely

Many people worry that asking about suicide will “put the idea in someone’s head”. It does not. Asking directly and calmly can be a relief for someone who has been carrying these thoughts alone.

• Ask clearly: “Sometimes when people feel this bad, they think about ending their life. Are you thinking about suicide?”
• Listen without arguing, lecturing or trying to talk them out of their feelings.
• Do not promise to keep it a secret if their life may be at risk. You can say that you care too much to keep it to yourself.
• If they are in immediate danger, do not leave them alone. Call 999 or take them to the nearest emergency department.
• Help them connect with a crisis line, a doctor, a counsellor or a psychologist, and check in with them again afterwards.

When talking or posting about suicide, avoid words like “commit” or “successful”, do not describe methods, and do not present suicide as a solution. Talk about hope, help and recovery instead.

When to seek help

Reach out for professional support if you or someone you know is self-harming, has thoughts of suicide, or feels hopeless for more than a short while. Effective help exists. Counselling and psychological therapy can help people understand what drives their distress, find safer ways of coping, and build a plan for staying safe when things feel overwhelming. A doctor or psychiatrist can also assess whether medical treatment would help. Only a qualified professional can assess risk and make a diagnosis.

At BeLive in Psychology, our registered psychologists and counsellors offer confidential support in English, Bahasa Malaysia and Chinese. You can learn more about counselling, depression counselling or support for children and teenagers. If you are a parent or student, you may also find our guide to student mental health and academic pressure helpful.

Related reading

• Teen suicide: warning signs and how parents can help
• Student mental health and academic pressure in Malaysia
• Free depression self-check

This article is for general education only and is not a substitute for professional assessment, diagnosis or treatment.

Written & reviewed by Jackie Yong

CEO & Consultant Senior Counselling Psychologist, BeLive in Psychology · View profile