There are many myths and stereotypes about those who harm themselves. In this section, we will outline some prevalent myths and consider some relevant research evidence.
In this video Professor Eugene Cassidy, Consultant Liaison Psychiatrist and Clinical Professor University College Cork/Cork University Hospital, discusses a number of myths associated with self-harm and suicide, outlines training available for frontline staff and mental health professionals, and provides advice on how to ascertain risk and ask about suicide.
“People who harm themselves seldom complete suicide”
Although self-harm is more common than suicide, previous self-harm is a very strong risk factor for suicide (Carroll et al, 2014). The risk of an eventual suicide is even higher when the previous self-harm episode involves highly lethal methods, such as attempted hanging and attempted drowning. However, most of those who engage in self-harm will not go on to die by suicide: efforts to intervene with people who have engaged in non-fatal self-harm can be very effective.
“There is a risk of evoking suicidal thoughts in a person’s mind if you ask about it”
There is strong evidence from a systematic review (Dazzi et al, 2014) that asking about suicidal ideation does not render a person more likely to experience ideation, and indeed reduces feelings of distress at follow-up. This suggests that asking a client about suicidal ideation or behaviour will not prompt suicidal ideation or increase distress, but rather creates a valuable opportunity to intervene with people at risk of translating suicidal ideation into action.
“As long as a person talks about suicide, they will never act on it. They are only looking for attention”
There is no evidence to support the common myth that anyone who discloses suicidal plans is at lower risk of acting on them. A disclosure of a suicidal plan should be taken serious until proven otherwise. “Attention-seeking” is a rare motive for self-harm: much more commonly reported motives are a wish to die, an attempt to escape unbearable mental pain, and self-punishment.
“People who cut themselves are not suicidal”
Self-cutting is the most common method of self-harm found in community samples. Among those who present to hospital, self-cutting is associated with a higher risk of repetition of self-harm and a higher rate of eventual suicide (Hawton et al, 2012), compared with overdose. While self-cutting episodes are usually associated with lower suicidal intent, there is rarely zero suicidal intent. Those who self-cut form a group at higher risk of negative outcomes and should be considered as ‘seriously’ as other self-harm cases. Men are a particularly vulnerable group and show a higher lethality of self-cutting compared to women ( Larkin et al, 2014).
“Once a person has had suicidal thoughts, he/she will never let them go”
Most people who experience suicidal ideation or who harm themselves will not go on to die by suicide. A suicidal crisis is time-limited (about 24-48 hours) and should be considered a medical emergency. If a person can be kept safe during this period, it is more likely than not that they will never die by suicide.