Self-Harm and Suicide

Self-harm is a behavior; the patient’s intent determines how it is classified and how urgently the nurse responds. Nonsuicidal self-injury (NSSI) is intentional damage to body tissue without an intent to die. It may temporarily regulate overwhelming emotion, express distress, punish the self, or interrupt emotional numbness. NSSI is not a benign finding or a formal DSM-5-TR disorder, and it can coexist with suicidal behavior. The nurse must ask about intent rather than infer it from the wound, method, or apparent lethality. Any degree of intent to die makes the act a suicide attempt, even when the injury is medically minor. A patient may be ambivalent, regret the act, or say, “I did not really think it would work.” Ambivalence does not eliminate risk. Suicidal ideation ranges from a passive wish to be dead to active thoughts about killing oneself. Planning adds details such as method, time, place, or sequence. Intent means the person expects or is determined to act. Preparatory behavior—obtaining a weapon, saving medication, writing a note, researching a method, or giving away possessions—shows movement from thought toward...