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Nonsuicidal self-injury (NSSI) is associated with suicidal ideation (SI) and capability for suicidal behavior. This chapter describes theoretical models of suicide in relation to NSSI, with implications for research and clinical practice. First, theories emphasize cognitive influences on suicide associated with NSSI, such as rumination, impaired problem-solving, and negative attributional style. These factors may exacerbate hopelessness, increasing risk for both NSSI and SI. Second, interpersonal difficulties are core to several suicide theories. NSSI is associated with loneliness, poor social support, and victimization; moreover, NSSI may prompt negative reactions from others, exacerbating interpersonal risk factors for SI. Finally, suicide theories often highlight the role of negative views of self in desire for suicide. NSSI is strongly associated with self-criticism, occurs as a means of self-punishment, and is frequently followed by guilt and shame, which may exacerbate negative self-views contributing to SI. NSSI is also associated with suicide capability. This may be due to differences in pain sensitivity or tolerance, fearlessness about death, exposure to painful and provocative events, or impulsivity, each of which has exhibited associations with NSSI. Further, NSSI involves repeated exposure to injury and pain, which may explain why chronic and severe NSSI elevates risk of suicide attempts. Taken together, research highlights the importance of assessing NSSI and suicide risk and protective factors in clinical practice, while leaving open unanswered questions about potentially causal relationships between these related, but distinct, experiences. Longitudinal work is needed to understand how NSSI most appropriately fits within existing theoretical models of suicide. |
