Self-Injury and Suicide: Practical Information for College Counselors.

The relationship between self-injury (SI) and suicide is largely unclear. However, researchers have suggested that clients who self-injure are at a heightened risk of suicide (Chapman & Dixon-Gordon, 2007; Toprak, Cetin, Guven, Can, & Demircan, 2011). Thus, it is important that college counselors be knowledgeable about both SI and suicide. In this article, the authors provide an overview of SI and suicide, as well as practical information for college counselors. Keywords: self-injury, suicide, counseling ********** Suicide and self-injury (SI) are complex treatment issues that can be dangerous, challenging to predict, and difficult to treat (Janis & Nock, 2008). Losing a client to suicide is likely every college counselor's worst fear. Similarly, SI evokes strong reactions from professional and lay communities alike (White, McCormick, & Kelly, 2003). Although the relationship between these two phenomena is not fully understood, researchers have found that individuals who self-injure are at an increased risk of suicide (Brausch & Gutierrez, 2010; Chapman & Dixon-Gordon, 2007; Toprak, Cetin, Guven, Can, & Demircan, 2011). Therefore, college counselors should be familiar with self-injurious behavior, signs of heightened risk, and specific indications for treatment. In this article, we present an overview of suicide and SI, followed by practical implications for the college counselor. Brief Overview of Suicide According to the U.S. Department of Health and Human Services (USDHHS; 2009), suicide is defined as deliberate and fatal self-harm with the presence of some intent to die as a result of the behavior. Because suicide is a major worldwide public health issue (Bebbington et al., 2010), substantial effort has been directed toward achieving a better understanding of it. When discussing suicide, one needs to differentiate between risk factors, warning signs, crises, attempts, and completions. Risk factors for suicide are those factors that have been empirically linked to suicide, such as gender, age, previous suicidal attempts, psychiatric diagnosis (Rudd et al., 2006), and childhood physical abuse (Fuller-Thomson, Baker, & Brennenstuhi, 2012). Rudd et al. (2006) proposed a differentiation of warning signs for suicide from risk factors, wherein warning signs indicate a near-term threat and risk factors indicate a long-term threat. Examples of warning signs include isolation, drastic changes in mood, hopelessness, anger and acting out, and increased use of alcohol and/or drugs. Stated concisely, warning signs for suicide are behavioral and observable (Van Orden et al., 2006) and episodic and variable, and they require immediate intervention (Rudd et al., 2006). The specific events that require immediate intervention because of an imminent threat of a suicide attempt or completion are referred to as suicide crises (Rudd et al., 2006). An accurate index of suicide statistics is difficult to calculate because of the deaths under unknown or questionable circumstances. A National Vital Statistics Report issued by the USDHHS indicated a total of 35,933 completed suicides in 2008, making suicide the 11th leading cause of death in the United States that year (Minino, Xu, & Kochanek, 2010). Current data indicate a rise in suicide rates. A report issued by the American Association of Suicidology stated that 39,518 people died by suicide in 2011, making suicide the 10th leading cause of death in the United States that year (McIntosh & Drapeau, 2014). Clear rates within the college population are difficult to obtain, in part because the cause of death is not always reported to the academic institution when the death occurs off campus. However, the current estimates of completed suicide are between six (J. C. Turner, Leno, & Keller, 2013) and seven per 100,000 students (Schwarz, 2011). Across the population, one person completes suicide roughly every 13. …