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Thoughts about harming or killing oneself are called thoughts of self-harm. They can be seen as a psychological cry for help in a situation that seems hopeless. If the person is out of resources and has difficulty finding ways to move forward in life, they may have desperate thoughts such as “death would make things easier”. Thoughts of self-harm can also occur without any wish to die. In this case, the aim is usually to punish or to hurt oneself or to relieve one’s mental pain. Thoughts of self-harm do not necessarily mean that the person would really want to die or hurt themselves but are more a way to try to get rid of the unbearable feeling.

Thoughts of self-harm commonly occur in connection with mental health disorders such as depressive episodes, recurrent depressive disorder, bipolar disorder, psychoses, anxiety disorders, substance abuse and some personality disorders. Loneliness, bereavement, and difficult situations in life may also cause thoughts of self-harm. Life events that lower self-esteem or social status can increase the risk of developing both self-harm related thoughts and behaviour.

Thoughts of self-harm are quite common. One in ten adults has thought about suicide during the past year. Thoughts of self-harm vary from temporary death wishes to long-term thoughts resulting in self-harm behaviour.

Self-care instructions for thoughts of self-harm

  • Remember that thoughts of self-harm are only thoughts and you don’t have to follow them.
  • Try to understand the reason behind your thoughts of self-harm: Do you feel trapped with no way out? Can you no longer find ways to deal with a situation that seems desperate? Is there too much stress in your life? Are you out of resources?
  • Talk about your thoughts. When you say them aloud, you may distance yourself from them and realise that there are other solutions available.
  • Discuss your thoughts and situation with someone you trust.
  • Avoid alcohol and other intoxicants, as they worsen the hopelessness and increase the likelihood of impulsive behaviour.

When should you seek treatment?

Thoughts of self-harm should be taken seriously. If you have such thoughts for the first time or if they’ve become constant or stronger, you should contact a healthcare professional.

If you find it hard to take your thoughts of self-harm as mere thoughts and are afraid that you may move from thoughts to action, seek emergency help at your own health centre or the nearest emergency clinic.

Seek treatment immediately if you have a strong urge to commit suicide, if you have a suicide plan or if you have deliberately harmed yourself.

Treatment of thoughts of self-harm

Treatment starts by determining the reasons behind the thoughts of self-harm. If such thoughts occur in connection with a mental health disorder, the treatment plan should be based on the disorder. During treatment, it’s useful to learn to realise that these are only thoughts, and to find ways to process them in other ways than self-harm. Cognitive psychotherapy can be used.

Information sources: Suomen Mielenterveysseura (Mental Health Finland), Mielenterveystalo.fi (MentalHub.fi)

FSHS Psychologist / 26 January 2024

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