Thoughts of Self Harm

 I can’t take it anymore!

I have had it!

I can’t bear to keep on living like this.

What is the point anyway?

No one would even notice if I was gone.

The world will be a better place without me.

No one cares about me.

Nothing I have tried works.

I would just be better off dead.

Maybe I will just kill myself.

 Does any of this sound familiar?

If you or someone you know has suffered severely enough from depression, you are undoubtedly familiar with one or all of these statements. In fact, they can be so severely intrusive that it may be the only self-talk you hear coming from within your mind.

All Thoughts of Self-Harm Should be Taken Seriously.

All Thoughts of Self-Harm Should be Taken Seriously.

Thoughts of self harm have co-existed with depression for as long as mankind has experienced depression and should be taken very seriously. If thoughts of self-harm, including thoughts of suicide, are present, professional mental health services should be sought. Skilled mental health professionals provide the necessary help to guide you through depression and help you return to a life of well-being.

The real concern comes when an individual begins to act on such thoughts and engages in the willful implementation of a plan to actually cause harm to oneself, or in the most dire situations, successfully completes suicide.

But what is it that causes a person to want to commit suicide in the first place? I do not believe that a person wakes up saying, “Today is a good day to die. That sounds like something I would really like to experience.” I honestly do not believe that death is the ultimate objective for those contemplating suicide. Consider this:

Freedom from pain and freedom from thinking about one’s pain is the ultimate objective for those who commit suicide. (See Healthy Living: “Don’t be Afraid of the Hard Stuff”) They primarily want to stop thinking and stop feeling. They have been thinking about their pain and feeling their pain for so long that they just want it to end.

After countless efforts of going through the “rolodex of options” to end this painful thinking and feeling, it is just a matter of time before death becomes an option. At this point, the problem solving becomes so narrow that death seems like the only viable option. After all, what other way is there to literally stop feeling and thinking? This is a cognitive distortion. We do not need to end our life to overcome such thinking and feeling, rather we need to find the way that best heals each of us from our pain. Empowered Life Solutions articles, Premium Content Workbook, Guided Imageries, and Relaxation Exercises can supplement (but are not intended to replace) the care received from a mental health professional.

When Someone You Know Expresses Thoughts of Self-Harm

A suicidal person usually does not ask for help. Most are ashamed and afraid to share any thoughts of suicide with friends or family, believing it will do no good. Similarly, many friends and family are unsure of how to respond to a loved one who expresses suicidal intentions. Friends and family should listen, without judgement, to anyone who expresses such intentions. Seek professional care from a mental health provider. Consult with a mental health professional, or call 911 if there is imminent threat.

You can help by understanding the warning signs. Some of the warning signs to be aware of include:

  • A complete and sudden shift from despair to complete calm (A sign the decision has been made with a feeling of relief because they believe the end of the pain is in sight)

  • Seeking out of lethal means (Hoarding or hiding pills, weapons, etc)

  • Self-hatred (Talk of how others would be better off without them around.)

  • Indications of saying goodbye (Giving away sentimental belongings.)

  • Indications of overwhelming feelings of hopelessness and despair

  • Increased social isolation and withdrawal.

If someone you know expresses thoughts of self-harm, do not dismiss expressions related to suicidal intentions. Doing so will only affirm the already established belief of the suicidal person that “no one cares.” Do not confuse listening with fixing or solving. You can offer empathy and support but the they must work through the underlying concerns. You can not do this for them.

Knowing you care can help.

Knowing you care can help.

So, the question then arises, “What can I do?” You help by having the courage to speak up if you are worried. Talk to the person and let them express their thoughts. If you can see the warning signs of suicide, have the courage to ask the question, “Are you thinking of harming yourself?” This is one time to be firm with your concerns. Be careful to not lecture, give shaming messages or put them on a guilt trip. Instead listen, offer support, and then seek professional help. Knowing that you care can make all the difference because the suicidal person has often gone to a place inside where they feel alone and worthless. Things that you can say that help are:

  • You are not alone.

  • Feelings shift over time. It may not seem like it now, but wait and see how you feel tomorrow.

  • I hear your sadness, and even though I might not completely understand, I care that this is so hard for you.

It can also help for you to get a future commitment from them. It can be as simple as “I will call you tomorrow at around nine.” Or, “I will see you tomorrow at school/work, right?” Don’t give advice or try to fix it, though. Rule of thumb is support, empathy, professional services. If there is immediate risk, do not leave the person alone. Call 911 or take them to the closest emergency room.

Suicide is not the only means of self-harm contemplated by those who are depressed. Other ways of incurring self-harm may include: substance abuse, developing an eating disorder, cutting, or burning oneself. All of these disorders should be addressed by seeking  professional help.



In order to assess the severity of one’s suicidal thoughts, a mental health professional will look at the following areas:

 1. Do you have a well-thought-out plan as to how you would commit suicide (higher), or just a very vague idea without any specifics (lower)?

 2. Do you have access to the means by which you would attempt suicide (higher), or would you have to go out of your way to obtain the means (lower)?

3. How lethal is the means once imposed on yourself? For example, does your plan include a firearm (higher), or taking a double dose of aspirin (lower)?

 4. What is the locale of your attempt and the chance of being found before you die? Alone in the mountains (higher), or in your room when all your roommates are around (lower)?

If any of your answers fall into the higher categories for any of these four questions, you should seek professional help by calling a local hospital, crisis line, mental health facility, mental health professional, or 911. Any thought or verbalization of suicidal intent should be taken extremely seriously. Do not leave such thoughts or intents unattended to by a professional.

 Let’s consider the following three examples, using the above stated assessment criteria:

Example Individual Circumstance Factors to Consider Degree of Risk
Person A Person A is wanting to attempt suicide. He has decided he will make his attempt next weekend on Friday night after work. He plans to shoot himself with the gun that is at home in his closet, using the bullets that were purchased last week. After work, he plans to drive out into the desert where he can be alone to commit this act.


  1. Well-thought-out plan as to how he would commit suicide.
  2. Access to the means by which he would attempt suicide. (He has access to the gun).
  3. The means (the gun) is highly lethal.
  4. The locale (alone in the desert) makes the chance of being found before death very low.


Person B Person B has thought about suicide but does not really have a specific time frame. She has thought that if she commits suicide, using a gun might be one of her options. However, she will need to purchase a gun and first pass a background check. She isn’t sure where she would make the attempt because having someone find her bloody body would be inconsiderate.


  1. The plan vague without specific details.
  2. Does not have current access to the means (doesn’t own a gun).
  3. The means would be lethal but many steps would need to be taken to purchase a gun.
  4. The locale is vague.
Person C Person C has barely had the thought of suicide ever cross his mind, though he honestly admits that it has on very rare occasion. As far as any kind of a plan goes, he reports to have no idea where he would even begin. He would never cut his wrists because “that would be too messy” and the sight of blood would just “creep me out.” He does not have any access to medications that would facilitate an overdose, and “the time lapse between taking the pills and waiting to die would just be unbearable.”
  1. There is no plan.
  2. There is no access to any means for self-harm.
  3. Due to no access to means there is no risk for lethal use of means.
  4. The locale has not even been considered.






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Related Reading:

USA Today Health Reports: Diseases and Disorders – Depression by Wendy Moragne

Depression: Your Questions Answered by Melvyn Lurie, MD

This is How it Feels:  A Memoir of Attempting Suicide and Finding Life by Craig Miller