remains unclear. It may be that suicidal thoughts lead the individual to self-harm – either to enact or to reduce the urge [11] - or that self-harm causes psychological distress which then contributes to suicidal thoughts [33], or that the two are co-occurring phenomena caused by a third factor, for example low self-esteem. Furthermore, it has been speculated that NSSI may make suicide/suicidal self-harm more “accessible” to high risk individuals as suicide is seen as a frightening and extreme action, but repetitive engagement in NSSI may make people more courageous and prepared to make suicide attempts [34].
