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Self-Harm & Suicidal Ideation
You do not have to face this alone.
If you are in crisis right now — call or text **988** · Distress Centre Calgary **403-266-4357** · If you are in immediate danger call **911**
What is Self-Harm & Suicidal Ideation?
Self-harm and suicidal ideation are among the most serious and most misunderstood experiences a person can have. They are not attention-seeking behaviours, manipulation or a sign of weakness. They are responses to pain that has become unbearable — signals that something needs to change and that more support is needed.
Self-harm refers to deliberate harm to one’s own body as a way of managing overwhelming emotional distress. It is most commonly a coping mechanism — not an attempt to end one’s life — though it carries significant risks and is always a sign that professional support is needed. Suicidal ideation refers to thoughts about ending one’s life — ranging from passive thoughts that life is not worth living to active planning of suicide.
At Karasick Psychology we provide compassionate, evidence-based assessment and treatment for self-harm and suicidal ideation across all presentations — including those with passive ideation, those with a history of self-harm and those who are actively struggling. You do not need to be in crisis to reach out. And reaching out is always the right thing to do.
Understanding Self Harm
Self-harm is most commonly a way of managing emotional pain that feels impossible to tolerate in any other way. It may provide temporary relief, a sense of control, a way of expressing feelings that cannot be put into words or a way of feeling something when emotional numbness has taken over. Understanding why self-harm is happening is essential to addressing it effectively.
Self-harm is not about wanting to die. But it is always a serious signal that the level of distress a person is experiencing exceeds their current capacity to cope — and that more support is urgently needed. It is also associated with increased risk of suicide, which is why professional assessment and treatment are always important.
Common forms of self-harm include cutting, burning, hitting or bruising, hair pulling and other self-injurious behaviours. Self-harm can also take less visible forms — including disordered eating, substance use or placing oneself in dangerous situations.
Understanding Suicidal Ideation
Suicidal ideation refers to thoughts about ending one’s life. It exists on a spectrum — from passive thoughts that life is not worth living or that others would be better off without you, to active thoughts about suicide with or without a specific plan. All forms of suicidal ideation deserve to be taken seriously and treated with compassion and appropriate clinical support.
Suicidal ideation is almost always a response to unbearable psychological pain — not a fixed desire to die. Most people who experience suicidal thoughts are not seeking death — they are seeking relief from suffering. Understanding this is central to effective treatment.
Suicidal ideation is a symptom — not a diagnosis. It can arise in the context of depression, bipolar disorder, PTSD, chronic pain, psychosis, substance use and many other conditions. Identifying and treating the underlying condition is an essential component of reducing suicidal ideation.
Does this sound familiar?
▪ Thoughts that life is not worth living or that you would be better off dead
▪ Urges to harm yourself as a way of managing overwhelming emotions
▪ Feeling like the pain you are in will never end
▪ Feeling like a burden to the people around you
▪ Withdrawing from people and activities as the pain intensifies
▪ Thoughts about suicide — with or without a specific plan
▪ A history of self-harm that you feel unable to stop
▪ Feeling ashamed or unable to talk to anyone about what you are experiencing
▪ Using substances, food or other behaviours to manage unbearable emotions
▪ Feeling like no one would understand or that nothing could help
Common Misconceptions About Suicide
Misconceptions about suicide are widespread — and they can prevent people from seeking help or supporting others effectively.
"Talking about suicide puts the idea in someone's head"
This is one of the most harmful and pervasive myths about suicide. Research consistently shows the opposite — asking directly about suicide reduces risk. It communicates that the person is seen, that their pain is taken seriously and that they are not alone. Avoiding the topic does not protect people. It isolates them.
"People who talk about suicide are just seeking attention"
Any expression of suicidal thoughts deserves to be taken seriously — every time. Dismissing suicidal statements as attention-seeking is dangerous. People who die by suicide have often communicated their distress beforehand. Connection and attention are exactly what someone in pain needs — that is not a reason to dismiss them.
"Suicide is a selfish act"
People who reach the point of suicidal crisis are typically in profound psychological pain — pain so intense that their thinking becomes severely distorted. Suicide is not a rational choice made without regard for others. It is the result of unbearable suffering and a distorted belief that others would be better off without them. Framing it as selfish adds shame to an already devastating experience.
"If someone really wanted to die they would not tell anyone"
Most people who are suicidal are ambivalent — they want the pain to end, not necessarily their life. Reaching out is often an expression of that ambivalence — a plea for help and connection. Every disclosure is an opportunity to intervene and connect the person with the support they need.
"Once someone is suicidal they will always be suicidal"
Suicidal crises are typically time-limited. With appropriate treatment and support the vast majority of people who experience suicidal ideation go on to live full and meaningful lives. Suicidal ideation is a symptom — and like all symptoms it responds to effective treatment.
"Asking about suicide will upset or offend someone"
Most people who are struggling with suicidal thoughts feel profound relief when someone asks directly — it breaks the isolation, reduces shame and communicates that the person is not alone. Asking about suicide with compassion and without judgment is one of the most helpful things another person can do.
Self-Harm & Suicidal Ideation in Teenagers
Self-harm is significantly more common in adolescents than in any other age group. The teenage years are a period of intense emotional experience, identity formation and social pressure — and for many young people the skills needed to manage overwhelming emotions have not yet fully developed. Self-harm can emerge as a way of coping with feelings that feel impossible to tolerate or express in any other way.
Adolescent self-harm and suicidal ideation often looks different from adult presentations. Triggers are frequently social — conflict with peers, romantic relationships, academic pressure, bullying or social media. The influence of peers and online communities can play a significant role in both the development and maintenance of self-harm in teenagers.
Teenagers are less likely than adults to seek help for themselves. Parents, caregivers and school staff are often the first to notice signs of distress — and knowing how to respond is essential. A compassionate, non-judgmental response that takes the young person’s distress seriously without panic or punishment is the foundation of effective support.
Signs to look for in teenagers:
▪ Unexplained cuts, burns or bruises — particularly on arms, legs or torso
▪ Wearing long sleeves or clothing that covers the body regardless of temperature
▪ Withdrawal from family, friends or activities previously enjoyed
▪ Significant changes in mood, behaviour or school performance
▪ Giving away possessions or saying goodbye in unusual ways
▪ Expressions of hopelessness, worthlessness or being a burden
▪ Increased secrecy around phone or online activity
Causes
Self-harm and suicidal ideation are symptoms — not diagnoses. They can arise from many underlying conditions and circumstances.
Depression
Depression is the most common underlying condition associated with suicidal ideation. Hopelessness — the belief that things will never improve — is the strongest psychological predictor of suicide risk.
Trauma & PTSD
Trauma — particularly complex or childhood trauma — significantly increases the risk of self-harm and suicidal ideation. Emotional dysregulation, dissociation and overwhelming shame are common drivers.
Bipolar Disorder
Suicidal ideation is significantly elevated in bipolar disorder — particularly during depressive episodes and mixed states. Risk assessment and safety planning are essential components of bipolar disorder treatment.
Chronic Pain
Chronic pain is strongly associated with depression and suicidal ideation. The relentlessness of persistent pain, its impact on functioning and identity and the hopelessness it can generate are significant risk factors.
Borderline Personality Disorder
Self-harm and suicidal behaviour are core features of BPD — driven by intense emotional dysregulation, fear of abandonment and an unstable sense of self. Effective treatment significantly reduces self-harm and suicidal behaviour.
Substance Use
Substance use significantly increases the risk of self-harm and suicidal behaviour — both through its direct effects on mood and impulse control and through the circumstances and consequences associated with addiction.
Treatment
Compassionate, evidence-based care for the full spectrum of risk.
At Karasick Psychology we provide thorough clinical assessment and evidence-based treatment for self-harm and suicidal ideation across all presentations. Treatment begins with a comprehensive risk assessment and safety planning — establishing a collaborative safety plan that provides concrete strategies for managing crisis moments.
We draw primarily from Cognitive Behavioural Therapy — addressing the thought patterns, emotional dysregulation and behavioural responses that maintain self-harm and suicidal ideation. Biofeedback is integrated to support nervous system regulation and build the physiological capacity for emotional self-regulation without self-harm.
Treatment addresses not just the self-harm or suicidal ideation itself but the underlying pain that is driving it. The goal is not simply to stop the behaviour — it is to develop the understanding, skills and support needed to make life genuinely worth living.
What to expect
Treatment begins with a thorough and compassionate assessment of your experiences, history and current level of distress. From there therapy is collaborative, paced to you and focused on both immediate safety and longer term wellbeing.
If you are in crisis
If you are having thoughts of suicide or urges to self-harm right now — please reach out. You do not have to manage this alone. The following services are available 24 hours a day, 7 days a week
Emergency services — 911 or your nearest emergency department if you are in immediate danger
988 Suicide Crisis Helpline — call or text 988 — available 24/7 across Canada in English and French
Distress Centre Calgary — call 403-266-4357 — 24/7 crisis support, counselling and referrals
Distress Line Edmonton — call 780-482-4357 — 24/7 crisis support
Alberta Mental Health Help Line — call 1-877-303-2642 — confidential crisis intervention and information
Kids Help Phone — call or text 1-800-668-6868 — 24/7 support for youth under 22
First Nations and Inuit Hope for Wellness Help Line — call 1-855-242-3310 — culturally competent support 24/7
CONTACT INFO
- 403 633-6545
- admin@karasick.ca
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Monday - Thursday: 8am - 7pm
Friday: 8am - 1pm - Special times available upon request
Reaching out for therapy is hard, but struggling alone is harder. Contact us to learn how we can support your path toward healing, development, and lasting improvement.
