Abstract

This study aimed to examine the similarities, differences, and continuity between non-suicidal self-injury (NSSI) and suicide. In-depth interviews were conducted with 56 school counselors experienced in counseling adolescents with NSSI or suicide. The data were analyzed using the Modified Consensual Qualitative Research (CQR-M) method. As a result, 3 domains, 8 higher-order categories, and 32 subcategories were identified. The similarities identified encompassed cognitive, emotional, behavioral, functional, and environmental dimensions, including a desire for attention and affection, limited awareness of extreme emotional and cognitive states, and a lack of acceptance within the family environment. In contrast, the differences highlighted that NSSI is often associated with a desire for improvement, whereas suicidal behavior tends to be accompanied by more severe depressive symptoms. The continuity from NSSI to suicide emerged in narratives indicating that self-injury alone does not alleviate feelings of isolation, which may lead to suicide attempts, and that repeated negative thoughts escalating to extremes can result in the progression from self-injury to suicidal behavior. Academic and practical implications based on these findings are discussed.