Your close friend has been talking lately about feeling depressed. She’s spending more and more time alone at home, she’s always tired and that she has admitted that a series of scars on her arms and legs are from self-inflicted wounds. Your friend is engaging in self-injury—but does that mean she’s suicidal?

There is a great deal of debate about what self-injury is and how it is different from suicidal behavior. People engaging in non-suicidal self-injury may do so for a number of reasons—to escape unbearable anguish, to change the behavior of others, to relieve tension, to seek help, etc. And, in fact, non-suicidal self-injury is quite common among young people.

A survey of college students in the United States found that more than 15 percent had engaged in non-suicidal self-injury at some time in their lives, without significant differences in rates between males and females. And non-suicidal self-injury can look like a lot of things, including:

1. Cutting, scratching or pinching skin enough to cause bleeding or a mark that remains on the skin
2. Banging or punching objects to the point of bruising or bleeding
3. Ripping and tearing skin
4. Carving words or patterns into skin
5. Interfering with the healing of wounds
6. Burning skin with cigarettes, matches or hot water
7. Pulling out large amounts of hair
8. Deliberately overdosing on medications when this is not meant as a suicide attempt

While self-injury can often be used as a coping mechanism, there is often no easy way to tell the difference between non-suicidal self-injury and a suicide attempt. The only way to know is to ask the person directly, “Are you thinking about suicide?”

Knowing how and when to start a conversation about self-injury or suicide could #BeTheDifference between life and death for someone you know.

If you are concerned about someone, let them know that you are willing to help. If you have serious concerns for someone’s safety or you are worried that they may be considering suicide, call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).