Classifying nonsuicidal overdoses: Nonsuicidal self-injury, suicide attempts, or neither?

• Misclassification of SIBs hinders clinical and scientific progress.
• We compared nonsuicidal overdoses to other self-injurious behaviors.
• The majority of participants reported a non-zero desire to die from engaging in NSSI.
• Suicidal thoughts and desires were similar during NSSI and nonsuicidal overdoses.
• Nonsuicidal overdoses were unique in likelihood of dying from the behavior.

Self-injurious behaviors (SIBs) are leading causes of death and injury. Unfortunately, disagreement regarding whether and how to classify suicidal and nonsuicidal SIBs has contributed to their misclassification, likely hindering clinical care and impeding scientific progress. The present study utilized a data-driven approach to facilitate classification and measurement of three forms of SIBs, with a particular focus on one with scant clinical and scientific attention: nonsuicidal overdoses (i.e. intentional overdoses where the person states that they had no intention of dying from the overdose). Results from this study demonstrated that nonsuicidal overdoses were similar to suicide attempts in terms of age of onset, and similar to nonsuicidal self-injury (NSSI) in terms of suicidal thoughts and desire to die when engaging in these behaviors. Nonsuicidal overdoses were unique from NSSI and suicide attempts in terms of the reported likelihood of dying from the behavior. The present study highlighted that current definitions for nonsuicidal behaviors (including requirements that the person has zero intent to die) may not accurately represent people's intent when engaging in these behaviors. Additionally, the present study highlighted that empirical analysis of SIBs can provide important insights for classification of SIBs.