However, the interpersonal theory of suicide may be onto something. Perhaps nonsuicidal self-injury is an early signal of a diathesis that can eventually lead to suicidal behavior. In some community studies, the age at onset of nonsuicidal self-injury is younger than the age at onset for suicidal behavior (8). Those with a history of both nonsuicidal self-injury and a suicide attempt, compared to those with nonsuicidal self-injury alone, show higher levels of depression, suicidal ideation, impulsivity, and family dysfunction (8). Therefore, it is possible that with a lower loading for the diathesis, one sees only nonsuicidal self-injury, but with the development of greater loading for psychopathology and family difficulties, one sees more frequent and persistent nonsuicidal self-injury-and eventually, suicidal behavior. A second possible explanation for the transition from nonsuicidal self-injury to suicidal behavior is based on the observation that those with nonsuicidal self-injury have difficulties with verbal expression (2). Since there are intra- and interpersonal motivations for both nonsuicidal self-injury and suicidal behavior, it is possible that if nonsuicidal self-injury does not achieve the desired result, adolescents may, in desperation, "turn up the volume" and engage in suicidal behavior (2). Therefore, nonsuicidal self-injury may not directly lead to suicidal behavior, but if the needs and deficits reflected in nonsuicidal self-injury are not addressed, suicidal behavior may ensue.