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Nonsuicidal Self-Injury in Children and Adolescents

By Josephine Elia, MD, Professor of Psychiatry and Human Behavior, Professor of Pediatrics;Attending Physician, Sidney Kimmel Medical College of Thomas Jefferson University;Nemours/A.I. duPont Hospital for Children

Nonsuicidal self-injury refers to intentional harm to self that is not intended to cause death. Examples are superficial scratching, cutting, or burning the skin (using cigarettes or curling irons), as well as stabbing, hitting, and repeated rubbing the skin with an eraser.

Adolescents who abuse drugs or other substances are more likely to injure themselves.

In some communities, self-injury suddenly becomes a fad in a high school, and many adolescents do it. In such cases, self-injuries gradually stop over time.

Self-injury suggests that an adolescent is in great distress. However, in many adolescents, self-injury does not indicate that suicide is a risk. Instead, it may be a self-punishing action that they feel they deserve. Self-injury can also be used to gain the attention of parents and/or significant others, express anger, or identify with a peer group. In other adolescents (those with more severe mental disturbances and less social support), the risk of suicide is increased.

Other factors that may increase the risk of suicide include the following:

  • Harming themselves often

  • Using several methods to harm themselves

  • Feeling less socially connected to other people, especially their parents

  • Feeling that life has little or no meaning

  • Seeking mental health care often

  • Having suicidal thoughts

All adolescents who deliberately injure themselves should be evaluated by a doctor experienced in working with troubled adolescents. The doctor tries to determine whether suicide is a risk and to identify the underlying distress that led to self-injury.