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Nonsuicidal Self-Injury (NSSI) 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

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Nonsuicidal self-injurious behaviors can include 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 or salt.

In some communities, self-injurious behaviors suddenly sweep through a high school in fad-like fashion and then gradually diminish over time. Such behaviors are often associated with illicit substance abuse and suggest that an adolescent is in great distress.

In many adolescents, these behaviors do not indicate suicidality but instead are self-punishing actions that they may feel they deserve; these behaviors are used to gain the attention of parents and/or significant others, express anger, or identify with a peer group. However, these adolescents, especially those who have used multiple methods of self-harm, have an increased risk of suicide (1).

All self-injurious behaviors should be evaluated by a clinician experienced in working with troubled adolescents to assess whether suicidality is an issue and to identify the underlying distress leading to the self-injurious behaviors.


  • 1. Greydanus DE, Apple RW: The relationship between deliberate self-harm behavior, body dissatisfaction, and suicide in adolescents: Current concepts. J Multidiscip Healthc 4:183–189, 2011. doi: 10.2147/JMDH.S11569.