Merck Manual

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Nonsuicidal Self-Injury in Children and Adolescents

(Self-Harm; Cutting)


Josephine Elia

, MD, Nemours/A.I. duPont Hospital for Children

Reviewed/Revised May 2023

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 repeatedly rubbing the skin with an eraser.

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 mental health professional experienced in working with mental health issues in adolescents. The doctor tries to determine whether suicide is a risk and to identify the underlying distress that led to self-injury. Doctors try to determine whether the adolescent has issues with low self-esteem or any number of other mental health issues, such as disorders of anxiety Overview of Anxiety Disorders in Children and Adolescents Anxiety disorders are characterized by fear, worry, or dread that greatly impairs the ability to function and is out of proportion to the circumstances. There are many types of anxiety disorders... read more , mood Depression and Mood Dysregulation Disorder in Children and Adolescents Depression includes a feeling of sadness (or, in children and adolescents, irritability), and/or loss of interest in activities. In major depression, these symptoms last 2 weeks or more and... read more , eating patterns Overview of Eating Disorders Eating disorders involve a disturbance of eating or of behavior related to eating, typically including Changes in what or how much people eat Measures people take to prevent food from being... read more , substance use Overview of Substance-Related Disorders Medications and other substances, whether used for legitimate medical purposes, as a habit (for example, caffeine), or recreationally, are an integral part of everyday life for many people ... read more , or trauma Acute and Posttraumatic Stress Disorders in Children and Adolescents Acute and posttraumatic stress disorders are reactions to overwhelming traumatic events that involve recurring, intrusive memories of the event as well as emotional numbness and increased tension... read more .

Treatment usually involves individual (and sometimes group) therapy. Therapy focuses on teaching adolescents how to be more aware of their emotions, how to accept negative emotions as part of life, how to develop more appropriate ways of responding to stress, and how to resist urges to behave self-destructively.

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