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.
Nonsuicidal self-injury (NSSI) is the intentional act of causing physical harm to oneself without the intention to end one’s life. Some but not all of adolescents with NSSI have other disorders such as mood disorders, anxiety disorders, poor self-esteem, eating disorders, PTSD, personality disorders, and substance use disorders.
Children and adolescents with NSSI may hurt themselves by cutting, burning, hitting, or using other methods of self-inflicted injury without suicidal intent. In many adolescents, self-injurious 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, regulate negative emotions, or identify with a peer group. However, these adolescents, especially those who have used multiple methods of self-harm, are likely to have other psychiatric disorders and increased risk of suicide.
Patients often injure themselves repeatedly in a single session, creating multiple lesions in the same location, typically in areas that are easily hidden but accessible (eg, forearms, front of thighs). The behavior is often repeated, resulting in extensive patterns of scarring. Patients are often preoccupied with thoughts about the injurious acts.
The motivations for NSSI are unclear, but self-injury may be
A way to reduce tension or negative feelings
A way to resolve interpersonal difficulties
Self-punishment for perceived faults
A plea for help
Diagnosis of Nonsuicidal Self-Injury in Children and Adolescents
A doctor’s (or behavioral health specialist's) evaluation
Ruling out suicidal behavior
All children and 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 child or adolescent has issues with low self-esteem or any number of other mental health issues, such as disorders of anxiety, mood, eating patterns, substance use, or trauma.
To diagnose NSSI, doctors must rule out suicidal behavior and determine that self-inflicted bodily harm (such as cutting or burning) occurred at least 5 times in the past year, without suicidal intent, primarily to gain relief from negative feelings, solve interpersonal problems, or feel positive emotions.
Treatment of Nonsuicidal Self-Injury in Children and Adolescents
Individual (and sometimes group) therapy
Rarely medication
Treatment of other disorders
Treatment usually involves individual (and sometimes group) therapy. Therapy typically involves a combination of techniques, such as cognitive-behavioral therapy, and family support, aimed at addressing underlying emotional issues and developing healthier coping strategies. In rare instances, medications have been found to be effective.
Cognitive behavioral therapy is typically done as outpatient, individual therapy, but it can also be done in groups or in an inpatient setting. Therapy focuses on teaching children and 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.
Follow-up appointments should be scheduled.
