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Nonsuicidal Self-Injury (NSSI) in Children and Adolescents

By

Josephine Elia

, MD, Sidney Kimmel Medical College of Thomas Jefferson University

Last full review/revision Apr 2021| Content last modified Apr 2021
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Nonsuicidal self-injurious behaviors occur mostly in adolescents and can include superficial scratching, cutting, or burning the skin (using cigarettes or curling irons), as well as stabbing, hitting, and repeated rubbing of the skin with an eraser or salt, in the absence of an intent to die.

Some but not all (1 General references Nonsuicidal self-injurious behaviors occur mostly in adolescents and can include superficial scratching, cutting, or burning the skin (using cigarettes or curling irons), as well as stabbing... read more ) of these adolescents have other co-occurring disorders such as mood disorders Overview of Mood Disorders Mood disorders are emotional disturbances consisting of prolonged periods of excessive sadness, excessive joyousness, or both. Mood disorders can occur in children and adolescents (see Depressive... read more (2 General references Nonsuicidal self-injurious behaviors occur mostly in adolescents and can include superficial scratching, cutting, or burning the skin (using cigarettes or curling irons), as well as stabbing... read more ) , anxiety disorders Overview of Anxiety Disorders in Children and Adolescents Anxiety disorders are characterized by fear, worry, or dread that greatly impairs the ability to function normally and that is disproportionate to the circumstances at hand. Anxiety may result... read more (3 General references Nonsuicidal self-injurious behaviors occur mostly in adolescents and can include superficial scratching, cutting, or burning the skin (using cigarettes or curling irons), as well as stabbing... read more ), poor self-esteem (4 General references Nonsuicidal self-injurious behaviors occur mostly in adolescents and can include superficial scratching, cutting, or burning the skin (using cigarettes or curling irons), as well as stabbing... read more ), eating disorders Introduction to Eating Disorders Eating disorders involve a persistent disturbance of eating or of behavior related to eating that Alters consumption or absorption of food Significantly impairs physical health and/or psychosocial... read more (5 General references Nonsuicidal self-injurious behaviors occur mostly in adolescents and can include superficial scratching, cutting, or burning the skin (using cigarettes or curling irons), as well as stabbing... read more ), PTSD Acute and Posttraumatic Stress Disorders (ASD and PTSD) in Children and Adolescents Acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) are reactions to traumatic events. The reactions involve intrusive thoughts or dreams, avoidance of reminders of the event... read more (3 General references Nonsuicidal self-injurious behaviors occur mostly in adolescents and can include superficial scratching, cutting, or burning the skin (using cigarettes or curling irons), as well as stabbing... read more ), personality disorders Overview of Personality Disorders Personality disorders in general are pervasive, enduring patterns of thinking, perceiving, reacting, and relating that cause significant distress or functional impairment. Personality disorders... read more (2, 3 General references Nonsuicidal self-injurious behaviors occur mostly in adolescents and can include superficial scratching, cutting, or burning the skin (using cigarettes or curling irons), as well as stabbing... read more ), and substance use disorders Overview of Substance-Related Disorders Substance-related disorders involve drugs that directly activate the brain's reward system. The activation of the reward system typically causes feelings of pleasure; the specific pleasurable... read more (6, 7 General references Nonsuicidal self-injurious behaviors occur mostly in adolescents and can include superficial scratching, cutting, or burning the skin (using cigarettes or curling irons), as well as stabbing... read more ).

In many adolescents, self-injurious behaviors do not indicate suicidality Suicidal Behavior in Children and Adolescents Suicidal behavior includes completed suicide, attempted suicide (with at least some intent to die), and suicide gestures; suicidal ideation is thoughts and plans about suicide. Psychiatric referral... read more 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 co-occurring psychiatric disorders (as noted above) and increased risk of suicide (4, 8 General references Nonsuicidal self-injurious behaviors occur mostly in adolescents and can include superficial scratching, cutting, or burning the skin (using cigarettes or curling irons), as well as stabbing... read more ) .

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 (9 General references Nonsuicidal self-injurious behaviors occur mostly in adolescents and can include superficial scratching, cutting, or burning the skin (using cigarettes or curling irons), as well as stabbing... read more ).

General references

  • 1. Swannell SV, Martin GE, Page A, et al: Prevalence of nonsuicidal self-injury in nonclinical samples: Systematic review, meta-analysis and meta regression. Suicide Life Threat Behav 44(3):273-303, 2013. doi: 10.1111/sltb.12070

  • 2. Cox LJ, Stanley BH, Melhem NM, et al: Familial and individual correlates of nonsuicidal self-injury in the offspring of mood-disordered parents. J Clin Psychiatry 73(6):813-820, 2012.

  • 3. Nock MK, Joiner TE, Gordon KH, et al: Nonsuicidal self-injury among adolescents: Diagnostic correlates and relation to suicide attempts. Psychiatry Res 144(1):65-72, 2006. doi: 10.1016/j.psychres.2006.05.010

  • 4. Lewis SP, Heath NL: Nonsuicidal self-injury among youth. J Pediatr 166(3):526-530, 2015. doi: 10.1016/j.jpeds.2014.11.062

  • 5. Cipriano A, Cella S, Cotrufo P: Nonsuicidal self-injury: A systematic review. Front Psychol 8:1946, 2017. doi: 10.3389/fpsyg.2017.01946

  • 6. Nock MK, Prinstein MJ: Contextual features and behavioral functions of self-mutilation among adolescents. J Abnorm Psychol 114(1):140-146, 2005. doi: 10.1037/0021-843X.114.1.140

  • 7. Lloyd-Richardson EE, Perrine N, Dierker L, et al: Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychol Med 37(8):1183-1192, 2007. doi: 10.1017/S003329170700027X

  • 8. 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.

  • 9. Brown RC, Plener PL: Non-suicidal self-injury in adolescence. Curr Psychiatry Rep19(3):20, 2017. doi: 10.1007/s11920-017-0767-9

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