Nonsuicidal Self-Injury (NSSI) in Children and Adolescents

ByJosephine Elia, MD, Sidney Kimmel Medical College of Thomas Jefferson University

Reviewed ByAlicia R. Pekarsky, MD, State University of New York Upstate Medical University, Upstate Golisano Children's Hospital

Reviewed/Revised Modified May 2023

v43476531

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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) of these adolescents have other co-occurring disorders such as mood disorders (2) , anxiety disorders (3), poor self-esteem (4), eating disorders (5), PTSD (3), personality disorders (2, 3), and substance use disorders (6, 7).

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 co-occurring psychiatric disorders (as noted above) and increased risk of suicide (4, 8) .

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

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. doi: 10.4088/JCP.11m07196
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. doi: 10.2147/JMDH.S11569
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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