Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-28T15:12:11.279Z Has data issue: false hasContentIssue false

Chapter 2 - Nonsuicidal Self-Injury in Adolescents

Research and Clinical Practice

Published online by Cambridge University Press:  01 February 2024

By
Judit Balazs  and
Romuald Brunner
Edited by
Andrea Fiorillo ,
Peter Falkai  and
Philip Gorwood
Andrea Fiorillo
Affiliation:
University of Campania “L. Vanvitelli”, Naples
Peter Falkai
Affiliation:
Ludwig-Maximilians-Universität München
Philip Gorwood
Affiliation:
Sainte-Anne Hospital, Paris
Get access

Summary

Nonsuicidal self-injury (NSSI) is a major mental health problem in youth worldwide. The World Health Organization has recognized it as among the top five major health threats to adolescents. NSSI is defined as deliberate infliction of direct physical harm to one’s own body without suicidal intent. Recently, NSSI was introduced for the first time in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5), under section III, “Conditions for Further Study.” In most cases, NSSI occurs for the first time around the age of twelve, with great increase in frequency within each year of adolescence. Injuries range from minor cuts to severe injuries, including biting, hitting, and burning oneself. Most self-harming behavior in adolescents ceases in the long-term, but a substantial proportion of adolescents show a continuity of NSSI into young adulthood accompanied by pronounced psychiatric comorbid disorders. A history of NSSI has also been identified as a strong risk factor for suicide attempts in later life. Emotional dysregulation has been acknowledged as the central clinical feature, both in pathogenesis and treatment of NSSI. Existing neurobiological findings increasingly support this clinical model. The development and implementation of effective intervention programs are of the greatest importance for the future.

Keywords

nonsuicidal self-injuryNSSIyouthDSM-5comorbiditysuicidal behavior
Type
Chapter
Information
Mental Health Research and Practice
From Evidence to Experience
 , pp. 19 - 26
Publisher: Cambridge University Press
Print publication year: 2024

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

World Health Organization. Health for the world’s adolescents: A second chance in the second decade. Executive Summary. 2014. https://apps.who.int/iris/handle/10665/112750 (Accessed August 29, 2021).Google Scholar
Plener, PL, Schumacher, TS, Munz, LM, Groschwitz, RC. The longitudinal course of non-suicidal self-injury and deliberate self-harm: A systematic review of the literature. Bord Personal Disord Emot Dysregul. 2015 2:2. https://doi.org/10.1186/s40479-014–0024–3.CrossRefGoogle ScholarPubMed
Swannell, SV, Martin, GE, Page, A, Hasking, P, St John, NJ. Prevalence of nonsuicidal self-injury in nonclinical samples: Systematic review, meta-analysis and meta-regression. Suicide Life Threat Behav. 2014;44:273–303. https://doi.org/10.1111/sltb.12070.CrossRefGoogle ScholarPubMed
Waals, L, Baetens, I, Rober, P, et al. The NSSI family distress cascade theory. Child Adolesc Psychiatry Ment Health. 2018;12:1–6. https://doi.org/10.1186/s13034-018–0259–7.CrossRefGoogle ScholarPubMed
American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). Arlington, TX: American Psychiatric Association (2013). https://doi.org/10.1176/appi.books.9780890425596.Google Scholar
Klonsky, ED. The functions of deliberate self-injury: A review of the evidence. Clin Psychol Rev. 2007;27(2):226–39.CrossRefGoogle ScholarPubMed
Bentley, KH, Cassiello-Robbins, CF, Vittorio, L, Sauer-Zavala, S, Barlow, DH. The association between nonsuicidal self-injury and the emotional disorders: A meta-analytic review. Clin Psychol Rev. 2015;37:72–88.CrossRefGoogle ScholarPubMed
Meszaros, G, Horvath, LO, Balazs, J. Self-injury and externalizing pathology: A systematic literature review. BMC Psychiatry. 2017;17(1):160.CrossRefGoogle ScholarPubMed
Cerutti, R, Manca, M, Presaghi, F, Gratz, KL. Prevalence and clinical correlates of deliberate self-harm among a community sample of Italian adolescents. J Adolesc. 2011;34:337–47.CrossRefGoogle ScholarPubMed
Izutsu, T, Shimotsu, S, Matsumoto, T, et al. Deliberate self-harm and childhood hyperactivity in junior high school students. Eur Child Adolesc Psychiatry. 2006;15:172–6.CrossRefGoogle ScholarPubMed
Taylor, MR, Boden, JM, Rucklidge, JJ. The relationship between ADHD symptomatology and self-harm, suicidal ideation, and suicidal behaviours in adults: A pilot study. Atten Deficit Hyperactivity Disord. 2014;6:303–12.Google ScholarPubMed
Jacobson, CM, Muehlenkamp, JJ, Miller, AL, Turner, JB. Psychiatric impairment among adolescents engaging in different types of deliberate self-harm. J Clin Child Adolesc Psychol. 2008;37:363–75.CrossRefGoogle ScholarPubMed
McCloskey, MS, Ben-Zeev, D, Lee, R, Coccaro, EF. Prevalence of suicidal and self-injurious behavior among subjects with intermittent explosive disorder. Psychiatry Res. 2008;158:248–50.CrossRefGoogle ScholarPubMed
Nock, MK, Joiner, TE Jr, Gordon, KH, Lloyd-Richardson, E, Prinstein, MJ. Non-suicidal self-injury among adolescents: Diagnostic correlates and relation to suicide attempts. Psychiatry Res. 2006;144:65–72.CrossRefGoogle ScholarPubMed
Kapur, N, Cooper, J, O’Connor, RC, Hawton, K. Non-suicidal self-injury v. attempted suicide: New diagnosis or false dichotomy? Br J Psychiatry. 2013;202:326–8.CrossRefGoogle ScholarPubMed
Nock, MK. Self-injury. Annu Rev Clin Psychol. 2010;6:339–63.CrossRefGoogle ScholarPubMed
Klonsky, ED, May, AM, Glenn, CR. The relationship between nonsuicidal self-injury and attempted suicide: Converging evidence from four samples. J Abnormal Psychol. 2013;122(1):231. https://doi.org/10.1037/a0030278.CrossRefGoogle ScholarPubMed
Stanley, B, Winchel, R, Molcho, A, et al. Suicide and the self-harm continuum: Phenomenological and biochemical evidence. Int Rev Psychiatry. 1992;4(2):149–55.CrossRefGoogle Scholar
Andover, MS, Gibb, BE. Non-suicidal self-injury, attempted suicide, and suicidal intent among psychiatric inpatients. Psychiatry Res. 2010;178(1):101–5.CrossRefGoogle ScholarPubMed
Muehlenkamp, JJ, Gutierrez, PM. Risk for suicide attempts among adolescents who engage in non-suicidal self-injury. Arch Suicide Res. 2007;11(1):69–82.CrossRefGoogle ScholarPubMed
Grandclerc, S, De Labrouhe, D, Spodenkiewicz, M, Lachal, J, Moro, M-R. Relations between nonsuicidal self-injury and suicidal behavior in adolescence: A systematic review. PLoS One. 2016;11(4):e0153760. https://doi.org/10.1371/journal.pone.0153760.CrossRefGoogle ScholarPubMed
Hornor, G. Nonsuicidal self-injury. J Pediatr Health Care. 2016;30(3):261–7. https://doi.org/10.1016/j.pedhc.2015.06.012.CrossRefGoogle ScholarPubMed
Asarnow, JR, Porta, G, Spirito, A, et al. Suicide attempts and nonsuicidal self-injury in the treatment of resistant depression in adolescents: findings from the TORDIA study. J Am Acad Child Adolesc Psychiatry. 2011;50(8):772–81.CrossRefGoogle ScholarPubMed
Wilkinson, P, Kelvin, R, Roberts, C, et al. Clinical and psychosocial predictors of suicide attempts and nonsuicidal self-injury in the Adolescent Depression Antidepressants and Psychotherapy Trial (ADAPT). Am J Psychiatry. 2011;168(5):495–501.CrossRefGoogle ScholarPubMed
Koenig, J, Brunner, R, Fischer-Waldschmidt, G, et al. Prospective risk for suicidal thoughts and behaviour in adolescents with onset, maintenance or cessation of direct self-injurious behaviour. Eur Child Adolesc Psychiatry. 2017;26(3):345–354.CrossRefGoogle ScholarPubMed
Mars, B, Heron, J, Klonsky, ED, et al. Predictors of future suicide attempt among adolescents with suicidal thoughts or non-suicidal self-harm: A Population-based birth cohort study. Lancet Psychiatry. 2019;6:327–37. https://doi.org/10.1016/s2215-0366(19)30030–6.CrossRefGoogle ScholarPubMed
Hamza, CA, Stewart, SL, Willoughby, T. Examining the link between nonsuicidal self-injury and suicidal behavior: A review of the literature and an integrated model. Clin Psychol Rev. 2012;32(6):482–95. https://doi.org/10.1016/j.cpr.2012.05.003.CrossRefGoogle Scholar
Swannell, S, Martin, GE, Page, A, Hasking, P, St John, NJ. Prevalence of nonsuicidal self-injury in nonclinical samples: systematic review, meta-analysis and meta-regression. Suicide and Life-Threatening Behavior. 2014;44(3):273–303. https://doi.org/10.1111/sltb.12070. Epub 2014 Jan 15. PMID: 24422986.Google ScholarPubMed
Nock, MK. Why do people hurt themselves? New insights into the nature and functions of self-injury. Curr Dir Psychol Sci. 2009;18(2):78–83. https://doi.org/10.1111/j.1467–8721.2009.01613.x.CrossRefGoogle ScholarPubMed
Kiekens, G, Hasking, P, Boyes, M, et al. The associations between non-suicidal self-injury and first onset suicidal thoughts and behaviors. J Affect Disord. 2018;239:171–9. https://doi.org/10.1016/j.jad.2018.06.033.CrossRefGoogle ScholarPubMed
Bem, D, Connor, C, Palmer, C, Channa, S, Birchwood, M. Frequency and preventative interventions for non-suicidal self-injury and suicidal behaviour in primary school-age children: A scoping review protocol. BMJ Open. 2017;7(7):e017291.CrossRefGoogle ScholarPubMed
Csorba, J, Dinya, E, Plener, P, Nagy, E, Páli, E. Clinical diagnoses, characteristics of risk behaviour, differences between suicidal and non-suicidal subgroups of Hungarian adolescent outpatients practising self-injury. European Child & Adolescent Psychiatry. 2009;18(5):309–20.CrossRefGoogle ScholarPubMed
Bakken, NW, Gunter, WD. Self-cutting and suicidal ideation among adolescents: Gender differences in the causes and correlates of self-injury. Deviant Behav. 2012;33(5):339–56.CrossRefGoogle Scholar
Klonsky, ED, Oltmanns, TF, Turkheimer, E. Deliberate self-harm in a nonclinical population: Prevalence and psychological correlates. Am J Psychiatry. 2003;160(8):1501–8.CrossRefGoogle Scholar
Brunner, R, Kaess, M, Parzer, P, et al. Life-time prevalence and psychosocial correlates of adolescent direct self-injurious behavior: A comparative study of findings in 11 European countries. J Child Psychol. 2014;55(4):337–48.CrossRefGoogle ScholarPubMed
Farkas BF, Takacs ZK, Kollárovics N, Balázs J. The prevalence of self-injury in adolescence: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry. 2023 Jul 24. https://doi: 10.1007/s00787-023-02264-y. Epub ahead of print. PMID: 37486387.CrossRefGoogle Scholar
American Psychiatric Association (APA). Diagnostic and statistical manual of mental disorders. 4th ed. Washington (DC): APA (1994).Google Scholar
Glenn, CR, Klonsky, ED. Nonsuicidal self-injury disorder: An empirical investigation in adolescent psychiatric patients. J Clin Child Adolesc Psychol. 2013;42:496–507.CrossRefGoogle ScholarPubMed
Stead, VE, Boylan, K, Schmidt, LA. Longitudinal associations between non-suicidal self-injury and borderline personality disorder in adolescents: A literature review. Bord Personal Disord Emot Dysregul. 2019;6:3.CrossRefGoogle ScholarPubMed
Cyders, MA, Smith, GT. Emotion based dispositions to rash action: Positive and negative urgency. Psychol Bull. 2008;134:807–828. https://doi.org/10.1037/a0013341.CrossRefGoogle ScholarPubMed
Hamza, CA, Willoughby, T, Heffer, T. Impulsivity and nonsuicidal self-injury: A review and meta-analysis. Clin Psychol Rev. 2015;38:13–24.CrossRefGoogle ScholarPubMed
Fox, KR, Franklin, JC, Ribeiro, JD, et al. Meta-analysis of risk factors for nonsuicidal self-injury. Clin Psychol Rev. 2015;42:156–67.CrossRefGoogle ScholarPubMed
Moran, P, Coffey, C, Romaniuk, H, et al. The natural history of self-harm from adolescence to young adulthood: A population-based cohort study. Lancet 2012;379(9812):236–43.CrossRefGoogle ScholarPubMed
Borschmann, R, Becker, D, Coffey, C, et al. 20-year outcomes in adolescents who self-harm: A population-based cohort study. Lancet Child Adolesc Health 2017;1(3):195–202.CrossRefGoogle ScholarPubMed
Daukantaitė, D, Lundh, LG, Wångby-Lundh, M, et al. What happens to young adults who have engaged in self-injurious behavior as adolescents? A 10-year follow-up. Eur Child Adolesc Psychiatry. 2021;30(3):475–92.CrossRefGoogle Scholar
Klonsky, ED, Victor, SE, Saffer, BY. Nonsuicidal self-injury: What we know, and what we need to know. Can J Psychiatry. 2014;59(11):565–8. https://doi.org/10.1177/070674371405901101.CrossRefGoogle ScholarPubMed
Weinberg, A., Klonsky, ED. The effects of self-injury on acute negative arousal: A laboratory simulation. Motivation Emot. 2011;36:242–54. https://doi.org/10.1007/s11031-011-9233-x.Google Scholar
Brown, SA, Williams, K, Collins, A. Past and recent deliberate self-harm: Emotion and coping strategy differences. J Clin Psychol. 2007;63(9):791–803.CrossRefGoogle ScholarPubMed
Andover, MS, Morris, BW. Expanding and clarifying the role of emotion regulation in nonsuicidal self-injury. Can J Psychiatry. 2014;59(11):569–75.CrossRefGoogle ScholarPubMed
Kaess, M, Hooley, JM, Klimes-Dougan, B, et al. Advancing a temporal framework for understanding the biology of nonsuicidal self-injury: An expert review. Neurosci Biobehav Rev. 2021;130:228–39. https://doi.org/10.1016/j.neubiorev.2021.08.022.CrossRefGoogle ScholarPubMed
Kaess, M, Hille, M, Parzer, P, et al. Alterations in the neuroendocrinological stress response to acute psychosocial stress in adolescents engaging in nonsuicidal self-injury. Psychoneuroendocrinology. 2012;37(1):157–61.CrossRefGoogle ScholarPubMed
Reichl, C, Heyer, A, Brunner, R, et al. Hypothalamic-pituitary-adrenal axis, childhood adversity and adolescent nonsuicidal self-injury. Psychoneuroendocrinology. 2016;74:203–11.CrossRefGoogle ScholarPubMed
Hooley, JM, Ho, DT, Slater, J., Lockshin, A. Pain perception and nonsuicidal self-injury: A laboratory investigation. Pers. Disord. Theory Res. Treat. 2010;1:170–9. https://doi.org/10.1037/a0020106.Google ScholarPubMed
Rinnewitz, L, Koenig, J, Parzer, P, et al. Childhood Adversity and Psychophysiological Reactivity to Pain in Adolescent Nonsuicidal Self-Injury. Psychopathology. 2018;51(5):346–52.CrossRefGoogle ScholarPubMed
Auerbach, RP, Pagliaccio, D, Allison, GO, Alqueza, KL, Alonso, MF. Neural correlates associated with suicide and nonsuicidal self-injury in youth. Biol Psychiatry. 2021;89(2):119–33. https://doi.org/10.1016/j.biopsych.2020.06.002. Epub 2020 Jun 10.CrossRefGoogle ScholarPubMed
Brañas, MJAA, Croci, MS, Ravagnani Salto, AB, et al. Neuroimaging studies of nonsuicidal self-injury in youth: A systematic review. Life (Basel). 2021;11(8):729. https://doi.org/10.3390/life11080729.Google ScholarPubMed
Westlund Schreiner, M, Klimes-Dougan, B, Mueller, BA, et al. Multi-modal neuroimaging of adolescents with non-suicidal self-injury: Amygdala functional connectivity. J Affect Disord 2017;221:47–55.CrossRefGoogle ScholarPubMed
Kaess, M, Edinger, A, Fischer-Waldschmidt, G, et al. Effectiveness of a brief psychotherapeutic intervention compared with treatment as usual for adolescent nonsuicidal self-injury: A single-centre, randomised controlled trial. Eur Child Adolesc Psychiatry. 2020;29, 881–91.CrossRefGoogle ScholarPubMed
Kothgassner, OD, Goreis, A, Robinson, K, et al. Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: A systematic review and meta-analysis. Psychol Med. 2021;51(7):1057–67.CrossRefGoogle ScholarPubMed
Plener, PL. Tailoring treatments for adolescents with nonsuicidal self-injury. Eur Child Adolesc Psychiatry. 2020;29(6):893–5. https://doi.org/10.1007/s00787-020-01523-6.CrossRefGoogle ScholarPubMed
Sedgwick, R, Ougrin, DJ. No better than chance? Developments in predicting adolescent suicide, a commentary on Mars et al. (2018) and Beckman et al. (2018). Child Psychol Psychiatry. 2019;60(1):100–1. https://doi.org/10.1111/jcpp.12982.PMID:30556605Sedwidge.CrossRefGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×