Non-suicidal self-injury in adolescents: a clinician’s guide to understanding the phenomenon, diagnostic challenges, and evidence-based treatments
Non-suicidal self-injury (NSSI) is a prevalent and complex behavior, particularly among adolescents. This review explores the definition, epidemiology, and clinical significance of NSSI, emphasizing its role as a risk factor for suicidal behavior and its association with emotional dysregulation. Emp...
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| Format: | Article |
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Frontiers Media S.A.
2025-07-01
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| Series: | Frontiers in Psychiatry |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpsyt.2025.1605508/full |
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| author | Massimo Apicella Massimo Apicella Maria Pontillo Gino Maglio Cristina Di Vincenzo Giorgia Della Santa Elisa Andracchio Stefano Vicari Stefano Vicari |
| author_facet | Massimo Apicella Massimo Apicella Maria Pontillo Gino Maglio Cristina Di Vincenzo Giorgia Della Santa Elisa Andracchio Stefano Vicari Stefano Vicari |
| author_sort | Massimo Apicella |
| collection | DOAJ |
| description | Non-suicidal self-injury (NSSI) is a prevalent and complex behavior, particularly among adolescents. This review explores the definition, epidemiology, and clinical significance of NSSI, emphasizing its role as a risk factor for suicidal behavior and its association with emotional dysregulation. Empirical and theoretical transdiagnostic approaches of different origins have advanced our understanding of NSSI, highlighting the importance of underlying psychological processes such as impulsivity, negative affect, and maladaptive coping strategies, yet NSSI in specific clinical presentations (e.g. Ultra-High Risk State for psychosis, autism spectrum disorders, gender dysphoria) remains understudied and less understood. Despite its inclusion in the DSM-5-TR as a condition for further study, NSSI remains undertreated, posing significant challenges for mental health care systems. The review examines the relationship between NSSI and specific psychiatric comorbidities, not limited to mood disorders, underscoring the need for tailored interventions. Psychotherapeutic approaches, such as Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Mentalization-Based Therapy (MBT), have shown promise in reducing NSSI, though long-term efficacy and comparative outcomes require further investigation. Pharmacological treatments, while limited, should focus on managing comorbid conditions rather than directly targeting NSSI. Emerging interventions may offer some potential but need further development. By integrating biological, psychological, and social perspectives, clinicians and researchers can better understand and address the multifaceted nature of NSSI. Early identification, comprehensive assessment, and targeted interventions are essential to mitigate the impact of NSSI and improve outcomes for affected individuals. |
| format | Article |
| id | doaj-art-e5e966232c8a46aba02cbc937d7ef62f |
| institution | DOAJ |
| issn | 1664-0640 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Psychiatry |
| spelling | doaj-art-e5e966232c8a46aba02cbc937d7ef62f2025-08-20T02:46:01ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402025-07-011610.3389/fpsyt.2025.16055081605508Non-suicidal self-injury in adolescents: a clinician’s guide to understanding the phenomenon, diagnostic challenges, and evidence-based treatmentsMassimo Apicella0Massimo Apicella1Maria Pontillo2Gino Maglio3Cristina Di Vincenzo4Giorgia Della Santa5Elisa Andracchio6Stefano Vicari7Stefano Vicari8Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, ItalyDepartment of Neuroscience, Catholic University of the Sacred Hearth, Rome, ItalyChild and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, ItalyChild and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, ItalyDepartment of Psychology, Catholic University of Sacred Hearth, Milan, ItalyChild and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, ItalyChild and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, ItalyChild and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, ItalyDepartment of Life Sciences and Public Health, Catholic University of the Sacred Hearth, Rome, ItalyNon-suicidal self-injury (NSSI) is a prevalent and complex behavior, particularly among adolescents. This review explores the definition, epidemiology, and clinical significance of NSSI, emphasizing its role as a risk factor for suicidal behavior and its association with emotional dysregulation. Empirical and theoretical transdiagnostic approaches of different origins have advanced our understanding of NSSI, highlighting the importance of underlying psychological processes such as impulsivity, negative affect, and maladaptive coping strategies, yet NSSI in specific clinical presentations (e.g. Ultra-High Risk State for psychosis, autism spectrum disorders, gender dysphoria) remains understudied and less understood. Despite its inclusion in the DSM-5-TR as a condition for further study, NSSI remains undertreated, posing significant challenges for mental health care systems. The review examines the relationship between NSSI and specific psychiatric comorbidities, not limited to mood disorders, underscoring the need for tailored interventions. Psychotherapeutic approaches, such as Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Mentalization-Based Therapy (MBT), have shown promise in reducing NSSI, though long-term efficacy and comparative outcomes require further investigation. Pharmacological treatments, while limited, should focus on managing comorbid conditions rather than directly targeting NSSI. Emerging interventions may offer some potential but need further development. By integrating biological, psychological, and social perspectives, clinicians and researchers can better understand and address the multifaceted nature of NSSI. Early identification, comprehensive assessment, and targeted interventions are essential to mitigate the impact of NSSI and improve outcomes for affected individuals.https://www.frontiersin.org/articles/10.3389/fpsyt.2025.1605508/fullnon-suicidal self-injurysuicideadolescencedepressionmood disordersemotion dysregulation |
| spellingShingle | Massimo Apicella Massimo Apicella Maria Pontillo Gino Maglio Cristina Di Vincenzo Giorgia Della Santa Elisa Andracchio Stefano Vicari Stefano Vicari Non-suicidal self-injury in adolescents: a clinician’s guide to understanding the phenomenon, diagnostic challenges, and evidence-based treatments Frontiers in Psychiatry non-suicidal self-injury suicide adolescence depression mood disorders emotion dysregulation |
| title | Non-suicidal self-injury in adolescents: a clinician’s guide to understanding the phenomenon, diagnostic challenges, and evidence-based treatments |
| title_full | Non-suicidal self-injury in adolescents: a clinician’s guide to understanding the phenomenon, diagnostic challenges, and evidence-based treatments |
| title_fullStr | Non-suicidal self-injury in adolescents: a clinician’s guide to understanding the phenomenon, diagnostic challenges, and evidence-based treatments |
| title_full_unstemmed | Non-suicidal self-injury in adolescents: a clinician’s guide to understanding the phenomenon, diagnostic challenges, and evidence-based treatments |
| title_short | Non-suicidal self-injury in adolescents: a clinician’s guide to understanding the phenomenon, diagnostic challenges, and evidence-based treatments |
| title_sort | non suicidal self injury in adolescents a clinician s guide to understanding the phenomenon diagnostic challenges and evidence based treatments |
| topic | non-suicidal self-injury suicide adolescence depression mood disorders emotion dysregulation |
| url | https://www.frontiersin.org/articles/10.3389/fpsyt.2025.1605508/full |
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