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Review
. 2018 Jan 19;115(3):23-30.
doi: 10.3238/arztebl.2018.0023.

Nonsuicidal Self-Injury in Adolescents

Paul L Plener  1 , Michael Kaess, Christian Schmahl, Stefan Pollak, Jörg M Fegert, Rebecca C Brown
Affiliations
Review

Nonsuicidal Self-Injury in Adolescents

Paul L Plener et al. Dtsch Arztebl Int. .

Abstract

Background: 25-35% of adolescents in random samples drawn from German schools have been found to have manifested at least one episode of nonsuicidal self-injury (NSSI). The prevalence in samples from child and adolescent psychiatric clinics is approximately 50%. NSSI can arise as a symptom in the setting of various types of mental illness.

Methods: This review is based on a selective literature search carried out in the PubMed, PsycINFO, and Cochrane Library databases, with special consideration of regional study samples.

Results: NSSI is usually resorted to as a dysfunctional coping strategy for emotional regulation. The main risk factors for NSSI include bullying, accompanying mental illnesses, and a history of abuse and neglect in childhood. Neurobiological studies have shown abnormal stress processing in persons with NSSI and an elevated pain threshold in persons with repetitive NSSI. Psychotherapeutic interventions of various kinds lessen the frequency of NSSI; to date, no particular type of psychotherapy has been found to be clearly superior to the others. Randomized controlled trials have revealed small to moderate effects from dialectic-behavioral therapy and mentalization-based therapy in adolescent patients. No psychoactive drug has yet been found to possess specific efficacy against NSSI in adolescents.

Conclusion: The first ever German-language clinical guidelines for the treatment of NSSI have now been issued. Psychotherapy is the treatment of first choice. More research is needed so that subgroups with different disease courses can be more clearly defined.

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Figures

Figure 1
Figure 1
Patterns of self-harming behavior a) Parallel tracks of fingernail scratches on the left upper arm of a 15-year-old boy who was involved in a knife attack and then injured himself in order to make his actions appear to be self-defense. b) 18-year-old male with parallel groups of scars on the front wall of the thorax, shoulder, and arm in bands, inflicted with a razor blade. c) Inner left forearm of a 14-year-old girl, showing scratch-like skin indents, inflicted using a razor blade.
Figure 2
Figure 2
Flow chart of the treatment of nonsuicidal self-injury (simplified), following the guidelines of the Association of Scientific Medical Societies in Germany (AWMF, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften) (DGKJP, 2015; [3]) DGKJP, German Association for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; NSSI, nonsuicidal self-injury
See this image and copyright information in PMC

References

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    1. Plener PL, Libal G, Keller F, Fegert JM, Muehlenkamp JJ. An international comparison of adolescent non-suicidal self-injury (NSSI) and suicide attempts: Germany and the USA. Psychol Med. 2009;39:1549–1558. - PubMed
    1. Deutsche Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie. Leitlinie Nicht-Suizidales Selbstverletzendes Verhalten (NSSV) im Kindes und Jugendalter. www.awmf.org/uploads/tx_szleitlinien/028-029l_S2k_Nicht-suizidales-selbs... (last accessed on 27 May 2017)
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