Non-Suicidal Self-Harm: Pathophysiology, diagnosis, treatment, and contemporary perspectives
DOI:
https://doi.org/10.33448/rsd-v15i5.51097Keywords:
Non-suicidal self-injury, NSSI, Self-harm, Pathophysiology, Suicide, Psychiatric treatment.Abstract
Non-suicidal self-injury (NSSI) represents a major clinical and public health challenge, particularly among adolescents and young adults. It is characterized by the deliberate destruction of body tissue without conscious suicidal intent, including behaviors such as cutting, burning, and self-hitting. Over recent decades, conceptual and diagnostic advances have enabled differentiation between NSSI and suicidal behaviors, culminating in the inclusion of Non-Suicidal Self-Injury Disorder (NSSI-D) in the DSM-5 as a condition for further study. This systematic review aimed to synthesize current evidence regarding the epidemiology, pathophysiology, risk factors, diagnostic criteria, assessment tools, and therapeutic approaches related to NSSI. Scientific articles indexed in PubMed, Scopus, and PsycINFO and published between 2000 and 2024 were reviewed, prioritizing systematic reviews, meta-analyses, and relevant clinical studies. Findings indicate that NSSI is a multifactorial phenomenon involving neurobiological alterations, emotional dysregulation, impulsivity, endogenous opioid system dysfunction, early trauma, and psychosocial vulnerabilities. Comorbidity with depressive disorders, borderline personality disorder, eating disorders, and post-traumatic stress disorder is highly prevalent. The most effective therapeutic approaches include dialectical behavior therapy, cognitive behavioral therapy, mentalization-based therapy, and family interventions. Although no pharmacological treatments have been specifically approved for NSSI, medications may assist in the management of associated psychiatric conditions. NSSI should be understood as a complex and dimensional phenomenon requiring early diagnostic strategies, multidisciplinary management, and evidence-based therapeutic protocols.
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