Generic placeholder image

Adolescent Psychiatry


ISSN (Print): 2210-6766
ISSN (Online): 2210-6774

Review Article

The Emergency Assessment and Management of Non-Suicidal Self-Injury in Adolescents

Author(s): Sindhu A. Idicula*, Amy Vyas and Nicole Garber

Volume 9, Issue 2, 2019

Page: [92 - 99] Pages: 8

DOI: 10.2174/2210676609666190618162558


Background and Goals: Non-suicidal self-injury (NSSI) is a common presenting issue mental health providers experience in all levels of care from outpatient clinics to inpatient units. It is common among adolescents seen in emergency settings, either as a presenting problem or as a covert condition that may not be detected unless specifically assessed for. The presence of NSSI increases the risk of suicide. This article aims to help the clinician develop a better understanding of NSSI – what it may entail, the prevalence, and the motivations for why young people engage in it.

Methods: We review the reasons adolescents injure themselves, the link between NSSI and psychiatric diagnoses and suicide, the assessment of NSSI, and treatment planning, with emphasis on ways to screen for NSSI and interventions that can be implemented in the Emergency Department. We illustrate the complexity of NSSI with the case of a young patient with a complex psychiatric history and an extensive history of self-injury.

Results and Discussion: Despite the seeming intractability of NSSI, a number of evidencebased treatments exist. Treatment primarily involves specialized forms of psychotherapy, but interventions can be implemented in the ED that will reduce the immediate risk of NSSI while more definitive intervention is awaited.

Conclusion: Mental health consultations in the ED should always include screening for NSSI. Mental health professionals in the ED can play an important role in the detection and treatment of this condition.

Keywords: Adolescents, non-suicidal self-injury, NSSI, psychiatric emergencies, psychiatric diagnosis, DBT.

« Previous
Asarnow, J., Porta, G., Spirito, A., Emsie, G., Clarke, G., Wagner, K. . . . Brent, D. (2011). Suicide attempts and nonsuicidal self-injury in the treatment of resistant depression in adolescents: Findings from the TORDIA trial. J. Am. Acad. Child Adolesc. Psychiatry, 50(8), 772-781.
Brausch, A., Gutierrez, P. (2010). Differences in non-suicidal self-injury and suicide attempts in adolescents. J. Youth Adolesc., 39(3), 233-242.
Cloutier, P., Martin, J., Kennedy, A., Nixon, M., Muehlenkamp, J. (2009). Characteristics and co-occurrence of adolescent non-suicidal self-injury and suicidal behaviors in pediatric emergency crisis services. J. Youth Adolesc., 39(3), 259-269.
Favazza, A. (1989). Why patients mutilate themselves. Hosp. Community Psychiatry, 40(2), 137-145.
Firestone, R., Seiden, R. (1990). Suicide and the continuum of self-destructive behavior. J. Am. Coll. Health, 38(5), 207-213.
Gicquel, L., Corcos, M. (2011). Les automutilations àl’adolescence [Self-injury in adolescents]. Paris, France: Dunod
Grandclerc, S., De Labrouhe, D., Spondenkiewicz, M., Lachal, J., Moro, M.R. (2016). Relations between nonsuicidal self-injury and suicidal behavior in adolescence: A systematic review. PLoS One, 11(4), 1-15.
Hawton, K., Bergen, H., Kapur, N., Cooper, J., Steeg, S., Ness, J., Waters, K. (2012). Repetition of self-harm and suicide following self-harm in children and adolescents: findings from the Multicentre Study of Selfharm in England. Journal od Child Psychology and Psychiatry, 53(12), 1212-1219.
Jacobson, C., Gould, M. (2007). The epidemiology of non-suicidal self-injurious behavior among adolescents: A critical review of the literature. Arch. Suicide Res., 11(2), 129-147.
Joiner, T. (2005). Why people die by suicide.. Cambridge, MA: Harvard University Press.
Katz, L.Y., Cox, B.J., Gunasekara, S., Miller, A.L. (2004). Feasibility of dialectical behavior therapy for suicidal adolescent inpatients. J. Am. Acad. Child Adolesc. Psychiatry, 43(3), 276-282.
Klonsky, E., Muehlenkamp, J. (2007). Self-injury: A research guide for the practitioner. J. Clin. Psychol., 63(11), 1045-1056.
Kress, V., Hoffman, R. (2008). Non-suicidal self-injury and motivational interviewing: Enhancing readiness for change. J. Ment. Health Couns., 30(4), 311-329.
Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder.. New York: Guilford Press.
Miller, W., Rollnick, S. (2002). Motivational interviewing: Preparing people for change.. New York: Guilford.
Muehlenkamp, J. (2006). Empirically supported treatments and general therapy guidelines for non-suicidal self-injury. J. Ment. Health Couns., 28, 166-185.
Nock, M., Joiner, T., Gordon, K., Lloyd-Richardson, E., Prinstein, M. (2006). Non-suicidal self-injury among adolescents: Diagnostic correlates and relation to suicide attempts. Psychiatry Res., 144(1), 65-72.
Nock, M. (2010). Self injury. Annu. Rev. Clin. Psychol., 6, 339-363.
Nock, M., Teper, R., Hollander, M. (2007). Psychological treatment of self –injury among adolescents. J. Clin. Psychol., 63(11), 1081-1089.
Olfson, M., Wall, M., Wang, S., Crystal, S., Bridge, J., Liu, S., Blanco, C. (2018). Suicide after deliberate self-harm in adolescents and young adults. Pediatrics, 141(4)e20173517
Peterson, J., Freedenthal, S., Sheldon, C., Andersen, R. (2008). Nonsuicidal self injury in adolescents. Psychiatry, 5(11), 20-26.
Rossouw, T., Fonagy, P. (2012). Mentalization-based treatment for self-harm in adolescents: A randomized controlled study. Journal of the American Academy of Child and Adolescent Psychiatry., 51(12), 1304-1313.
Taylor, T., Hawton, K., Fortune, S., Kapur, N. (2009). Attitudes towards clinical services among people who self-harm: Systematic review. The British Journal of Psychiatry, 194(2), 104-110.
Walsh, B. (2012). Treating self injury: A practical guide.. New York: Guilford Press.
Westers, N., Muezenkamp, J., Lau, M. (2016). SOARS model: Risk assessment of nonsuicidal self-injury. Contemp. Pediatr., 33(7), 25-31.
Whitlock, J., Eckenrode, J., Silverman, D. (2006). Self-injurious behaviors in a college population. Pediatrics, 117(6), 1939-1948.
Whitlock, J., Exner-Cortens, D., Purington, A. (2014). Validity and reliability of the non-suicidal self-injury assessment test (NSSI-AT). Psychol. Assess., 26(3), 935-946.

© 2023 Bentham Science Publishers | Privacy Policy