Nonsuicidal Self-Injury and Suicidal Behaviors in Girls: The Case for Targeted Prevention in Adolescence


Nonsuicidal self-injury (NSSI) – defined as deliberate self-harm without intent to die – affects 15 to 20% of adolescents, disproportionately girls, many of whom now initiate the behavior before age 10. Furthermore, NSSI – including behaviors such as banging/hitting, burning, carving, and cutting oneself – is a strong predictor of eventual suicide. In fact, about 75% of inpatients who engage in NSSI eventually attempt suicide, and about 10% eventually die by suicide.

Despite these findings, no empirically supported prevention programs exist for preadolescents; rather, interventions are typically initiated in adolescence. The timing of intervention is problematic because, once established, NSSI and its psychological correlates – particularly emotion dysregulation – are difficult to treat.

However, gaps in how to identify vulnerable individuals remain, and mechanisms of behavior change must be specified, engaged, and measured effectively as preventative for self-harm in order to prevent NSSI and eventual suicide attempts.

The researchers behind this paper review evidence that (a) current understanding of etiology – at least for a sizable subset of girls – is sufficient to identify vulnerable individuals before they engage in NSSI or suicidal behaviors (SBs) and before they affiliate with deviant peers who reinforce self-harm; (b) family, peer, and other social mechanisms that reinforce self-harm are malleable using existing interventions; and (c) carefully selected neurobiological markers of vulnerability can be used to evaluate prevention response without waiting to assess distal outcomes of NSSI and SBs.

They do this to (a) call attention to the need for early intervention for NSSI and SBs; (b) identify ADHD, maltreatment, and their interaction as risk factors for NSSI and SBs; (c) specify neurobiological correlates of NSSI and SBs; and (d) review the roles of parenting and maltreatment on developing regulatory functions and brain systems among children.

Their hope is to combine these principles and apply them in an integrated strategy for preventing the second leading cause of death in the United States among adolescents and young adults: suicide.

Beauchaine, T.P., Hinshaw, S.P., Bridge, J.A. (2019). Nonsuicidal Self-Injury and Suicidal Behaviors in Girls: The Case for Targeted Prevention in Adolescence. Clinical Psychological Science, Vol 7(4), 643-667

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