Nonsuicidal self-injury (nssi)

[Mary Mallozziberg]

Nonsuicidal self-injury is a self-inflicted act that causes pain or superficial damage but is not intended to cause death.
Although the methods used sometimes overlap with those of suicide attempts (eg, cutting the wrists with a razor blade), nonsuicidal self-injury is distinct from suicide because patients do not intend the acts to be lethal. Patients may specifically state a lack of intent, or the lack may be inferred by their repeated use of clearly nonlethal methods. Despite the lack of immediate lethality, long-term risk of suicide attempts and of suicide is increased, and thus, nonsuicidal self-injury should not be dismissed lightly.
The most common examples of nonsuicidal self-injury include

Cutting or stabbing the skin with a sharp object (eg, knife, razor blade, needle)
Burning the skin (typically with a cigarette)

Patients often injure themselves repeatedly in a single session, creating multiple lesions in the same location, typically in areas that are easily hidden but accessible (eg, forearms, front of thighs). The behavior is often repeated, resulting in extensive patterns of scarring. Patients are often preoccupied with thoughts about the injurious acts.
Nonsuicidal self-injury tends to start in the early teens (1), and although data are not conclusive, may be slightly more prevalent in females, unlike suicide attempts, which are much more common in girls. The natural history is unclear, but the behavior appears to decrease after young adulthood. Prevalence is also high in criminal populations, which tend to be predominantly male.
The motivations for nonsuicidal self-injury are unclear, but self-injury may be

A way to reduce tension or negative feelings
A way to resolve interpersonal difficulties
Self-punishment for perceived faults
A plea for help

Some patients view the self-injury as a positive activity and thus tend not to seek or accept counseling.
Nonsuicidal self-injury is often accompanied by other disorders, particularly borderline personality disorder, antisocial personality disorder, eating disorders, alcohol and substance abuse, and autism.