Non-Suicidal Self-Injury in Adolescents - Assessment, Risk Stratification, and Disposition Planning
I. Defining and Differentiating Self-Harming Behaviors A psychiatrist is called by an emergency room doctor and told there is a girl in Room 8 who was “cutting her thighs.” The girl denies any suicidal thoughts and replied “I don’t know,” when asked why she cut herself. How should the evaluation precede? A precise clinical understanding of self-harming behaviors is essential for accurate diagnosis, effective treatment, and appropriate risk management. The nomenclature has evolved significantly from historically pejorative terms to the current, function-based conceptualizations that guide modern psychiatric practice. This section will define Non-Suicidal Self-Injury (NSSI), distinguish it from Body-Focused Repetitive Behaviors (BFRBs), and provide a comparative framework for differential diagnosis. A. The Clinical Definition of Non-Suicidal Self-Injury (NSSI) NSSI is formally defined as the intentional, direct, and deliberate destruction or alteration of one's own body...