Nonsuicidal self-injury (NSSI) is prevalent and affects mainly the youth population. It is prospectively associated with suicide attempts, making it a target for suicide prevention. Recently, several studies have investigated neural pathways of NSSI using neuroimaging. However, there is a lack of systematized appraisal of these findings. This systematic review aims to identify and summarize the main neuroimaging findings of NSSI in youth. We followed PRISMA statement guidelines and searched MEDLINE, APA PsycInfo, and Google Scholar databases for neuroimaging studies, irrespective of imaging modality, specifically investigating NSSI in samples with a mean age of up to 25 years old. Quality assessment was made using the Newcastle–Ottawa and Joanna Briggs Institute scales. The initial search retrieved 3030 articles; 21 met inclusion criteria, with a total of 938 subjects. Eighteen studies employed functional neuroimaging techniques such as resting-state and task-based fMRI (emotional, interpersonal exposure/social exclusion, pain, reward, and cognitive processing paradigms). Three studies reported on structural MRI. An association of NSSI behavior and altered emotional processing in cortico-limbic neurocircuitry was commonly reported. Additionally, alterations in potential circuits involving pain, reward, interpersonal, self-processing, and executive function control processes were identified. NSSI has complex and diverse neural underpinnings. Future longitudinal studies are needed to understand its developmental aspects better.
Nonsuicidal self-injury is a common development among adolescents that varies in severity, frequency, and associated psychiatric vulnerability. A key challenge is to understand how clinicians can identify those at greater risk, specifically for transition to suicide attempts. Shared functions (eg, to escape negative emotions) and risk factors in selected domains (eg, exposure to self-harm in others, impulsivity, cannabis and other drug use, diminished social connections, and history of bullying) between self-injury and suicide can explain this association and guide interventions. General guidelines for nonsuicidal self-injury and comorbid suicidal behavior in youth include mapping its predisposing factors and psychological functions, assessing severity and acute risk, and elucidating context (eg, interpersonal stressors). No medication has proven effective in reducing self-harm. Outpatient psychological treatment is the first option to address relevant emotional, behavioral, and interpersonal vulnerabilities, and evidence-based treatments can be effective (eg, dialectical behavior therapy, mentalization-based treatment, and cognitive-behavioral therapy). [ Psychiatr Ann. 2022;52(8):311–317.]
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