Closing in on Crisis

Informing Clinical Practice Regarding Nonsuicidal Self-injury in Youth

Cara C. Young, PhD, RN, FNP-C; Amanda J. Simonton, BSN, RN; Stephanie Key, RN, MSN, CPNP-PC; Amanda N. Barczyk, PhD, MSW; Karla A. Lawson, PhD, MPH


J Pediatr Health Care. 2017;31(3):334-341. 

In This Article

Abstract and Introduction


Nonsuicidal self-injury (NSSI) in youth is a major public health concern. A retrospective chart review was conducted within a hospital system to examine (a) youth self-reports of reasons for engaging in NSSI and (b) additional contextual circumstances that may contribute to youth NSSI. Detailed history, physical examination, and treatment/discharge data were extracted by thoroughly reviewing all electronic documents in each medical record. The final sample (N = 135) were predominantly female (71.1%), and well over half (63.8%) reported Medicaid or uninsured status. Qualitative content analysis of youth self-reports and hospital progress notes showed that NSSI served as an emotional and functional coping mechanism. Five primary themes characterized the contextual influences on youth engaging in NSSI: (1) Personal Emotions, (2) Trauma, (3) Relationship Quality, (4) Sense of Loss, and (5) Risk Behaviors. Practical clinical practice suggestions for working with youth are discussed using these themes as a template for assessing risk and protective factors.


Suicidal and self-injurious behaviors in youth are a major public health concern. For youth in the United States between the ages of 10 and 24 years, suicide is the third leading cause of death, and more than one in six high school students (Grades 9–12) have reported seriously considering suicide in the past year (Kann et al., 2014). Nonsuicidal self-injury (NSSI), defined as deliberate, socially unacceptable self-inflicted damage to one's body without suicidal intent (Guerry & Prinstein, 2010; Nock & Prinstein, 2004), is also widely prevalent. As a distinct phenomenon related to suicidal behavior, NSSI is characterized by significant morbidity (e.g., pain, risk of infection, and scarring), and it is associated with increased risk for mortality via suicide attempts (Nock, Joiner, Gordon, Lloyd-Richardson, & Prinstein, 2006; Wilkinson & Goodyer, 2011).. People who deliberately harm themselves are 30 times more likely to commit suicide than those who do not (Cooper et al., 2005).

Lifetime prevalence rates of NSSI ranging from 13% to 45% have been reported in community-based samples of youth (Lloyd-Richardson, Perrine, Dierker, & Kelley, 2007; Plener, Libal, Keller, Fegert, & Muehlenkamp, 2009), with clinical samples reporting an even higher prevalence ranging from 40% to 75% (Darche, 1990; Guerry & Prinstein, 2010). The inclusion of NSSI criteria within the Emerging Measures and Models section of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (American Psychiatric Association, 2013) points to an increasing awareness of NSSI as a distinct disorder and suggests a need for more empirical research to document the unique characteristics of NSSI and its associated risk factors.