Defining Nonsuicidal Self-Injury in Autistic People: A Framework for Assessment Using Key Elements to Aid in Characterization

Nonsuicidal self-injury (NSSI) is the intentional destruction of one’s own body tissue without suicidal intent and for purposes that are not socially or culturally accepted or practiced (e.g., intentional self-cutting, self-biting). Research on NSSI in autistic people is limited but increasing. NSSI is strongly associated with suicide, and it is an important behavior to better understand given the high rates of NSSI and suicide in autistic people. To date, research that focused on autistic people has mostly used self-report questionnaires to assess NSSI, with a more limited application of clinical interviews of NSSI. However, researchers and clinicians may find it challenging to determine whether a behavior is categorized as NSSI in autistic people, especially since autistic people may present with other behaviors that cause self-injury. We build upon the International Society for the Study of Self-Injury's key elements in defining NSSI to support better reliability of NSSI assessment across studies. We emphasize that when assessing for NSSI the behavior must meet these key elements: (1) not intended to cause death, (2) the physical self-injury/harm is intentional, (3) there is immediate physical injury following the behavior, (4) the physical injury is to the external body, not internal body, (5) the physical injury is self-imposed and not done by another being, and (6) it is not a part of social or cultural practices. It will be important for future work to develop measures that can accurately assess NSSI in autistic people and advance mechanistic and intervention research related to NSSI.