Beyond the scars: current understanding of risk factors, neurobiological mechanisms and effective interventions for non-suicidal self-injury in young adults

Non-suicidal self-injury (NSSI) is highly prevalent in adolescents and young adults. However, NSSI in young adulthood remains understudied despite this developmental stage is characterized by increading life demands, social transitions, and ongoing brain maturation. This manuscript synthesizes current evidence on risk factors, neurobiology, and treatments for NSSI in emerging adults. Emotional dysregulation, rumination and impulsivity emerge as core individual vulnerabilities, often interacting with adverse childhood experiences and interpersonal stressors. Conversely, perceived social support and metacognitive capacity serve as protective factors. Neurobiological findings, although limited, implicate genetic and epigenetic alongside structural and functional brain abnormalities. Neuroimaging studies reveal that young adults with NSSI exhibit intact nocioceptive encoding but attenuated affective pain responses, together with abnormal recruitment of striatal-midbrin reward pathways. Furthermore, evidence indicates disrupted frontolimbic connectivity underlying emotion regulation deficits and altered self-other processing within medial prefrontal and temporoparietal networks. Treatment research focused on young adults is limited. The Treatment for Sel-Injurious Behaviors (T-SIB) represents the only age-specific intervention with preliminary efficacy evidence. Future research should prioritize young adult samples to clarify the neurobiological mechanisms of NSSI in this critical developmental period and to develop more accessible and effective interventions.