Informal and Professional Awareness of Nonsuicidal Self-Injury: Clinical and Functional Correlates Among Arab Female University Students

Background/Objectives: Clinical assessment of nonsuicidal self-injury (NSSI) typically documents the behavior, its functions, and current safety, but less attention has been given to who is aware of the NSSI. Informal and professional recipients occupy different roles in support, assessment, and referral, yet disclosure research often combines them. We examined whether clinical and functional correlates differed by recipient type among Arab female university students. Methods: A cross-sectional online survey included 8320 participants, of whom 2396 reported lifetime NSSI. Recipient awareness was classified as no awareness among five assessed categories (n = 812), informal-only awareness by a friend, family member, or partner (n = 824), or professional awareness by a mental health professional or physician, with or without informal awareness (n = 760). Analyses included multinomial logistic regression, adjusted probabilities, generalized estimating equations, and sensitivity analyses. Results: Depressive symptoms and NSSI method versatility were more strongly associated with professional than informal awareness (ORs for the recipient-class slope differences = 1.54 and 1.32, respectively). Interpersonal-function endorsement was associated with both informal and professional awareness and distinguished professional from informal-only awareness (RRR = 1.25). Intrapersonal-function endorsement did not retain an independent association after adjustment. Conclusions: Informal-only and professional awareness were associated with different concurrent NSSI profiles. In clinical assessment, asking who knows about the NSSI, how awareness arose, and what happened afterward may add useful context to formulation. Professional awareness should not be taken as evidence that adequate assessment or care occurred. The cross-sectional data do not establish disclosure, help-seeking, treatment engagement, or temporal sequence.