Key points are not available for this paper at this time.
Background: Non-suicidal self-injury (NSSI) represents a significant public health concern, particularly among adolescents. Recent conceptualizations posit that a severe, repetitive form of NSSI may be understood through an addiction framework, characterized by craving, loss of control, and continued use despite harm. However, an integrative model linking its behavioral phenotype, neurobiological underpinnings, and evidence-based treatment remains to be fully articulated. Methods: This narrative review synthesizes contemporary literature across psychological, neurobiological, and clinical domains to propose an integrative model of NSSI with addictive features. Results: The review establishes three key pillars of evidence. First, behaviorally, repetitive NSSI exhibits core addiction-like features driven by potent negative reinforcement. Intriguingly, this occurs alongside intact or even enhanced reactive inhibitory control, suggesting a specific dysregulation in reward-based decision-making rather than a global impulse deficit. Second, neurobiologically, this phenotype is supported by convergent findings of hypothalamic-pituitary-adrenal (HPA) axis dysregulation, a reward system biased towards distress relief, and dysfunctional fronto-limbic circuitry marked by limbic hyperreactivity and impaired prefrontal regulation. Third, therapeutically, Dialectical Behavior Therapy (DBT) emerges as the most effective intervention, with emerging evidence indicating it promotes symptom reduction through the neuroplastic normalization of this same fronto-limbic circuitry. The development of this addictive cycle is moderated by a transaction between risk factors (e.g., childhood adversity, peer victimization) and protective factors (e.g., resilience, self-efficacy). Conclusion: This synthesis supports the heuristic value of an addiction model for severe NSSI, providing a coherent framework that bridges behavior, brain, and treatment. Future translational research should focus on identifying biomarkers for the addictive subtype, developing circuit-targeted interventions, and implementing staged, multi-systemic prevention strategies.
Chen et al. (Fri,) studied this question.