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Nonsuicidal Self-Injury (NSSI)


Christine Moutier

, MD, American Foundation For Suicide Prevention

Reviewed/Revised Jul 2023

Nonsuicidal self-injury is a self-inflicted act that causes pain or superficial damage but is not intended to cause death.

Although the methods people use to hurt themselves, such as cutting their wrists with a razor blade, sometimes overlap with those of suicide attempts Suicidal Behavior Suicide is death caused by an act of self-harm that is intended to be lethal. Suicidal behavior includes completed suicide, attempted suicide, and suicidal ideation (thoughts and ideas). Suicide... read more , nonsuicidal self-injury is different because people do not intend the acts to cause death. Often, people specifically state that they are not trying to kill themselves. In other cases, doctors presume people are not actually trying to die when they repeatedly do something that clearly cannot cause death—for example, burning themselves with cigarettes.

However, the first time people hurt themselves, it may not be clear whether they actually intended to die. For example, people may think that they could kill themselves by taking an overdose of antibiotics or vitamins, take such dose, and then realize that such a dose is harmless.

Even when self-injury does not cause death, people who injure themselves are probably more likely over the long term to attempt or commit suicide. Thus, doctors and family members should not lightly dismiss nonsuicidal self-injury.

The most common examples of nonsuicidal self-injury include

  • Cutting or stabbing the skin with a sharp object, such as a knife, razor blade, or needle

  • Burning the skin, typically with a cigarette

Nonsuicidal self-injury tends to start during early adolescence. It is more common among people who have other disorders, particularly borderline personality disorder Borderline Personality Disorder (BPD) Borderline personality disorder is a mental health condition that is characterized by a pervasive pattern of instability in relationships, self-image, moods, and behavior and hypersensitivity... read more , antisocial personality disorder Antisocial Personality Disorder Antisocial personality disorder is a mental health condition that is characterized by a pervasive pattern of disregard for consequences and for the rights of others. People with antisocial personality... read more , an eating disorder Overview of Eating Disorders Eating disorders involve a disturbance of eating or of behavior related to eating, typically including Changes in what or how much people eat Measures people take to prevent food from being... read more , or substance use disorders Overview of Substance-Related Disorders Medications and other substances, whether used for legitimate medical purposes, as a habit (for example, caffeine), or recreationally, are an integral part of everyday life for many people ... read more (including alcohol use disorder Alcohol Use Alcohol (ethanol) is a depressant (it slows down brain and nervous system functioning). Consuming large amounts rapidly or regularly can cause health problems, including organ damage, coma,... read more ), and autism spectrum disorders Autism Spectrum Disorders Autism spectrum disorders are conditions in which people have difficulty developing normal social relationships, use language abnormally or not at all, and show restricted or repetitive behaviors... read more . Nonsuicidal self-injury is only slightly more common among girls than boys, whereas suicidal behavior Suicidal Behavior Suicide is death caused by an act of self-harm that is intended to be lethal. Suicidal behavior includes completed suicide, attempted suicide, and suicidal ideation (thoughts and ideas). Suicide... read more is much more common among girls than boys. Most people stop hurting themselves when they get older.

People often injure themselves repeatedly in a single session, creating several cuts or burns in the same location. Usually, people choose an area that is at once accessible and easily hidden by clothing, such as the forearms or front of the thighs. Typically, people also hurt themselves repeatedly, resulting in extensive scars from previous episodes. People are often preoccupied with thoughts about the injurious acts.

Why people injure themselves is unclear, but self-injury may be

  • A way to reduce tension or negative feelings

  • A way to resolve interpersonal difficulties

  • Self-punishment for perceived faults

  • A plea for help

Some people do not think their self-injury is a problem and thus tend not to seek or accept counseling.

Diagnosis of Nonsuicidal Self-Injury

  • A doctor's evaluation

First, doctors examine the person to determine whether any of the person's injuries require treatment.

To diagnose nonsuicidal self-injury, doctors must determine whether the act was intended to cause death (suicidal behavior) or not (nonsuicidal self-injury). To do so, doctors evaluate the person's intent, reasons, and mood. People who engage in nonsuicidal self-injury may state that they harm themselves to obtain relief from negative feelings rather than to kill themselves. Or they may repeatedly use methods unlikely to result in death. However, people who engage in self-injury can and do attempt suicide. So doctors talk to other people who are close to the person about changes in the person's mood and stresses in the person's life so that they can evaluate the person's risk of suicide.

If people do not think their self-injury is a problem, they may be reluctant to talk about it. Thus, to evaluate people who have injured themselves, doctors first try to help these people talk about their self-injury. To do so, doctors communicate the following:

  • That they have heard the person and take the person's experiences seriously

  • That they understand how the person feels and how those feelings could result in self-injury

Doctors then try to determine the following:

  • How people injure themselves and how many different ways they do it (for example, do they burn and cut themselves?)

  • How often they injure themselves

  • How long they have been injuring themselves

  • What purpose injuring themselves serves

  • How willing they are to participate in treatment

Doctors also check for other mental disorders and try to estimate how likely people are to attempt suicide.

Treatment of Nonsuicidal Self-Injury

  • Certain types of psychotherapy

  • Treatment of any other disorders present

Certain types of psychotherapy may help people who injure themselves. They include

  • Cognitive-behavioral therapy

  • Dialectical behavior therapy

  • Emotion-regulation group therapy

Cognitive-behavioral therapy helps people identify distortions in thinking and understand how these distortions lead to problems in their lives. The premise is that how people feel and behave is determined by how they interpret experiences. Through the identification of core beliefs and assumptions, people learn to think in different ways about their experiences, reducing symptoms and resulting in improvement in behavior and feelings.

Dialectical behavior therapy provides weekly individual and group sessions for 1 year and a therapist who is available 24 hours a day by telephone. The therapist acts as a behavior coach. The aim is to help people find more appropriate ways of responding to stress—for example, to resist urges to behave self-destructively.

Emotion-regulation group therapy involves 14 weeks of group therapy. It helps people become aware of, understand, and accept their emotions. This therapy helps people be willing to accept negative emotions as part of life and thus not to respond to such emotions so intensely and impulsively.

No medications have been approved for the treatment of nonsuicidal self-injury. However, some antidepressants, newer antipsychotics, and naltrexone have been effective for some people.

More Information

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

  • Self-Injury & Recovery Resources (SIRR): This web site was launched by Cornell University in 2003 to address the emerging phenomenon of self-injury among youth and young adults and eventually produced a series of resources to educate laypeople and professionals about nonsuicidal self-injury (NSS), as well as assessment and recovery tools to assist in the treatment of NSSI.

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