Viewing Nonsuicidal Self-Injury in Adolescence Through a Developmental Neuroscience Lens: The Impact of Neural Sensitivity to Socioaffective Pain and Reward

Abstract

Nonsuicidal self-injury (NSSI)—deliberate self-harm without the intent to die—is a high-risk and impairing behavior associated with long-term morbidity and mortality risks. The prevalence of NSSI escalates in adolescence, indicating a sensitive developmental period for the emergence of this behavior. Neurobiological, interpersonal, and affective processes leading to NSSI have been proposed. However, the link between neurodevelopment and the emergence of NSSI in adolescence remains unclear. Therefore, in this review, we integrate a diverse literature of human and animal studies that have examined features of NSSI and identify two neurodevelopmental mechanisms that increase risk of NSSI in adolescence: sensitivity to socioaffective pain and reward. We propose a two-step process in which neurodevelopmental sensitivity exacerbates socioaffective risk pathways leading to the onset of NSSI and strengthens the maintenance of self-harm in adolescence. We discuss implications of this theoretical framework for improving prevention and intervention strategies by capitalizing on developmental sensitivity in potentiating mechanisms.