A groundbreaking study recently published in BMC Psychiatry delves into the intricate web of relationships among various nonsuicidal self-injurious (NSSI) behaviors, shedding new light on the complexity and interconnectivity of methods such as cutting, biting, burning, and carving. This research challenges traditional person-centred approaches by employing advanced variable-centred network analysis to unravel how different NSSI behaviors co-occur and influence one another, potentially revolutionizing clinical understanding and treatment strategies for individuals who engage in self-harm.
NSSI is a significant clinical concern, often indicative of underlying psychological distress, and the severity of self-harm has long been gauged by the presence of multiple methods. However, until now, little has been understood about the structural patterns and direct associations between different NSSI techniques. By adopting network analysis—an approach that prioritizes interactions and relationships between variables—the researchers were able to identify which self-injurious behaviors occupy central positions within the network and which tend to cluster together, thereby revealing overarching patterns of behavior that transcend isolated incidents.
The investigation was conducted on a robust community adult sample consisting of 1,873 individuals, among whom nearly 40% reported engaging in at least one episode of nonsuicidal self-injury over their lifetime. This substantial prevalence underscores the widespread nature of NSSI beyond clinical populations and highlights the urgent need to understand the dynamics at play. Importantly, the study found that a considerable majority (77%) of participants who engaged in NSSI used more than one method, indicating a high degree of behavioral versatility that complicates clinical assessment and intervention.
In quantifying the frequency and types of NSSI, the researchers employed the Inventory of Statements About Self-Injury (ISAS), a validated tool specifically designed to assess different categories and patterns of self-injurious behavior. This methodological choice allowed for a nuanced, standardized evaluation of 12 distinct NSSI behaviors, covering a spectrum from commonly recognized methods such as cutting and burning to less studied behaviors like pinching and interfering with wound healing. Such granularity is crucial for teasing apart the multifaceted nature of NSSI and for revealing subtle yet clinically meaningful interactions.
The network analysis unveiled several key findings: notably, severe scratching, cutting, and pinching emerged as the most central behaviors within the NSSI network, demonstrating the highest degree of interconnectivity with other methods. These central behaviors appear to act as hubs, potentially facilitating or reflecting the presence of additional self-injurious practices. Understanding the role of these central nodes could provide clinicians with targeted markers for assessing risk, severity, and the progression of self-harm behaviors.
Another compelling aspect of the study is the identification of specific clusters of behaviors exhibiting tight interrelations and greater risk of co-occurrence. For example, cutting showed strong interconnectedness with burning and carving, whereas severe scratching was closely linked with pinching, biting, and hitting oneself. The presence of such clusters highlights the possibility that certain combinations of NSSI methods may reflect underlying psychological mechanisms or coping strategies, and suggests that interventions could benefit from addressing these groupings rather than isolated behaviors alone.
These insights into the structural organization of NSSI behaviors offer the potential to refine clinical assessments significantly. By mapping the individual’s unique “NSSI-methods network,” mental health professionals could better identify patterns indicating increased risk or severity, allowing for more personalized and precise therapeutic interventions. This network-informed approach could guide the development of treatment plans that specifically target central behaviors or critical interconnections within the individual’s self-harm repertoire.
Moreover, the study’s findings have profound implications for understanding the function of NSSI methods in emotional regulation and maladaptive coping. The central roles of certain behaviors may reflect their effectiveness—or perceived effectiveness—in managing distress or achieving psychological relief, suggesting that these behaviors warrant focused attention when devising coping alternatives in therapy. This perspective aligns with growing evidence supporting the need to move beyond simplistic categorizations toward more sophisticated models of self-injury psychology.
From a research standpoint, applying network analysis to behavioral data represents an exciting methodological advancement. Traditional analyses often treat behaviors as independent variables, overlooking the possibility that these actions interact dynamically within individuals. The present study exemplifies how network analysis can uncover latent patterns, allowing researchers to capture the multidimensional nature of behaviors like NSSI and to identify emergent properties that have direct clinical relevance.
The implications extend beyond clinical settings; public health initiatives aiming to decrease self-harm prevalence may also benefit from understanding these behavioral networks. Preventive programs tailored to disrupt central behaviors or intervene in key clusters could be more effective in curtailing the escalation and diversification of NSSI methods, especially among vulnerable populations.
Furthermore, the study’s reliance on a community adult sample, rather than exclusively clinical populations, broadens the applicability of its conclusions. Self-injury is often stigmatized or underreported outside clinical milieus, so encompassing a wide demographic spectrum enhances the generalizability of findings and emphasizes the necessity for outreach and education efforts at the community level.
In summary, this pioneering network analysis offers an innovative lens through which to view nonsuicidal self-injury, revealing that while distinct behaviors remain identifiable, they do not exist in isolation but instead form a complex web of interrelations. Recognizing the centrality of specific methods like severe scratching, cutting, and pinching could provide critical insights for clinicians and researchers alike, supporting the evolution of more effective assessment and intervention strategies. Ultimately, this work lays the foundation for transforming how the mental health field conceptualizes and addresses self-harm, with the promise of improving outcomes for individuals grappling with these challenging behaviors.
Subject of Research: Interconnections and structural patterns among various nonsuicidal self-injurious behaviors using network analysis.
Article Title: Interconnectivity among different nonsuicidal self-injurious methods – a network analysis
Article References:
Reinhardt, M., Rice, K.G., Cho, H. et al. Interconnectivity among different nonsuicidal self-injurious methods – a network analysis. BMC Psychiatry 25, 601 (2025). https://doi.org/10.1186/s12888-025-07045-2
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