A new review in Translational Psychiatry is drawing attention to a behavior that is often misunderstood, hidden from view and frequently reduced to its visible aftermath: non-suicidal self-injury, or NSSI, among young adults. The article, “Beyond the scars: current understanding of risk factors, neurobiological mechanisms and effective interventions for non-suicidal self-injury in young adults,” by D. Vega, J. Soler, C. Schmidt and colleagues, brings together current evidence on why some young people deliberately injure themselves without the intention of dying—and why effective support must address far more than the injuries themselves.
NSSI is generally defined as the intentional damaging of one’s own body tissue without suicidal intent. Although it is distinct from a suicide attempt, the two can occur in the same person, and a history of NSSI is associated with increased future suicide risk. The behavior can therefore function as both a signal of acute psychological distress and a marker of longer-term vulnerability. The review places young adulthood at the center of this issue, a developmental period marked by major changes in identity, relationships, education, employment and independence, alongside continuing maturation of brain systems involved in emotional control and decision-making.
Rather than attributing NSSI to a single diagnosis or personality trait, researchers increasingly describe it as the outcome of interacting biological, psychological and social factors. Emotional dysregulation is one of the most consistent themes: some individuals may experience emotions that rise rapidly in intensity and become difficult to identify, tolerate or communicate. Interpersonal conflict, rejection, trauma, chronic invalidation and social isolation can amplify this vulnerability. Depression, anxiety, post-traumatic stress, eating disorders and borderline personality disorder are also frequently associated with NSSI, although self-injury is not limited to people with any one psychiatric condition.
The review highlights the importance of understanding what the behavior does for the person in the moment. For some, NSSI may temporarily reduce overwhelming emotional arousal; for others, it may interrupt emotional numbness, express distress that feels impossible to put into words or create a sense of control during chaotic experiences. Relief can reinforce the behavior through a process known as negative reinforcement: an aversive internal state decreases immediately after the act, making the response more likely to recur under similar conditions. This short-term effect can conceal growing long-term costs, including shame, secrecy, physical complications and increasing dependence on self-injury as a coping strategy.
Neuroscience offers several possible explanations for this pattern, although the evidence remains complex and no single “NSSI brain” has been identified. Studies have implicated communication between the prefrontal cortex, which supports planning and regulation, and limbic regions such as the amygdala, which help process threat and emotional salience. Altered responses in reward and pain-processing networks may also contribute. Some models propose that endogenous opioid systems, the brain’s natural pain-regulating chemistry, could help explain why injury sometimes produces temporary calm or emotional release. Research has additionally examined stress biology, including the hypothalamic-pituitary-adrenal axis, which coordinates hormonal responses to adversity.
These biological findings should not be interpreted as proof that NSSI is predetermined or purely neurological. Brain activity is shaped by learning, relationships and environment, and repeated behavior can itself influence neural pathways. The review instead presents neurobiology as one layer of a dynamic system. Genetics may affect sensitivity to stress or impulsivity, while early adversity and ongoing social conditions can modify how those vulnerabilities are expressed. Digital environments may add another dimension by exposing young people to triggering content, social comparison or communities that unintentionally normalize injury, while also offering opportunities for connection and help-seeking.
Treatment research increasingly favors structured psychological interventions that teach practical alternatives rather than relying on warnings or punishment. Dialectical behavior therapy, or DBT, has the strongest established profile among approaches used for recurrent self-injury, particularly because it combines emotion-regulation training, distress-tolerance skills, mindfulness and interpersonal effectiveness. Cognitive behavioral approaches can help identify triggers, challenge rigid interpretations and develop safer responses. Mentalization-based and emotion-focused therapies may assist individuals in understanding their own mental states and those of others, especially when self-injury is linked to unstable relationships or difficulty interpreting emotions.
The review also emphasizes that intervention must extend beyond the therapy room. Clinicians need to assess suicidal thoughts separately from NSSI, understand the function of the behavior, identify immediate medical needs and develop collaborative safety plans. Medication may be appropriate for co-occurring conditions such as depression or anxiety, but no medication has been established as a universal treatment for NSSI itself. Families, universities, primary-care services and emergency departments can play an important role by responding without shock, blame or excessive judgment. A calm, curious approach can make disclosure more likely and help replace secrecy with coordinated care.
One of the field’s most urgent challenges is improving the quality and reach of evidence-based support. Studies often differ in how they define NSSI, measure frequency and account for suicidal intent, making results difficult to compare. Young adults from marginalized communities, men, sexual and gender minorities, people with disabilities and those outside traditional healthcare systems remain underrepresented in many investigations. The authors’ broader message is that future research should combine neuroscience with lived experience, follow people over time and test interventions in ordinary clinical and community settings—not only specialized research programs.
The emerging picture is neither a story of inevitable escalation nor a problem solved by willpower. NSSI is a learned, often rapidly reinforced response to distress that can be changed when people receive timely, respectful and technically informed care. By moving beyond the visible scars, researchers and clinicians can focus on the emotional functions, brain processes and social conditions that sustain the behavior. For young adults, that shift may turn an isolating pattern into an opportunity for earlier recognition, safer coping and recovery.
Subject of Research: Non-suicidal self-injury, including its risk factors, neurobiological mechanisms and effective interventions in young adults.
Article Title: Beyond the scars: current understanding of risk factors, neurobiological mechanisms and effective interventions for non-suicidal self-injury in young adults.
Article References: Vega, D., Soler, J., Schmidt, C. et al. “Beyond the scars: current understanding of risk factors, neurobiological mechanisms and effective interventions for non-suicidal self-injury in young adults.” Translational Psychiatry (2026). https://doi.org/10.1038/s41398-026-04309-7
Image Credits: AI Generated
DOI: https://doi.org/10.1038/s41398-026-04309-7
Keywords: non-suicidal self-injury, NSSI, young adults, mental health, neurobiology, emotion regulation, dialectical behavior therapy, suicide prevention, psychiatry, neuroscience
