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This narrative review synthesizes major theoretical models of NSSI psychopathology and critically evaluates evidence-based psychotherapies using high-level research up to June 2025, emphasizing adolescent-focused studies, including randomized controlled trials and meta-analyses. Results highlight integrated models centering on emotion dysregulation, experiential avoidance, impaired mentalization, and operant conditioning, with dialectical behavior therapy supported by the strongest high-certainty evidence for symptom reduction. The review concludes that DBT is the current first-line treatment while urging personalized and mechanism-informed future care.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/understanding-adolescent-non-suicidal-self-injury-a-narrative-review-of-theoretical-models-and-evidence-based-psychotherapies/459492/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/understanding-adolescent-non-suicidal-self-injury-a-narrative-review-of-theoretical-models-and-evidence-based-psychotherapies/459492.png","ImageObject",300,407,{"name":92,"@type":93},"Rhys","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-27","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",13,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What is adolescent non-suicidal self-injury (NSSI) and how is it defined?","Question",{"text":113,"@type":114},"NSSI is defined as deliberate, self-inflicted damage to one’s body without suicidal intent. It commonly includes behaviors such as cutting, burning, scratching, and self-hitting.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Which theoretical models are used to explain NSSI in the review?",{"text":118,"@type":114},"The review summarizes integrated models highlighting emotion dysregulation (biosocial theory), experiential avoidance (cognitive-behavioral models), impaired mentalization (attachment theory), and operant conditioning via a functional model.",{"name":120,"@type":111,"acceptedAnswer":121},"Why is dialectical behavior therapy (DBT) emphasized as the first-line treatment?",{"text":122,"@type":114},"High-level evidence synthesis indicates DBT has the strongest empirical support, with high-certainty evidence for reducing adolescent NSSI. Other therapies are described as promising but with preliminary or uncertain effectiveness for NSSI.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},459492,1791269744,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":140,"language":141,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":142,"faqs":143,"seo_title":144,"seo_description":67,"update_tm":145,"read_time":146,"preview_page_count":4},687207024643,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","SPECIAL ARTICLE: Evidence-Based Psychotherapy in Child and Adolescent Psychiatry  \nJ Korean Acad Child Adolesc Psychiatry 2026;37(1):33-43 [https://doi.org/10.5765/jkacap.250050](https://doi.org/10.5765/jkacap.250050)  \neISSN 2233-9183  \nUnderstanding Adolescent Non-Suicidal Self-Injury: A Narrative Review of Theoretical Models and Evidence-Based Psychotherapies  \nKukju Kweon1,2,3  \n1Department of Psychiatry, Chungnam National University Hospital, Daejeon, Korea 2Institute of Brain Research, Chungnam National University, Daejeon, Korea  \n3Department of Psychiatry, Chungnam National University School of Medicine, Daejeon, Korea  \nObjectives: Adolescent non-suicidal self-injury (NSSI) is a marker of severe emotional distress and a significant public health concern. This narrative review aimed to synthesize major theoretical models explaining the psychopathology of NSSI and critically evaluate the efficacy of evidence-based psychotherapies using the most recent high-level evidence.  \nMethods: We searched articles in major academic databases published from January 2000 up to June 2025. We prioritized studies on adolescents, including efficacy studies (randomized controlled trials and meta-analyses) addressing NSSI as a primary outcome, and key theoretical papers.  \nResults: NSSI was understood through integrated models, prominently featuring emotion dysregulation (biosocial theory), experiential avoidance (cognitive-behavioral models), impaired mentalization (attachment theory), and operant conditioning (functional model). The synthesis of high-level evidence, including a 2021 review from Cochrane, indicated that dialectical behavior therapy (DBT) had the strongest empirical support (high-certainty evidence) for reducing adolescent NSSI. However, while mentalization-based treatment, acceptance and commitment therapy, and attachment-based family therapy offered promising mechanism-specific approaches, evidence for their effectiveness for NSSI was preliminary or uncertain.  \nConclusion: DBT is currently the first-line treatment for NSSIs in adolescents. However, the field must move toward personalized care. Future research should focus on validating alternative therapies through head-to-head randomized controlled trials, identifying the core change mechanisms across treatments, and implementing stepwise care models to improve accessibility.  \nKeywords: Adolescent; Self-injurious behavior; Psychotherapy; Dialectical behavior therapy; Mentalization-based treatment;  \nCognitive behavioral therapy; Acceptance and commitment therapy.  \nReceived: August 30, 2025 / Revised: October 22, 2025 / Accepted: November 18, 2025  \nAddress for correspondence: Kukju Kweon, Department of Psychiatry, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Korea  \nTel: +82-42-280-8277, Fax: +82-42-280-7886, E-mail: [kukju@cnu.ac.kr](kukju@cnu.ac.kr)  \nINTRODUCTION  \nNon-suicidal self-injury (NSSI) is defined as the deliberate, self-inflicted damage to one’s body without suicidal intent. Common manifestations include cutting, burning, scratching and self-hitting. NSSI is distinct from socioculturally sanctioned body modifications (e.g., tattoos and piercings) and minor normative behaviors (e.g., nail biting) [1].  \nNSSI gained formal recognition as a clinically significant issue in 2013 when the American Psychiatric Association (APA) included it as a “Condition for Further Study” in the Diagnostic and Statistical Manual of Mental Disorders, Fifth  \nThis is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ([https://creativecommons.org/licenses/by-nc/4.0](https://creativecommons.org/licenses/by-nc/4.0)) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.  \nEdition (DSM-5) [2]. The DSM-5 criteria for NSSI diagnosis require engagement in self-injury for five or more days within the past year","cbCaiqyBriDvUvXe","https://ap.wps.com/l/cbCaiqyBriDvUvXe","pdf",428166,11,"English","# Introduction\n## Definition and clinical significance of NSSI\n## Diagnostic framework (DSM-5 criteria)\n# Objectives, Methods, Results, and Conclusion\n## Objectives\n## Methods\n## Integrated theoretical models and evidence synthesis\n## Treatment implications and future research directions","[{\"question\":\"What is adolescent non-suicidal self-injury (NSSI) and how is it defined?\",\"answer\":\"NSSI is defined as deliberate, self-inflicted damage to one’s body without suicidal intent. It commonly includes behaviors such as cutting, burning, scratching, and self-hitting.\"},{\"question\":\"Which theoretical models are used to explain NSSI in the review?\",\"answer\":\"The review summarizes integrated models highlighting emotion dysregulation (biosocial theory), experiential avoidance (cognitive-behavioral models), impaired mentalization (attachment theory), and operant conditioning via a functional model.\"},{\"question\":\"Why is dialectical behavior therapy (DBT) emphasized as the first-line treatment?\",\"answer\":\"High-level evidence synthesis indicates DBT has the strongest empirical support, with high-certainty evidence for reducing adolescent NSSI. Other therapies are described as promising but with preliminary or uncertain effectiveness for NSSI.\"}]","Understanding Adolescent Non-Suicidal Self-Injury - A Narrative Review of Theoretical Models and Evidence-Based Psychotherapies | PDF",1790756029,28]