Neural mechanisms and neuromodulation therapies for non-suicidal self-injury

Non-suicidal self-injury (NSSI) refers to intentional self-inflicted bodily harm without suicidal intent. NSSI has been linked to various neurobiological dysfunctions, but its precise neural mechanisms have not been fully elucidated. Clinically, conventional pharmacological and psychotherapeutic interventions often exhibit prolonged treatment durations, delayed onset of efficacy, and considerable side effects, limiting their ability to effectively target the core pathological mechanisms of NSSI. These limitations highlight the urgent need for novel therapeutic approaches. Neuromodulation techniques, which have the potential to directly modulate neural activity, have recently been explored as promising interventions for NSSI. However, research in this field remains in its early stages. Existing evidence is limited and heterogeneous, with substantial interindividual variability in treatment response and a lack of high-quality, systematic clinical data. This review synthesizes findings from recent neuroimaging studies to examine the neural circuits potentially involved in NSSI from four key domains: emotion regulation, reward feedback, pain processing, and impulse control. By elucidating the underlying neurobiological mechanisms, summarizing current evidence on neuromodulation, and exploring future directions for therapeutic innovation and optimization, this review aims to provide a foundation for advancing neuromodulation-based treatments for NSSI.