Reframing adolescent self-harm as a functional continuum.

Area of Science:

• Psychiatry
• Psychology
• Neurobiology

Background:

• The traditional separation of adolescent self-harm into non-suicidal self-injury (NSSI) and suicide attempts (SA) based on intent is clinically limiting.
• This dichotomy oversimplifies the complex reality of fluctuating intent and obscures functional links between self-harm behaviors.
• Existing frameworks fail to capture the shared psychological functions underlying NSSI and SA.

Purpose of the Study:

• To advocate for a conceptual shift from the NSSI/SA dichotomy to a functional continuum model (FCM) for adolescent self-harm.
• To reframe NSSI and SA as expressions of a shared pathological process serving emotional regulation (psychache).
• To propose a new framework for clinical intervention focusing on functional rehabilitation rather than solely behavioral cessation.

Main Methods:

• This perspective article reinterprets existing epidemiological, psychological, and neurobiological evidence.
• It proposes a functional continuum model (FCM) for understanding adolescent self-harm.
• It suggests future research directions, including ecological momentary assessment (EMA).

Main Results:

• NSSI and SA are not disparate phenomena but rather evolving expressions of the same underlying process.
• NSSI can contribute to the development of capability for suicide.
• Self-harm behaviors primarily function to regulate overwhelming emotional pain (psychache).

Conclusions:

• A functional continuum model (FCM) offers a more accurate and compassionate understanding of adolescent self-harm.
• Clinical interventions should focus on functional rehabilitation, teaching adaptive coping skills.
• Future research should utilize EMA and function-specific tools to refine this model for improved care.