Urges matter: Building an ideation-to-action approach to nonsuicidal self-injury

This viewpoint article clarifies the relevance of urges as an independent focus of study and proposes a novel ideation to-action approach to the study of non-suicidal self-injury (NSSI) urges and behaviors. NSSI is a highly prevalent, trans-diagnostic clinical problem that contributes to poor mental health, physical injury, and perhaps most concerning, increased risk of suicidal thoughts and behaviors. Relatively less work has conceptualized the underlying cognitive states that precede or prompt NSSI behaviors, variously described as NSSI thoughts, urges, or ideation. Although no formal nomenclature exists for these constructs, we view NSSI thoughts as inclusive of multiple cognitive states related to NSSI (e.g., thinking about past NSSI, desire for NSSI in the present, and NSSI expectancies); in contrast, we define NSSI urges as thinking about NSSI with at least some desire to engage in the behavior. Clinical science and practice can be improved by integrating models from other fields to better operationalize, examine, and, ultimately, ameliorate NSSI urges among people struggling with NSSI. The dramatic growth in daily life research on NSSI over the last 10 years has elucidated underlying mechanisms relevant to theory and clinical practice. Now, we can take even more exciting steps forward, by recognizing NSSI urges as a meaningful independent outcome and by more carefully clarifying when and how these urges are most likely to lead to NSSI itself. In turn, we can better understand the lived and living experiences of people who struggle with NSSI and identify personalized interventions that can interrupt NSSI urges and behaviors in daily life. (PsycInfo Database Record (c) 2026 APA, all rights reserved).