Clinical and Psychological Characteristics of Adolescent Girls with Non- Suicidal Self-Injury

Background: nonsuicidal self-injury (NSSI) behavior in adolescent girls is considered a clinically significant manifestation of emotional dysregulation associated with anxiety, depression, and impaired social adaptation. Considerable differences in the severity, functional significance, and predictors of such episodes make it difficult to develop a unified approach to the diagnosis and management of adolescents with NSSI. The aim was to identify and describe the clinical and social characteristics of adolescent girls with NSSI and to analyze their relationship with psychoemotional indicators. Patients and methods: the study included 186 girls aged 12–17 years, who were hospitalized in the “Specialized Psychoneurological Hospital” of Krasnodar Region in 2022–2024. Along with the clinical assessment of the past medical history and mental state, the following instrumental methods were used: Children's Depression Inventory (CDI) by M. Kovacs, the method of multidimensional assessment of children's anxiety, the questionnaire of social-psychological adaptation (SPA) by K. Rogers and R. Diamond, Reasons for Self-Injury Scale (N.A. Polskaya), Child and Adolescent Social Support Scale (CASSS) by K. Malecki. Hierarchical clustering, elbow method, and K-means algorithm were used for the analysis. Statistical processing was performed in Python and Statistica. Results: three stable clusters were identified as follows: with low, moderate and high severity of NSSI. Patients with high NSSI intensity committed severe and multiple self-harms. The mental state of these patients was characterized by high levels of anxiety and depression, decreased adaptation, and low levels of social support. The cluster with moderate NSSI severity was distinguished by the predominance of compulsive NSSI forms and an average level of psychological vulnerability. Patients with low NSSI severity demonstrated favorable results on all scales. Significant differences were obtained between patients of the three clusters on the scales of anxiety, depression, adaptation, and social support (p < 0.001). Conclusion: the cluster approach allowed us to form typical psychosocial profiles of girls with NSSI, which has practical significance for the development of differentiated and personalized approaches to prevention and therapy and psychosocial assistance programs.

1. Townsend E. Time to take self-harm in young people seriously. Lancet Psychiatry. 2019;6(4):279–280. doi: 10.1016/S2215-0366(19)30101-4

2. Lyubov EB, Zotov PB. Adolescents non-suicidal self-injury: general and particular. Part II. Suicidology. 2020;11(4):26–55. (In Russ.). doi: 10.32878/suiciderus.20-11-04(41)-26-55

3. Wilkinson PO, Qiu T, Neufeld S, Jones PB, Goodyer IM. Sporadic and recurrent non-suicidal self-injury before age 14 and incident onset of psychiatric disorders by 17 years: prospective cohort study. Br J Psychiatry. 2018;212(4):222–226. doi: 10.1192/bjp.2017.45

4. Miller M, Redley M, Wilkinson PO. A Qualitative Study of Understanding Reasons for Self-Harm in Adolescent Girls. Int J Environ Res Public Health. 2021;18(7):3361. doi: 10.3390/ijerph18073361

5. Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry. 2015;56(3):345–365. doi: 10.1111/jcpp.12381

6. Davidovsky SV, Igumnov SA. Modern conceptions and manifestation features of self-harming behavior. Suicidology. 2020;11(3):33–43. (In Russ.). doi: 10.32878/suiciderus.20-11-03(40)-33-43

7. Niu S, Yin X, Pan B, Chen H, Dai C, Tong C, Fang Chen, Xiuqin Feng. Understanding Comorbidity Between Non-Suicidal Self-Injury and Depressive Symptoms in a Clinical Sample of Adolescents: A Network Analysis. Neuropsychiatr Dis Treat. 2024;20:1–17. doi: 10.2147/NDT.S443454

8. Taylor PJ, Jomar K, Dhingra K, Forrester R, Shahmalak U, Dickson JM. A meta-analysis of the prevalence of different functions of non-suicidal self-injury. J Affect Disord. 2018;227:759–769. doi: 10.1016/j.jad.2017.11.073

9. Vergara GA, Stewart JG, Cosby EA, Lincoln SH, Auerbach RP. Non-suicidal self-injury and suicide in depressed adolescents: Impact of peer victimization and bullying. J Affect Disord. 2019;245:744–749. doi: 10.1016/j.jad.2018.11.084

10. Johnson SL, Robison M, Anvar S, Swerdlow BA, Timpano KR. Emotion-related impulsivity and rumination: Unique and conjoint effects on suicidal ideation, suicide attempts, and nonsuicidal self-injury across two samples. Suicide Life Threat Behav. 2022;52(4):642–654. doi: 10.1111/sltb.12849

11. Davydov DG, Chmykhova EV. Administered of the Raven's Standard Progressive Matrices with a time limit. Voprosy Psikhologii. 2016;(4):129–139. (In Russ.). Available at SSRN: https://ssrn.com/ab-stract=2833427

12. Kovacs M. The Children's Depression, Inventory (CDI). Psychopharmacol Bull. 1985;21(4):995–8. PMID: 4089116.

13. Razuvaeva TN. Personality diagnosis. Shadrinsk: Iset'; 1993. 26 p. (In Russ.).

14. Malkova EE. Psychodiagnostic method of multidimensional assessment of child anxiety: a manual for doctors and psychologists. St. Petersburg: Bekhterev Institute; 2007. 35 p. (In Russ.).

15. Osnitsky AK. Determining the characteristics of social adaptation. Psychological Science and Education. 2004;1(1):43–56. (In Russ.).

16. Sobchik LN. Psychology of Individuality: Theory and Practice of Psychodiagnostics. St. Petersburg: Rech'; 2005. 480 p. (In Russ.).

17. Polskaya NA. Causes of self-harm in adolescence (based on self-report scale). Counseling Psychology and Psychotherapy. 2014;22(2):140–152. (In Russ.).

18. Lifintseva AA, Ryaguzova AV. Adaptation of the “Child and Adolescent Social Support Scale” technique by C. Malecki. Clinical Psychology and Special Education. 2013;2(2). (In Russ.).

19. Darin EV. Self-harm among hospitalized adolescent girls. A cross-sectional study. Mendeley Data. 2025;V4. doi: 10.17632/f3hkb9vg6h.4 Available from: https://data.mendeley.com/datasets/f3hkb9vg6h/4

20. Skegg K. Self-harm. Lancet. 2005;366(9495):1471– 1483. doi: 10.1016/S0140-6736(05)67600-3

21. Klonsky ED. The functions of deliberate self-injury: a review of the evidence. Clin Psychol Rev. 2007;27(2):226–239. doi: 10.1016/j.cpr.2006.08.002

22. Frey LM, Higgins GE, Fulginiti A. Testing the psychometric properties of the self-harm and suicide disclosure scale. Psychiatry Res. 2018;270:134–142. doi: 10.1016/j.psychres.2018.09.016

23. Darin EV, Korol IS, Boyko EO, Zaitseva OG, Sokolova EN. Non-Suicidal Self-Injuries in Adolescent Girls: Clinical, Social, and Behavioral Characteristics. Neurology Bulletin. 2025;LVII(2):113–123. (In Russ.). doi: 10.17816/nb646625

24. Andrewes HE, Hulbert C, Cotton SM, Betts J, Chanen AM. Relationships between the frequency and severity of non-suicidal self-injury and suicide attempts in youth with borderline personality disorder. Early Interv Psychiatry. 2019;13(2):194–201. doi: 10.1111/eip.12461

25. Ghinea D, Koenig J, Parzer P, Brunner R, Carli V, Hoven CW, Sarchiapone M, Wasserman D, Resch F, Kaess M. Longitudinal development of risk-taking and self-injurious behavior in association with late adolescent borderline personality disorder symptoms. Psychiatry Res. 2019 Mar;273:127–133. doi: 10.1016/j.psychres.2019.01.010 Epub 2019 Jan 3. PMID: 30641342.

26. Sekowski M, Gambin M, Sumlin E, Sharp C. Associations between symptoms of borderline personality disorder and suicidality in inpatient adolescents: The significance of identity disturbance. Psychiatry Res. 2022;312:114558. doi: 10.1016/j.psychres.2022.114558

27. Cailhol L, Gicquel L, Raynaud J. Borderline personality disorder. In: Rey J.M., ed. IACAPAP e-Textbook of Child and Adolescent Mental Health. Vol. 4, Chapter H. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions; pp. 18.

28. Sharp C, Romero C. Borderline personality disorder: a comparison between children and adults. Bull Menninger Clin. 2007;71(2):85–114. doi: 10.1521/bumc.2007.71.2.85

29. Andrei LE, Efrim-Budisteanu M, Mihailescu I, Buică AM, Moise M, Rad F. Non-Suicidal Self-Injury (NSSI) Patterns in Adolescents from a Romanian Child Psychiatry Inpatient Clinic. Children (Basel). 2024;11(3):297. doi: 10.3390/children11030297

30. Antokhina RI, Antokhin EYu, Nemtseva EK. Deviant behavior in adolescents: the role of non-suicidal self-harm, depression and the desire to find new sensations. Neurology Bulletin. 2023;LV(4):50–55. (In Russ.). doi: 10.17816/nb624445

31. Wan Y, Chen R, Ma S, McFeeters D, Sun Y, Hao J, Tao F. Associations of adverse childhood experiences and social support with self-injurious behaviour and suicidality in adolescents. Br J Psychiatry. 2019;214(3):146–152. doi: 10.1192/bjp.2018.263

32. Wester K, Trepal H, King K. Nonsuicidal Self-Injury: Increased Prevalence in Engagement. Suicide Life Threat Behav. 2018;48(6):690–698. doi: 10.1111/sltb.12389

33. Serra M, Presicci A, Quaranta L, Caputo E, Achille M, Margari F. et al. Assessing Clinical Features of Adolescents Suffering from Depression Who Engage in Non-Suicidal Self-Injury. Children (Basel). 2022;9(2):201. doi: 10.3390/children9020201

34. Polskaya NA. Emotion dysregulation in self-injurious behaviour. Psychological Journal. 2018;39(4):27–37. (In Russ.). doi: 10.31857/S020595920000067-9

35. Polskaya NA. Emotion Dysregulation in the Structure of Self-Injurious Behavior. Counseling Psychology and Psychotherapy. 2018;26(4):65–82. (In Russ.). doi: 10.17759/cpp.2018260405

36. Brown RC, Heines S, Witt A, Braehler E, Fegert JM, Harsch D, Plener PL. The impact of child maltreatment on non-suicidal self-injury: data from a representative sample of the general population. BMC Psychiatry. 2018 Jun 8;18(1):181. doi: 10.1186/s12888-018-1754-3 PMID: 29884152; PMCID: PMC5994090.