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Treatment in Psychiatry   |    
An Adolescent With Nonsuicidal Self-Injury: A Case and Discussion of Neurobiological Research on Emotion Regulation
Kathryn R. Cullen, M.D.; Melinda K. Westlund, B.A.; Lori L. LaRiviere, M.D.; Bonnie Klimes-Dougan, Ph.D.
Am J Psychiatry 2013;170:828-831. doi:10.1176/appi.ajp.2013.12121598
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The authors report no financial relationships with commercial interests.

Dr. Cullen’s time for writing this review was supported by NIMH grant K23-MH090421. The study mentioned in the case vignette is supported by the NIMH project “Exploring the Neural Circuitry of Deliberate Self Harm in Adolescents” (grant R21MH094558; principal investigator, Dr. Cullen) and by a Faculty Research Development grant from the Academic Health Center, University of Minnesota (principal investigator, Dr. Cullen).

From the Department of Psychiatry, University of Minnesota Medical School, and the Department of Psychology, University of Minnesota, Minneapolis.

Address correspondence to Dr. Cullen (rega0026@umn.edu).

Copyright © 2013 by the American Psychiatric Association

Received December 20, 2012; Revised March 08, 2013; Revised April 03, 2013; Accepted April 15, 2013.


The management of nonsuicidal self-injurious behavior is a common focus of clinical care, particularly in the treatment of adolescents and young adults. Increased recognition of this problem has led to proposed criteria for future study in DSM-5, which may be beneficial in advancing the field. Clinical care may be fruitfully informed by an understanding of the neurodevelopmental underpinnings of this behavior. The authors discuss the current status of neurobiological research related to nonsuicidal self-injury with a focus on the key dimension of emotion regulation. A case is presented to illustrate the critical points. Preliminary empirical evidence suggests disturbances in neurobiological systems relevant to emotion regulation. Disturbances involve engagement of limbic brain regions and frontal regulatory brain regions that may evolve over time. Additionally, disturbances are observed in serotonin and physiological response systems relevant to emotion regulation. Treatment with serotonin reuptake inhibitors may be most beneficial in combination with dialectical behavioral therapy to address safety, build self-soothing strategies to enhance emotion regulation, and reduce interpersonal sensitivity. Delineation of the neurobiological markers that reflect successful treatment response will help in the identification of new avenues for research and the development of personalized treatments for adolescents with nonsuicidal self-injury.

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