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Treating Nonsuicidal Self-Injury: A Systematic Review of Psychological and Pharmacological Interventions
Open accessAbstract
Objective: Nonsuicidal self-injury (NSSI), the deliberate, self-inflicted damage of bodily tissue without the intent to die, is associated with various negative outcomes. Although basic and epidemiologic research on NSSI has increased during the last 2 decades, literature on effective interventions targeting NSSI is still emerging. Here, we present a comprehensive, systematic review of existing psychological and pharmacological treatments designed specifically for NSSI, or including outcome assessments examining change in NSSI. Method: We conducted a systematic search of PsycINFO, MEDLINE, and ERIC databases to retrieve relevant articles that met inclusion criteria; specifically, uncontrolled and controlled trials that 1) presented quantitative outcome data on NSSI, and 2) clearly differentiated NSSI from suicidal self-injury (SSI). Consistent with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, definition of NSSI, we excluded studies examining populations with developmental or intellectual disabilities, or with psychotic disorders. Results: Several interventions appear to hold promise for reducing NSSI, including dialectical behaviour therapy, emotion regulation group therapy, manual-assisted cognitive therapy, dynamic deconstructive psychotherapy, atypical antipsychotics (aripiprazole), naltrexone, and selective serotonin reuptake inhibitors (with or without cognitive-behavioural therapy). Nevertheless, there remains a paucity of well-controlled studies investigating treatment efficacy for NSSI. Conclusions: Structured psychotherapeutic approaches focusing on collaborative therapeutic relationships, motivation for change, and directly addressing NSSI behaviours seem to be most effective in reducing NSSI. Medications targeting the serotonergic, dopaminergic and opioid systems also have demonstrated some benefits. Future studies employing controlled designs as well as a clear delineation of NSSI and SSI will improve knowledge regarding treatment effects.
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“In their systematic review of non-suicidal self-injury, Turner et al. (2014) concluded that structure and collaboration were the most effective components of treatment, but did not identify a clear front runner in psychological interventions.”
From A multi‐method evaluation of a compassion‐focused cognitive behavioural psychotherapy group for people who self‐harm. (2022) · cites this paper as Turner et al. (2014)
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Cited by
Sorted by citations
Nonsuicidal Self-Injury: What We Know, and What We Need to Know
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“This is consistent with recent meta-analytical findings on adolescents (Ougrin et al., 2015), although qualitatively contrasting results have been reported (Turner et al., 2014).”
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“Medications targeting the serotonergic, dopaminergic and opioid systems also have demonstrated some bene fi ts (Turner et al. 2014).”
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Self-citationLifetime and 12-Month Nonsuicidal Self-Injury and Academic Performance in College Freshmen.
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“Rates of initial engagement with therapy Web sites were high (88%–92% starting the intervention; van Spijker et al., 2018, 2014) but fewer accessed at least three of the six modules (44%–56%).”
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“In a recent systematic review of treatments for NSSI in both adolescent and adult populations [12], the authors concluded that the psychological treatments that show promise in reducing NSSI frequency are dialectical behavior therapy [13], emotion regulation group therapy (ERGT; [14]), manual-assisted cognitive therap…”
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“Existing cognitive–behavioral treatments for NSSI also contain many components, making it difficult to define the specific ingredients responsible for improvements when they occur (e.g., Lynch & Cozza, 2009; Turner et al., 2014).”
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“…Andover & Morris, 2014), as well as the effectiveness of DBT, which targets emotion regulation skills, in treating the behavior, suggests that interventions focusing on building emotion regulation strategies may be particularly useful in the treatment of NSSI (Gratz, 2007; Turner et al., 2014).”
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“Noteworthy, previous research has shown that teaching coping skills to reduce and resist frequent NSSI thoughts and urges is a key component of successful treatment for NSSI (78, 79).”
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“Dialectical behavior therapy (DBT) may be the most effective treatment for reducing NSSI (Elmaghraby, Nobari, & Cullen, 2019), although its efficacy is mixed, and studies are often limited to populations with BPD (Turner et al., 2014).”
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“in emotion regulation), motivation for treatment, and a focus on improving family and other interpersonal relationships (Glenn et al., 2015; Turner et al., 2014).”
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“emphasizing emotional regulation such as dialectical behaviour therapy are effective at treating NSSI [34].”
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“This prevalent behavior can result in serious physical consequences such as physical injury, infectious disease, medical complications, and death (6-9).”
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“This suggests that, in addition to developing emotion regulation skills, NSSI interventions should also focus on self-related cognitions (Turner et al., 2014).”
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“, 2019) and skills training to strengthen interpersonal bonding and family relationships such as communication training, problemsolving and/or conflict management (Hetrick, Robinson, Spittal, & Carter, 2016; Turner et al., 2014).”
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Suicidal ideation and behaviour
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Nonsuicidal Self-Injury: Management on the Inpatient Psychiatric Unit
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“Pharmacological treatments for NSSI have included SSRIs (selective serotonin reuptake inhibitors), SNRIs (serotonin–norepinephrine reuptake inhibitors), atypical antipsychotics, opioids, and opioid antagonists (Bresin & Gordon, 2013; Norelli, Smith, Sher, & Blackwood, 2013; Turner et al., 2014).”
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BackgroundMultimodal assessment of sustained threat in adolescents with nonsuicidal self-injury
Başgöze, Z., Mirza, S. A., Silamongkol, T., Hill, D. C., Falke, C. A., Thai, M., Schreiner, M. W., Parenteau, A. M., Roediger, D. J., Hendrickson, T. J., et al. (2021) · Development and Psychopathology · doi:10.1017/s0954579421000754 · Cited by 28
Dunlop, B. J., Hunter, C., Shafti, M., Coleman, S. E., Hartley, S., & Taylor, P. J. (2021) · Psychology and Sexuality · doi:10.1080/19419899.2021.1924241 · Cited by 20
“, 2016), Dialectical Behaviour Therapy (Turner et al., 2014) and emotion-regulation group therapy (Turner et al.”
BackgroundInfluentialSimonsson, O., Engberg, H., Bjureberg, J., Ljótsson, B., Stensils, J., Sahlin, H., & Hellner, C. (2021) · JMIR Formative Research · doi:10.2196/17910 · Cited by 32
“A total of 2 interview guides, 1 for the adolescents and 1 for the caregivers (Multimedia Appendices 1 and 2), were developed based on previous research (ie, on structure [49] and content [25,26,37,40]) and clinical experience and reviewed by the authors.”
BackgroundMethodResultHolth, F., Walby, F. A., Røstbakken, T., Lunde, I., Ringen, P. A., Ramleth, R., Romm, K. L., Tveit, T., Torgersen, T., Urnes, Ø., et al. (2018) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2018.1511751 · Cited by 23
Johnson, B. N., McKernan, L. C., & Bruehl, S. P. (2022) · Current Pain and Headache Reports · doi:10.1007/s11916-022-01043-9 · Cited by 26
Koposov, R. A., Stickley, A., & Ruchkin, V. V. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.652004 · Cited by 23
Ward‐Ciesielski, E. F., Schumacher, J. A., & Bagge, C. L. (2016) · Crisis · doi:10.1027/0227-5910/a000400 · Cited by 18
Peterson, E. J., Worlein, J., Lee, G. H., Dettmer, A., Varner, E., & Novak, M. A. (2016) · American Journal of Primatology · doi:10.1002/ajp.22569 · Cited by 19
“…similar responses to treatment, for example, some efficacy with fluoxetine [Fontenot et al., 2009] and naltrexone [Kempf et al., 2012] in rhesus monkeys along with a meta-analysis of research on humans suggesting treatment efficacy with SSRIs, and naltrexone [see Turner et al., 2014 for a review].”
BackgroundBaer, M. M., LaCroix, J. M., Browne, J. C., Hassen, H. O., Perera, K. U., Soumoff, A., Weaver, J., & Ghahramanlou-Holloway, M. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.08.082 · Cited by 18
Eggart, V., Cordier, S., Hasan, A., & Wagner, E. M. (2022) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-022-01385-w · Cited by 26
“Previous reviews evaluating treatment options of self-injurious behavior included either SH in adults and adolescents [22, 23] or NSSI in adolescents [24, 25] and reported the absence of evidence for effective pharmacological interventions to improve SH or NSSI.”
BackgroundLindquist, E. G., & West, A. E. (2021) · Clinical Psychological Science · doi:10.1177/21677026211049367 · Cited by 18
Non-Suicidal Self-Injury in Russian Patients with Suicidal Ideation
Зинчук, М. С., Beghi, M., Beghi, E., Bianchi, E., Аведисова, А. С., Yakovlev, A. A., & Guekht, A. B. (2020) · Archives of Suicide Research · doi:10.1080/13811118.2020.1833801 · Cited by 21
Clozapine Reduces Self-Injurious Behavior in a State Prison Population.
Zarzar, T. R., Catlett, T. L., O'Connell, M. G., Harrelson, B. H., Wilson, V. P., Rashad, G. N., Morris, D. B., Williams, J. B., Peebles, S. S., & Sheitman, B. (2019) · PubMed · doi:10.29158/jaapl.003818-19 · Cited by 13
“Two recent reviews show limited effectiveness of pharmacological management of SIB in adults in non-correctional settings; however, these reviews relied exclusively on randomized trials and did not include clozapine.(13,14) Clozapine is a second-generation antipsychotic medication with demonstrated effectiveness for t…”
BackgroundRoley‐Roberts, M. E., Zielinski, M. J., Hurtado, G., Hovey, J. D., & Elhai, J. D. (2016) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12306 · Cited by 15
Neural mechanisms and neuromodulation therapies for non-suicidal self-injury
Wu, D., Wang, S., Wang, H., Zhang, J., & Tian, Y. (2025) · Molecular Psychiatry · doi:10.1038/s41380-025-03125-7 · Cited by 18
“Current treatment approaches primarily involve pharmacotherapy [8, 9] and psychotherapy [10 – 12], but their ef fi cacy is limited, and effective, targeted treatments are lacking.”
Chen, X., Dong, Y., Ye, M., Wang, X., Yan, J., Yao, Y., Zhou, Q., Qian, C., & Liu, Z. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-06735-1 · Cited by 17
A person-centred conceptualisation of non-suicidal self-injury recovery: a practical guide
Hasking, P. A., Lewis, S. P., & Tonta, K. E. (2023) · Counselling Psychology Quarterly · doi:10.1080/09515070.2023.2225045 · Cited by 18
“Here, dialectical behaviour therapy (DBT) may help given its use for NSSI more generally and its utility in fostering distress tolerance and coping with emotional pain (Turner, Austin, & Chapman, 2014).”
Dai, L., Zhang, X., Yu, R.-Q., Wang, X., Deng, F., Li, X., & Kuang, L. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1177227 · Cited by 16
“There remains a paucity of wellcontrolled studies investigating treatment efficacy of NSSI (16).”
BackgroundHamza, C. A., Robinson, K., Hasking, P. A., Heath, N. L., Lewis, S. P., Lloyd‐Richardson, E. E., Whitlock, J. L., & Wilson, M. (2021) · Journal of American College Health · doi:10.1080/07448481.2021.1961782 · Cited by 22
“24,25 Should this training be unavailable, hosting professional development workshops or related opportunities for campus mental health professionals may be needed.”
BackgroundMethodInfluentialModerators of Treatment Response to an Intervention for Nonsuicidal Self-Injury in Young Adults
Andover, M. S., Schatten, H. T., Holman, C. S., & Miller, I. (2020) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000603 · Cited by 16
“Interventions demonstrating a decrease in NSSI have been identified among adolescents and adults (e.g., Glenn, Esposito, Porter, & Robinson, 2019; Turner et al., 2014), including dialectical behavior therapy (DBT; e.”
BackgroundResultInfluentialSelf-Injury as an Addictive Disorder.
Worley, J. A. (2020) · Journal of Psychosocial Nursing and Mental Health Services · doi:10.3928/02793695-20200513-03 · Cited by 16
The Development of a Measure to Assess Social Reactions to Self-Injury Disclosure
Ammerman, B. A., & McCloskey, M. S. (2020) · Assessment · doi:10.1177/1073191120903081 · Cited by 19
“When identified, NSSI can be reduced through psychological and pharmacological interventions (Andover et al., 2017; Bentley et al., 2017; Cook & Gorraiz, 2016; Turner et al., 2014).”
BackgroundTaylor, P. J., Fien, K., Mulholland, H., Duarte, R. V., Dickson, J. M., & Kullu, C. (2020) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12277 · Cited by 18
“Whilst clinical trials support the efficacy of a number of psychological therapies for self-harm (Hawton et al., 2017; Hetrick et al., 2016; Turner et al., 2014), work is still needed to determine which approaches might be most effective and in which settings.”
BackgroundStudy of Risk Factors Associated with Suicide Attempt in Patients with Bipolar Disorder Type I
Subramanian, K., Menon, V., Sarkar, S., Chandrasekaran, V., & Selvakumar, N. (2020) · Journal of Neurosciences in Rural Practice · doi:10.1055/s-0040-1709347 · Cited by 15
Peters, E. M., John, A. M., Baetz, M., & Balbuena, L. (2018) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2018.07.008 · Cited by 18
Baer, M. M., LaCroix, J. M., Browne, J. C., Hassen, H. O., Perera, K. U., Weaver, J. J., Soumoff, A. A., & Ghahramanlou‐Holloway, M. (2017) · Archives of Suicide Research · doi:10.1080/13811118.2017.1358225 · Cited by 19
Molecular Pathways, Neural Circuits and Emerging Therapies for Self-Injurious Behaviour
Zhang, K., Ibrahim, G. M., & Gouveia, F. V. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26051938 · Cited by 15
“These approaches are best implemented in a family-based setting, where caregivers are trained to identify triggers and implement consistent behavioural strategies that mitigate SIB [86,187,190].”
InfluentialBergen, C., & McCabe, R. (2021) · Social Science & Medicine (1967) · doi:10.1016/j.socscimed.2021.114082 · Cited by 14
Functions of nonsuicidal self-injurious behavior in Russian patients with suicidal ideation
Зинчук, М. С., Kustov, G., Popova, S. B., Mishin, I., Voinova, N., Gersamija, A., Yakovlev, A. A., & Guekht, A. B. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1270944 · Cited by 10
Enhanced reactive inhibition in adolescents with non‐suicidal self‐injury disorder
Mirabella, G., Mancini, C. M., Pacifici, S., Guerrini, D., & Terrinoni, A. (2023) · Developmental Medicine & Child Neurology · doi:10.1111/dmcn.15794 · Cited by 15
Morthorst, B. R., Olsen, M. H., Jakobsen, J. C., Lindschou, J., Gluud, C. N., Heinrichsen, M., Møhl, B., Rubæk, L., Ojala, O., Hellner, C., et al. (2022) · JCPP Advances · doi:10.1002/jcv2.12115 · Cited by 11
“There is a lack of large‐scale NSSI intervention trials (Turner et al., 2014).”
BackgroundColet, I. E., Casadó‐Marín, L., Orós‐Navas, L., & Torner, R. D. R. (2025) · Journal of Child and Adolescent Psychiatric Nursing · doi:10.1111/jcap.70039 · Cited by 11
“These findings are consistent with a systematic review by Turner et al. (2014), which highlights the efficacy of various structured therapies focused on emotional regulation and enhancing coping skills in reducing NSSI.”
Qin, Y., Chen, H.-Y., Liu, F., Zou, T.-X., Jin, K., Teng, Z.-W., Liu, J.-Y., Yuan, H., Yang, J., Huang, C., et al. (2025) · Molecular Psychiatry · doi:10.1038/s41380-025-03183-x · Cited by 12
Reichl, C., Rockstroh, F., Lerch, S., Fischer-Waldschmidt, G., Koenig, J., & Kaess, M. (2023) · Psychological Medicine · doi:10.1017/s0033291723001447 · Cited by 12
Nonsuicidal self-injury in adolescents: current developments to help inform assessment and treatment
Pluhar, E., Lois, R., & Burton, E. T. (2018) · Current Opinion in Pediatrics · doi:10.1097/mop.0000000000000655 · Cited by 21
Flaherty, H. B. (2017) · Child and Adolescent Social Work Journal · doi:10.1007/s10560-017-0505-5 · Cited by 19
“This review reflects the finding of other notable reviews (Ougrin et al., 2012, 2015; Turner et al., 2014; Brent et al., 2013; Kerr et al., 2010; Townsend et al., 2001) that conclude that at this time there very few published randomized control trial (RCT) of therapeutic interventions (TI) that…”
Steele, S. J., Hearon, B. A., Batejan, K. L., Gironde, S., & Björgvinsson, Þ. (2016) · Journal of Clinical Psychology · doi:10.1002/jclp.22342 · Cited by 11
Zhou, H., Tang, Y., Li-juan, S., Wang, S., Guo, J., Xiao, J., Yan, C., & Gong, J. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.10.042 · Cited by 9
Hudson, E. M., Hemmings, B., Hartley, S., & Taylor, P. J. (2024) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12552 · Cited by 11
Taylor, P. J., Adeyemi, I., Marlow, K., Cottam, S., Airnes, Z., Hartley, S., Howells, V., Dunn, B. D., Elliott, R. A., Hann, M., et al. (2024) · Pilot and Feasibility Studies · doi:10.1186/s40814-024-01526-z · Cited by 13
“Whilst some systematic reviews suggest preliminary support for talking therapies [19, 20], other reviews have highlighted a lack of promising interventions [21].”
The functions of binge eating scale (FBES): Development and preliminary psychometric validation
O’Loghlen, E., Galligan, R. F., & Grant, S. (2023) · Appetite · doi:10.1016/j.appet.2023.106479 · Cited by 12
“, the use of evidence-based treatments such as dialectical behavioural therapy to treat binge eating as a form of self-punishment or non-suicidal self-injury (Turner et al., 2014), or modified substance use interventions (e.”
Hylén, U., McGlinchey, A. J., Orešič, M., Bejerot, S., Humble, M. B., Särndahl, E., Hyötyläinen, T., & Eklund, D. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.778325 · Cited by 15
Molaie, A. M., Chiu, C.-Y., Habib, Z., Galynker, I., Briggs, J., Rosenfield, P. J., Calati, R., & Yaseen, Z. S. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00289 · Cited by 11
“Future studies should explore possible treatment approaches that can modulate opioid system function in patients with NSSI (Turner et al., 2014).”
BackgroundYu, W., Li, S., Xiao, W., Li, X., Wang, R., Liu, J., Zhang, S., & Wan, Y. (2023) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2023.106113 · Cited by 10
Correlates of disclosure of non-suicidal self-injury amongst Australian university students
Mirichlis, S., Hasking, P. A., Lewis, S. P., & Boyes, M. (2022) · Journal of Public Mental Health · doi:10.1108/jpmh-07-2021-0089 · Cited by 10
The relationship between alexithymia and self-harm: The mediating role of mindfulness
Norman, H., Marzano, L., Oskis, A., & Coulson, M. (2021) · Current Psychology · doi:10.1007/s12144-021-01553-6 · Cited by 12
“Whilst a systematic review indicated tentatively promising results for DBT in treating self-harm (Turner et al., 2014), little research has been conducted to identify the types of people engaging in self-harm for whom mindfulness training would be most beneficial.”
Identifying Suicide and Self-Harm Research Priorities in North West England
Saini, P., Clements, C., Gardner, K. J., Chopra, J., Latham, C., Kumar, R., & Taylor, P. J. (2021) · Crisis · doi:10.1027/0227-5910/a000757 · Cited by 10
Fife, S., Blumenfeld, F., Williams, C., & Wood, L. (2019) · Psychiatry Research · doi:10.1016/j.psychres.2019.112609 · Cited by 11
Non-suicidal self-injury: clinical presentation, assessment and management
Dhingra, K., & Ali, P. A. (2016) · Nursing Standard · doi:10.7748/ns.2016.e10301 · Cited by 14
“However, the most promising psychological approaches include dialectical behaviour therapy, emotion-regulation group therapy, manual-assisted cognitive therapy and dynamic deconstructive psychotherapy (Turner et al 2014).”
BackgroundInfluentialWeedage, D., Kool-Goudzwaard, N., Meijnckens, D., Vermeiren, R. R. J. M., & Boonmann, C. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-06868-3 · Cited by 16
“Although there is no gold standard for the treatment of self-injury, several interventions have shown promise in reducing or stopping NSSI [12, 94].”
Metadata
- Authors
- Turner, B. J., Austin, S. B., & Chapman, A. L.
- Affiliations
- Simon Fraser University (CA)
- Corresponding author
- Turner, Brianna J
- Venue
- The Canadian Journal of Psychiatry
- Publisher
- SAGE Publications
- Published
- 2014-11
- Volume
- 59
- Issue
- 11
- Pages
- 576-585
- ISSN
- 0706-7437 (ISSN-L)
- 1497-0015
- PMC
- PMC4244876
- OpenAlex
- W2226199416
- Cited by
- 259
- References
- 109
- Citations by year
- 2026: 17 · 2025: 30 · 2024: 31 · 2023: 36 · 2022: 23 · 2021: 37 · 2020: 19 · 2019: 13 · 2018: 15 · 2017: 15 · 2016: 17 · 2015: 3 · 2014: 1
- FWCI
- 1.81
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Canadian Journal of Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Psychological Association
- Michael Smith Health Research BC
- Health Canada
- Canadian Institutes of Health Research
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- non-suicidal self-injury, suicidal self-injury, psychological intervention, pharmacotherapy, dialectical behavior therapy, atypical antipsychotics, aripiprazole, naltrexone, selective serotonin reuptake inhibitors, cognitive behavioral therapy, treatment efficacy
- MeSH terms
- Adolescent, Adult, Borderline Personality Disorder, Combined Modality Therapy, Humans, Psychotherapy, Psychotherapy, Group, Psychotropic Drugs, Suicide, Attempted, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Self-Injurious Behavior, Outcome Assessment, Health Care, Young Adult, Theory of Mind
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