Neuroimaging Studies of Nonsuicidal Self-Injury in Youth: A Systematic Review.

Marcelo J A A Brañas,Ana Beatriz Ravagnani Salto,Marcos S Croci,Eduardo Martinho,Marcos Macedo,Pedro M Pan,Victoria F Doretto,Euripedes C Miguel,Leonardo Roever

doi:10.3390/life11080729

Marcelo J A A Brañas, Ana Beatriz Ravagnani Salto + Show 7 more

Open Access

https://doi.org/10.3390/life11080729

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Abstract

Nonsuicidal self-injury (NSSI) is prevalent and affects mainly the youth population. It is prospectively associated with suicide attempts, making it a target for suicide prevention. Recently, several studies have investigated neural pathways of NSSI using neuroimaging. However, there is a lack of systematized appraisal of these findings. This systematic review aims to identify and summarize the main neuroimaging findings of NSSI in youth. We followed PRISMA statement guidelines and searched MEDLINE, APA PsycInfo, and Google Scholar databases for neuroimaging studies, irrespective of imaging modality, specifically investigating NSSI in samples with a mean age of up to 25 years old. Quality assessment was made using the Newcastle–Ottawa and Joanna Briggs Institute scales. The initial search retrieved 3030 articles; 21 met inclusion criteria, with a total of 938 subjects. Eighteen studies employed functional neuroimaging techniques such as resting-state and task-based fMRI (emotional, interpersonal exposure/social exclusion, pain, reward, and cognitive processing paradigms). Three studies reported on structural MRI. An association of NSSI behavior and altered emotional processing in cortico-limbic neurocircuitry was commonly reported. Additionally, alterations in potential circuits involving pain, reward, interpersonal, self-processing, and executive function control processes were identified. NSSI has complex and diverse neural underpinnings. Future longitudinal studies are needed to understand its developmental aspects better.

Highlights

Nonsuicidal self-injury (NSSI) refers to the direct and intentional self-inflicted lesion of body tissue without lethal intention or socially sanctioned purposes [1]
May occur in the absence of mental conditions, psychiatric disorders can be identified in up to 85% of the cases [2]. This condition has been historically linked to borderline personality disorder (BPD), but recent studies showed that NSSI is associated with several other mental conditions such as mood, anxiety, trauma, substance use, eating disorders, and even autism spectrum disorder [3,4]
Decreased anisotropy in the left cingulum and the left uncinate fasciculus were correlated with, respectively, the time elapsed since the first NSSI episode and higher levels of attentional impulsivity [28]. These findings suggest that among NSSI subjects, greater impulsivity and NSSI severity are associated with significant frontolimbic white matter tract integrity deficits [28]

Summary

Introduction

Nonsuicidal self-injury (NSSI) refers to the direct and intentional self-inflicted lesion of body tissue without lethal intention or socially sanctioned purposes [1]. NSSI may occur in the absence of mental conditions, psychiatric disorders can be identified in up to 85% of the cases [2]. Recent classifications for mental health conditions, such as the DSM-5, recognize the relevance of NSSI and consider this behavior as a separate condition, independent of other psychiatric disorders but still requiring further studies [7,8]. Self-harm behavior was associated with increased pituitary volume in young BPD patients [15,16]. This finding suggested that NSSI behavior may be related to the hyper-reactivity of stress response systems [5,16]. New evidence emerged linking altered limbic processing, such as hyperactivity of the amygdala and anterior cingulate cortex (ACC), with NSSI [17]

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