title: An adolescent with nonsuicidal self-injury: a case and discussion of neurobiological research on emotion regulation.
abstract: 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.
authors.affiliation: Department of Psychiatry, University of Minnesota Medical School, Minneapolis, USA. rega0026@umn.edu
authors.forename: Kathryn R
authors.initials: KR
authors.lastname: Cullen
authors.forename: Melinda K
authors.initials: MK
authors.lastname: Westlund
authors.forename: Lori L
authors.initials: LL
authors.lastname: LaRiviere
authors.forename: Bonnie
authors.initials: B
authors.lastname: Klimes-Dougan
mesh_terms: D000223:Adaptation, Psychological / Q000502:physiology*; D000293:Adolescent; D000494:Allosteric Regulation / Q000502:physiology; D000928:Antidepressive Agents / Q000627:therapeutic use; D001341:Autonomic Nervous System / Q000187:drug effects / Q000503:physiopathology; D001921:Brain / Q000187:drug effects / Q000503:physiopathology; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000503:physiopathology* / Q000523:psychology* / Q000628:therapy; D056348:Emotional Intelligence / Q000502:physiology*; D054541:Family Conflict; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects / Q000503:physiopathology; D007389:Internal-External Control; D010287:Parent-Child Relations; D010379:Peer Group; D010913:Pituitary-Adrenal System / Q000187:drug effects / Q000503:physiopathology; D011613:Psychotherapy / Q000379:methods; D012059:Rejection, Psychology; D016728:Self-Injurious Behavior / Q000503:physiopathology* / Q000523:psychology* / Q000628:therapy; D012701:Serotonin / Q000502:physiology; D012944:Social Support
chemical_list: D000928:Antidepressive Agents; D005473:Fluoxetine; D012701:Serotonin
references.citation: Am J Psychiatry. 2010 Jul;167(7):748-51
references.pmid: 20595427
references.citation: Eur J Nucl Med. 2001 Feb;28(2):175-82
references.pmid: 11303887
references.citation: Biol Psychiatry. 2010 Aug 15;68(4):383-91
references.pmid: 20537612
references.citation: J Abnorm Child Psychol. 2012 Jan;40(1):45-57
references.pmid: 22016199
references.citation: Psychol Bull. 2009 May;135(3):495-510
references.pmid: 19379027
references.citation: Mol Psychiatry. 2003 Jul;8(7):646-53
references.pmid: 12874600
references.citation: Psychiatry Res. 2012 Aug-Sep;203(2-3):146-52
references.pmid: 22901627
references.citation: J Am Acad Child Adolesc Psychiatry. 2012 Dec;51(12):1304-1313.e3
references.pmid: 23200287
references.citation: Acta Psychiatr Belg. 1985 May-Jun;85(3):450-8
references.pmid: 3876688
references.citation: Psychoneuroendocrinology. 2012 Jan;37(1):157-61
references.pmid: 21676550
references.citation: Clin Psychol Rev. 2007 Mar;27(2):226-39
references.pmid: 17014942
references.citation: Child Adolesc Psychiatry Ment Health. 2012 Mar 30;6:10
references.pmid: 22462815
references.citation: Int J Psychophysiol. 2011 May;80(2):166-70
references.pmid: 21376761
references.citation: Am J Psychiatry. 1991 Mar;148(3):306-17
references.pmid: 1847025
references.citation: Nat Rev Neurosci. 2003 Oct;4(10):819-28
references.pmid: 14523381
references.citation: J Consult Clin Psychol. 2008 Feb;76(1):52-62
references.pmid: 18229983
references.citation: Cogn Behav Ther. 2008;37(1):14-25
references.pmid: 18365795
references.citation: Child Adolesc Psychiatry Ment Health. 2011 Jan 28;5(1):3
references.pmid: 21276211
references.citation: J Pharm Pract. 2011 Oct;24(5):472-7
references.pmid: 21940603
references.citation: Eur Psychiatry. 2010 Jan;25(1):19-25
references.pmid: 19699062
references.citation: Acta Psychiatr Scand. 2010 Jan;121(1):41-51
references.pmid: 19522883
references.citation: J Consult Clin Psychol. 2008 Feb;76(1):28-38
references.pmid: 18229980
references.citation: Psychiatry Res. 2013 Apr 30;206(2-3):265-72
references.pmid: 23159195
references.citation: J Child Psychol Psychiatry. 2009 Jul;50(7):807-15
references.pmid: 19490314