DSM Update: Nonsuicidal Self-Injury Disorder, or a Clinical Specifier?

In this episode, four of the top experts in researching and treating nonsuicidal self-injury (NSSI) talk about the research behind NSSI Disorder, the evolution of how they now think about NSSI within the context of the DSM, and why they now advocate for an NSSI specifier rather than an NSSI Disorder in the DSM. They also delineate their proposed criteria for self-harm as a specifier and both the positive and negative consequences of doing so.

Below are papers referenced in this episode:

1. Lengel, G. J., Muehlenkamp, J. J., Zetterqvist, M., Ammerman, B. A., Brausch, A. M., & Washburn, J. J. (2025). Non-suicidal self-injury: proposal to shift designation from disorder to a clinical specifier. The Lancet Psychiatry. Online advanced publication.
2. Shaffer, D., & Jacobson, C. (2009). Proposal to the DSM-V childhood disorder and mood disorder work groups to include non-suicidal self-injury (NSSI) as a DSM-V disorder. American Psychiatric Association, 1-21.
3. Muehlenkamp, J. J. (2005). Self-injurious behavior as a separate clinical syndrome. American Journal of Orthopsychiatry, 75(2), 324–333.
4. Brausch, A. (2019). Diagnostic classification of nonsuicidal self-injury. In J. J. Washburn (Ed.), Nonsuicidal self-injury: Advances in research and practice (pp. 71-87). Routledge.

NONSUICIDAL SELF-INJURY SPECIFIER (PROPOSED CRITERIA):

A. The specifier should be used when the nonsuicidal self-injury (NSSI) behavior is characterized by the following:

1. The individual intentionally engages in NSSI behavior to inflict bodily damage or pain
2. The individual's NSSI behavior is recent, such that it occurred at least once during the past month
3. The individual’s NSSI behavior is repetitive, such that it occurred on about 5 or more days in an individual’s lifetime

Note: culturally specific NSSI behavior (e.g., piercings and tattoos) and harm that is habitual (e.g., scab picking, nail biting, and hair pulling) should not be considered to be NSSI unless the behavior is explicitly for the purposes of causing damage or pain to one’s body. The NSSI specifier can still be applied if the behavior occurs under the influence of substances, as long as the behavior meets the required features.

Coding note: use code Z91.52 for individuals with a previous history of NSSI when all criteria except for recency are met (A2).

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