Биологические основы несуицидального самоповреждающего поведения в подростковом возрасте: нарративный обзор

Обоснование. Несуицидальные самоповреждения — значимая проблема психического здоровья подростков и фактор риска суицида. Понимание биологических основ самоповреждающего поведения важно для разработки эффективных диагностических и терапевтических стратегий.

Цель: обобщить и критически проанализировать современные научные данные о биологических механизмах несуицидальных самоповреждений у подростков.

Методы. Проведен нарративный обзор (поиск в базах данных: MEDLINE, Web of Science, eLIBRARY.RU, КиберЛенинка). В обзор включали исследования биологических аспектов несуицидальных самоповреждений в подростковых выборках. Результаты отобранных исследований структурировали по биологическим системам, данные обобщали c учетом взаимодействия отдельных дисфункций в динамике развития самоповреждающего поведения.

Результаты. Обзор выявил мультисистемные нарушения при несуицидальном самоповреждающем поведении: структурные и функциональные изменения мозга (особенно в префронтальной коре, соматосенсорных областях, сети пассивного режима работы мозга); дисфункцию нейрохимических систем (дефицит эндогенных опиоидов, изменения эндоканнабиноидов); дисрегуляцию гипоталамо-гипофизарно-надпочечниковой оси и вегетативной нервной системы (гипореактивность на психосоциальный стресс, гиперреактивность на боль); активацию иммуновоспалительных механизмов; снижение болевой чувствительности; генетические (умеренная наследуемость, полиморфизмы генов серотонинергической системы) и эпигенетические факторы (гиперметилирование гена POMC). Обсуждены взаимодействия между отдельными биологическими факторами в рамках временнóй модели (дистальные предикторы, проксимальные корреляты, непосредственные маркеры эпизода).

Заключение. Несуицидальное самоповреждающее поведение подростков характеризуется мультисистемными биологическими нарушениями, формирующимися под влиянием генетической предрасположенности и среды. Полученные данные, несмотря на неоднородность, углубляют понимание механизмов развития и поддержания самоповреждающего поведения и открывают перспективы для разработки биомаркеров риска и биологически обоснованных, персонализированных подходов к терапии. Для преодоления методологических ограничений необходимы лонгитюдные исследования с интегративной оценкой биологических и психосоциальных факторов.

1. Кибитов А.А., Мазо Г.Э. Генетика и эпигенетика несуицидального самоповреждающего поведения: нарративный обзор. Генетика. 2023;59(12):1347-1359.

2. Ando A, Reichl C, Scheu F, Bykova A, Parzer P, Resch F, et al. Regional grey matter volume reduction in adolescents engaging in non-suicidal self-injury. Psychiatry Res Neuroimaging. 2018;280:48-55. https://doi.org/10.1016/j.pscychresns.2018.08.005

3. Auerbach RP, Pagliaccio D, Allison GO, Alqueza KL, Alonso MF. Neural correlates associated with suicide and nonsuicidal self-injury in youth. Biol Psychiatry. 2021;89(2):119-133. https://doi.org/10.1016/j.biopsych.2020.06.002

4. Bai S, Asarnow JR, Babeva KN, Irwin MR. IL-6 predicts non-suicidal self-injury over 3 months in high-risk adolescents. BJPsych Open. 2024;10(2):e51. https://doi.org/10.1192/bjo.2023.656

5. Bekrater-Bodmann R, Chung BY, Richter I, Wicking M, Foell J, Mancke F, et al. Deficits in pain perception in borderline personality disorder: results from the thermal grill illusion. Pain. 2015;156(10):2084-92. https://doi.org/10.1097/j.pain.0000000000000275

6. Bellato A, Admani MA, Deak C, Farhat LC, Fontana Antunes de Oliveira MC, Vasconcelos R, et al. Autonomic dysregulation and self-injurious thoughts and behaviours in children and young people: a systematic review and meta-analysis. JCPP Adv. 2023;3(3):e12148. https://doi.org/10.1002/jcv2.12148

7. Bernegger A, Kienesberger K, Carlberg L, Swoboda P, Ludwig B, Koller R, et al. The impact of COMT and childhood maltreatment on suicidal behaviour in affective disorders. Sci Rep. 2018;8:692. https://doi.org/10.1038/s41598-017-19040-z

8. Bernik TR, Friedman SG, Ochani M, DiRaimo R, Ulloa L, Yang H, et al. Pharmacological stimulation of the cholinergic antiinflammatory pathway. J Exp Med. 2002;195(6):781-8. https://doi.org/10.1084/jem.20011714

9. Blankenburg M, Boekens H, Hechler T, Maier C, Krumova E, Scherens A, et al. Reference values for quantitative sensory testing in children and adolescents: developmental and gender differences of somatosensory perception. Pain. 2010;149(1):76-88. https://doi.org/10.1016/j.pain.2010.01.011

10. Brañas MJAA, Croci MS, Ravagnani Salto AB, Doretto VF, Martinho E Jr, Macedo M, et al. Neuroimaging studies of nonsuicidal self-injury in youth: a systematic review. Life (Basel). 2021;11(8):729. https://doi.org/10.3390/life11080729

11. Bresin K, Sima Finy M, Verona E. Childhood emotional environment and self-injurious behaviors: the moderating role of the BDNF Val66Met polymorphism. J Affect Disord. 2013;150(2):594-600. https://doi.org/10.1016/j.jad.2013.01.050

12. Brown RC, Plener PL. Non-suicidal self-injury in adolescence. Curr Psychiatry Rep. 2017;19(3):20. https://doi.org/10.1007/s11920-017-0767-9

13. Butler RK, Finn DP. Stress-induced analgesia. Prog Neurobiol. 2009;88(3):184-202. https://doi.org/10.1016/j.pneurobio.2009.04.003

14. Cakin Memik N, Hunc F, Kalayci S, Demir N, Senturk E, Yildiz Gundogdu O, et al. Assessment of plasma-endogenous opioid neuropeptide levels and psychometric properties of non-suicidal self-injury in adolescents. Arch Suicide Res. 2023;27(2):74968. https://doi.org/10.1080/13811118.2022.2066494

15. Campos AI, Verweij KJH, Statham DJ, Madden PAF, Maciejewski DF, Davis KAS, et al. Genetic aetiology of self-harm ideation and behaviour. Sci Rep. 2020;10(1):9713. https://doi.org/10.1038/s41598-020-66737-9

16. Crowell SE, Beauchaine TP, McCauley E, Smith CJ, Vasilev CA, Stevens AL. Parent-child interactions, peripheral serotonin, and self-inflicted injury in adolescents. J Consult Clin Psychol. 2008;76(1):15-21. https://doi.org/10.1037/0022-006X.76.1.15

17. Daukantaitė D, Lundh LG, Wångby-Lundh M, Claréus B, Bjärehed J, Zhou Y, et al. What happens to young adults who have engaged in self-injurious behavior as adolescents? A 10-year follow-up. Eur Child Adolesc Psychiatry. 2021;30(3):475-92. https://doi.org/10.1007/s00787-020-01533-4

18. De Luca L, Pastore M, Palladino BE, Reime B, Warth P, Menesini E. The development of non-suicidal self-injury (NSSI) during adolescence: a systematic review and Bayesian meta-analysis. J Affect Disord. 2023;339:648-59. https://doi.org/10.1016/j.jad.2023.07.091

19. De Riu PL, Petruzzi V, Caria MA, Mameli O, Casu AR, Nuvoli S, et al. Beta-endorphin and cortisol levels in plasma and CSF following acute experimental spinal traumas. Physiol Behav. 1997;62(1):1-5. https://doi.org/10.1016/s0031-9384(97)00099-1

20. Dell’osso L, Mandelli L, Carlini M, Bouanani S, Rotondo A, Conversano C, et al. Temperamental and genetic predictors of suicide attempt and self-mutilation. Neuropsychobiology. 2013;68(4):250-7. https://doi.org/10.1159/000356228

21. Distel MA, Willemsen G, Ligthart L, Derom CA, Martin NG, Neale MC, et al. Genetic covariance structure of the four main features of borderline personality disorder. J Pers Disord. 2010;24(4):427-44. https://doi.org/10.1521/pedi.2010.24.4.427

22. Duerden EG, Card D, Roberts SW, Mak-Fan KM, Chakravarty MM, Lerch JP, et al. Self-injurious behaviours are associated with alterations in the somatosensory system in children with autism spectrum disorder. Brain Struct Funct. 2014;219(4):1251-61. https://doi.org/10.1007/s00429-013-0562-2

23. Edwards KM, Bosch JA, Engeland CG, Cacioppo JT, Marucha PT. Elevated macrophage migration inhibitory factor (MIF) is associated with depressive symptoms, blunted cortisol reactivity to acute stress, and lowered morning cortisol. Brain Behav Immun. 2010;24(7):1202-8. https://doi.org/10.1016/j.bbi.2010.03.011

24. Evans J, Battersby S, Ogilvie AD, Smith CA, Harmar AJ, Nutt DJ, et al. Association of short alleles of a VNTR of the serotonin transporter gene with anxiety symptoms in patients presenting after deliberate self harm. Neuropharmacology. 1997;36(4-5):439-43. https://doi.org/10.1016/s0028-3908(97)00027-0

25. Ferger MD, Sigrist C, Brodesser S, Kaess M, Koenig J. Alterations of the endocannabinoid system in adolescents with non-suicidal self-injury as a function of childhood maltreatment. Transl Psychiatry. 2024;14(1):491. https://doi.org/10.1038/s41398-024-03205-2

26. Few LR, Werner KB, Sartor CE, Grant JD, Trull TJ, Nock MK, et al. Early onset alcohol use and selfharm: a discordant twin analysis. Alcohol Clin Exp Res. 2015;39(11):2134-42. https://doi.org/10.1111/acer.12889

27. Fikke LT, Melinder A, Landrø NI. The effects of acute tryptophan depletion on impulsivity and mood in adolescents engaging in non-suicidal self-injury. Hum Psychopharmacol. 2013;28(1):61-71. https://doi.org/10.1002/hup.2283

28. Gao Y, Xiong Y, Liu X, Wang H. The effects of childhood maltreatment and non-suicidal self-injury in male adolescents: the moderating roles of the monoamine oxidase a (MAOA) gene and the catechol-O-methyltransferase (COMT) gene. Int J Environ Res Public Health. 2021;18(5):2598. https://doi.org/10.3390/ijerph18052598

29. Gavcar EG, Kabukçu Başay B, Avci E, Başay Ö. Relationship between saliva opiorphin levels, pain threshold, and cutting number in adolescents with non suicidal self injury. J Psychiatr Res. 2022;151:611-8. https://doi.org/10.1016/j.jpsychires.2022.05.030

30. Gennatas ED, Avants BB, Wolf DH, Satterthwaite TD, Ruparel K, Ciric R, et al. Age-related effects and sex differences in gray matter density, volume, mass, and cortical thickness from childhood to young adulthood. J Neurosci. 2017;37(20):5065-73. https://doi.org/10.1523/JNEUROSCI.3550-16.2017

31. Glenn JJ, Michel BD, Franklin JC, Hooley JM, Nock MK. Pain analgesia among adolescent self-injurers. Psychiatry Res. 2014;220(3):921-6. https://doi.org/10.1016/j.psychres.2014.08.016

32. Gorodetsky E, Carli V, Sarchiapone M, Roy A, Goldman D, Enoch MA. Predictors for self-directed aggression in italian prisoners include externalizing behaviors, childhood trauma and the serotonin transporter gene polymorphism 5-HTTLPR. Genes Brain Behav. 2016;15(5):465-73. https://doi.org/10.1111/gbb.12293

33. Guo Z, Liu Y, Wang C, Li S, Yu L, Wu W, et al. Exploring the association of addiction-related genetic factors with non-suicidal self-injury in adolescents. Front Psychiatry. 2023;14:1126615. https://doi.org/10.3389/fpsyt.2023.1126615

34. Hammann N, Kaess M, Rujescu D, Brunner R, Hartmann AM, Reichl C. Methylation of the Glucocorticoid Receptor Gene (NR3C1) in adolescents with a history of childhood adversity engaging in non-suicidal self-injury. Psychopathology. 2024;57(2):81-90. https://doi.org/10.1159/000531253

35. Hankin BL, Barrocas AL, Young JF, Haberstick B, Smolen A. 5-HTTLPR × interpersonal stress interaction and nonsuicidal self-injury in general community sample of youth. Psychiatry Res. 2015;225(3):609-12.doi:10.1016/j.psychres.2014.11.037

36. Hodgson K, Coleman JRI, Hagenaars SP, Purves KL, Glanville K, Choi SW, et al. Cannabis use, depression and self-harm: phenotypic and genetic relationships. Addiction. 2020;115(3):482-92. https://doi.org/10.1111/add.14845

37. Huang Q, Xiao M, Ai M, Chen J, Wang W, Hu L, et al. Disruption of neural activity and functional connectivity in adolescents with major depressive disorder who engage in non-suicidal self-injury: a resting-state fMRI study. Front Psychiatry. 2021;12:571532. https://doi.org/10.3389/fpsyt.2021.571532

38. Huang X, Rootes-Murdy K, Bastidas DM, Nee DE, Franklin JC. Brain differences associated with self-injurious thoughts and behaviors: a meta-analysis of neuroimaging studies. Sci Rep. 2020;10(1):2404. https://doi.org/10.1038/s41598-020-59490-6

39. James KM, Balderrama-Durbin C, Israel E, Feurer C, Gibb BE. Self- and co-regulation of physiological activity during mother-daughter interactions: the role of adolescent non-suicidal self-injury. J Child Psychol Psychiatry. 2024;65(1):91-9. https://doi.org/10.1111/jcpp.13859

40. Joyce PR, McKenzie JM, Mulder RT, Luty SE, Sullivan PF, Miller AL, et al. Genetic, developmental and personality correlates of self-mutilation in depressed patients. Aust N Z J Psychiatry. 2006;40(3):225-9. doi:10.1080/j.1440-1614.2006.01778.x

41. Kaess M, Hooley JM, Klimes-Dougan B, Koenig J, Plener PL, Reichl C, et al. Advancing a temporal framework for understanding the biology of nonsuicidal self-injury: an expert review. Neurosci Biobehav Rev. 2021;130:228-39. https://doi.org/10.1016/j.neubiorev.2021.08.022

42. Kao HT, Mürner-Lavanchy I, Lerch S, von Stosch E, Berger T, Koenig J, et al. Longitudinal associations between beta-endorphin, nonsuicidal self-injury and comorbid psychopathology. Psychiatry Res. 2024;340:116142. https://doi.org/10.1016/j.psychres.2024.116142

43. Kao HT, Mürner-Lavanchy I, von Stosch E, Josi J, Berger T, Koenig J, et al. Pain sensitivity as a state marker and predictor for adolescent non-suicidal self-injury. Psychol Med. 2024;54(9):2291-8. https://doi.org/10.1017/S0033291724000461

44. Kempke S, Luyten P, De Coninck S, Van Houdenhove B, Mayes LC, Claes S. Effects of early childhood trauma on hypothalamic-pituitary-adrenal (HPA) axis function in patients with chronic fatigue syndrome. Psychoneuroendocrinology. 2015;52:14-21. https://doi.org/10.1016/j.psyneuen.2014.10.027

45. Kim JS, Kang ES, Bahk YC, Jang S, Hong KS, Baek JH. Exploratory analysis of behavioral impulsivity, pro-inflammatory cytokines, and resting-state frontal EEG activity associated with non-suicidal self-injury in patients with mood disorder. Front Psychiatry. 2020;11:124. https://doi.org/10.3389/fpsyt.2020.00124

46. Kindler J, Koenig J, Lerch S, van der Venne P, Resch F, Kaess M. Increased immunological markers in female adolescents with non-suicidal self-injury. J Affect Disord. 2022;318:191-195. https://doi.org/10.1016/j.jad.2022.08.125

47. Klimes-Dougan B, Begnel E, Almy B, Thai M, Schreiner MW, Cullen KR. Hypothalamic-pituitary-adrenal axis dysregulation in depressed adolescents with non-suicidal self-injury. Psychoneuroendocrinology. 2019;102:216-24. https://doi.org/10.1016/j.psyneuen.2018.11.004

48. Koenig J, Lischke A, Bardtke K, Heinze AL, Kröller F, Pahnke R, et al. Altered psychobiological reactivity but no impairment of emotion recognition following stress in adolescents with non-suicidal self-injury. Eur Arch Psychiatry Clin Neurosci. 2023;273(2):379-95. https://doi.org/10.1007/s00406-022-01496-4

49. Koenig J, Rinnewitz L, Niederbäumer M, Strozyk T, Parzer P, Resch F, et al. Longitudinal development of pain sensitivity in adolescent non-suicidal self-injury. J Psychiatr Res. 2017;89:81-4. https://doi.org/10.1016/j.jpsychires.2017.02.001

50. Koenig J, Rinnewitz L, Warth M, Hillecke TK, Brunner R, Resch F, Kaess M. Psychobiological response to pain in female adolescents with nonsuicidal self-injury. J Psychiatry Neurosci. 2017;42(3):189-199. https://doi.org/10.1503/jpn.160074

51. Koenig J, Thayer JF, Kaess M. A meta-analysis on pain sensitivity in self-injury. Psychol Med. 2016;46(9):1597-612. https://doi.org/10.1017/s0033291716000301

52. Kolevzon A, Lim T, Schmeidler J, Martello T, Cook EH Jr, Silverman JM. Self-injury in autism spectrum disorder: an effect of serotonin transporter gene promoter variants. Psychiatry Res. 2014;220(3):987-90. https://doi.org/10.1016/j.psychres.2014.09.018

53. Lam JCW, Shields GS, Trainor BC, Slavich GM, Yonelinas AP. Greater lifetime stress exposure predicts blunted cortisol but heightened DHEA responses to acute stress. Stress Health. 2019;35(1):15-26. https://doi.org/10.1002/smi.2835

54. Leone C, Galosi S, Mollica C, Fortunato M, Possidente C, Milone V, et al. Dissecting pain processing in adolescents with non-suicidal self-injury: could suicide risk lurk among the electrodes? Eur J Pain. 2021;25(8):1815-28. doi:10.1002/ejp.1793

55. Li C, Liang X, Cheng S, Wen Y, Pan C, Zhang H, et al. A multi-environments-gene interaction study of anxiety, depression and self-harm in the UK Biobank cohort. J Psychiatr Res. 2022;147:59-66. https://doi.org/10.1016/j.jpsychires.2022.01.009

56. Li L, Liang Z, Li G, Xu H, Yang X, Liu X, et al. Unveiling convergent and divergent intrinsic brain network alternations in depressed adolescents engaged in non-suicidal self-injurious behaviors with and without suicide attempts. CNS Neurosci Ther. 2024;30(5):e14684. https://doi.org/10.1111/cns.14684

57. Lim KX, Rijsdijk F, Hagenaars SP, Socrates A, Choi SW, Coleman JRI, et al. Studying individual risk factors for self-harm in the UK Biobank: a polygenic scoring and Mendelian randomisation study. PLoS Med. 2020;17(6):e1003137. https://doi.org/10.1371/journal.pmed.1003137

58. Ludäscher P, Greffrath W, Schmahl C, Kleindienst N, Kraus A, Baumgärtner U, et al. A cross-sectional investigation of discontinuation of self-injury and normalizing pain perception in patients with borderline personality disorder. Acta Psychiatr Scand. 2009;120(1):62-70. https://doi.org/10.1111/j.1600-0447.2008.01335.x

59. Maciejewski DF, Creemers HE, Lynskey MT, Madden PAF, Heath AC, Statham DJ, et al. Overlapping genetic and environmental influences on nonsuicidal self-injury and suicidal ideation: different outcomes, same etiology? JAMA Psychiatry. 2014;71(6):699-705. https://doi.org/10.1001/jamapsychiatry.2014.89

60. Marusak HA, Evanski J, Desai S, Rabinak CA. Impact of Childhood Trauma Exposure, Genetic Variation in Endocannabinoid Signaling, and Anxiety on Frontolimbic Pathways in Children. Cannabis Cannabinoid Res. 2023;8(6):1079-1089. https://doi.org/10.1089/can.2022.0144

61. Masi G, Pisano S, Sesso G, Mazzullo C, Berloffa S, Fantozzi P, et al. Persistent non-suicidal self-injury and suicidality in referred adolescents: a longitudinal study exploring the role of cyclothymic temperament. Brain Sci. 2023;13(5):755. https://doi.org/10.3390/brainsci13050755

62. Meier M, Jansen K, Vertgewall H, Claes L. The lifetime prevalence of non-suicidal self-injury in children and adolescents with eating disorders—a systematic review and meta-analysis. Eur Eat Disord Rev. 2025;33(3):511-24. https://doi.org/10.1002/erv.3158

63. Micale V, Drago F. Endocannabinoid system, stress and HPA axis. Eur J Pharmacol. 2018;834:230-239. https://doi.org/10.1016/j.ejphar.2018.07.039

64. Muehlenkamp JJ, Claes L, Havertape L, Plener PL. International prevalence of adolescent non-suicidal self-injury and deliberate self-harm. Child Adolesc Psychiatry Ment Health. 2012;6:10. doi:10.1186/1753-2000-6-10

65. Mürner-Lavanchy I, Kao HT, Sele S, Koenig J, Kaess M. Prefrontal oxygenation during experimental pain in adolescents engaging in non-suicidal self-injury. J Affect Disord. 2025;370:100-8. https://doi.org/10.1016/j.jad.2024.10

66. Mürner-Lavanchy I, Koenig J, Reichl C, Brunner R, Kaess M. Altered resting-state networks in adolescent non-suicidal self-injury-a graph theory analysis. Soc Cogn Affect Neurosci. 2022;17(9):819-27. https://doi.org/10.1093/scan/nsac007.

67. Murphy F, Nasa A, Cullinane D, Raajakesary K, Gazzaz A, Sooknarine V, et al. Childhood Trauma, the HPA Axis and Psychiatric Illnesses: A Targeted Literature Synthesis. Front Psychiatry. 2022;13:748372. https://doi.org/10.3389/fpsyt.2022.748372

68. Nahman-Averbuch H, Banerjee G, Brown J, McMichael A, Ben Abdallah A, Buday S, et al. The role of puberty in experimental pain sensitivity in healthy adolescent girls. Pain Rep. 2025;10(4):e1292. doi:10.1097/PR9.0000000000001292

69. Nock MK, Mendes WB. Physiological arousal, distress tolerance, and social problem-solving deficits among adolescent self-injurers. J Consult Clin Psychol. 2008;76(1):28-38. https://doi.org/10.1037/0022-006X.76.1.28

70. O’Connor DB, Thayer JF, Vedhara K. Stress and Health: A Review of Psychobiological Processes. Annu Rev Psychol. 2021;72:663-688.

71. Otto A, Jarvers I, Kandsperger S, Reichl C, Ando A, Koenig J, et al. Stress-induced alterations in resting-state functional connectivity among adolescents with non-suicidal self-injury. J Affect Disord. 2023;339:162-71. https://doi.org/10.1016/j.jad.2023.07.032

72. Petti TA, Chen A. A Narrative Approach to Understanding and Using the Role of Hope in Adolescent and Emerging Adult Non-Suicidal Self-Injury. Psychol Psychology Res Int J. 2024;9(2):000409. https://doi.org/10.23880/prij-16000409

73. Reichl C, Heyer A, Brunner R, Parzer P, Völker JM, Resch F, et al. Hypothalamic-pituitary-adrenal axis, childhood adversity and adolescent nonsuicidal self-injury. Psychoneuroendocrinology. 2016;74:203-11. https://doi.org/10.1016/j.psyneuen.2016.09.011.

74. Richmond-Rakerd LS, Trull TJ, Gizer IR, McLaughlin K, Scheiderer EM, Nelson EC, et al. Common genetic contributions to high-risk trauma exposure and self-injurious thoughts and behaviors. Psychol Med. 2019;49(3):421-30. https://doi.org/10.1017/S0033291718001034

75. Russell AE, Hemani G, Jones HJ, Ford T, Gunnell D, Heron J, et al. An exploration of the genetic epidemiology of non-suicidal self-harm and suicide attempt. BMC Psychiatry. 2021;21(1):207. https://doi.org/10.1186/s12888-021-03216-z

76. Russell K, Allan S, Beattie L, Bohan J, MacMahon K, Rasmussen S. Sleep problem, suicide and selfharm in university students: A systematic review. Sleep Med Rev. 2019;44:58-69. https://doi.org/10.1016/j.smrv.2018.12.008

77. Shah BP, Vong L, Olson DP, et al. MC4R-expressing glutamatergic neurons in the paraventricular hypothalamus regulate feeding and are synaptically connected to the parabrachial nucleus. Proc Natl Acad Sci U S A. 2014;111(36):13193-8. https://doi.org/10.1073/pnas.1407843111

78. Sigrist C, Jakob H, Beeretz CJ, Schmidt SJ, Kaess M, Koenig J. Diurnal variation of cardiac autonomic activity in adolescent non-suicidal self-injury. Eur Arch Psychiatry Clin Neurosci. 2024;274(3):609-28. https://doi.org/10.1007/s00406-023-01574-1

79. Sohn JW. Network of hypothalamic neurons that control appetite. BMB Rep. 2015;48(4):229-33. https://doi.org/10.5483/bmbrep.2015.48.4.272

80. Steiger H, Fichter M, Bruce KR, Joober R, Badawi G, Richardson J, et al. Molecular-genetic correlates of self-harming behaviors in eating-disordered women: findings from a combined Canadian-German sample. Prog Neuropsychopharmacol Biol Psychiatry. 2011;35(1):102-6. https://doi.org/10.1016/j.pnpbp.2010.09.012

81. Steiger H, Labonté B, Groleau P, Turecki G, Israel M. Methylation of the glucocorticoid receptor gene promoter in bulimic women: associations with borderline personality disorder, suicidality, and exposure to childhood abuse. Int J Eat Disord. 2013;46(3):246255. https://doi.org/10.1002/eat.22113

82. Störkel LM, Karabatsiakis A, Hepp J, Kolassa IT, Schmahl C, Niedtfeld I. Salivary beta-endorphin in nonsuicidal self-injury: an ambulatory assessment study. Neuropsychopharmacology. 2021;46(7):135763. https://doi.org/10.1038/s41386-020-00914-2

83. Thaler L, Groleau P, Badawi G, Sycz L, Zeramdini N, Too A, et al. Epistatic interactions implicating dopaminergic genes in bulimia nervosa (BN): relationships to eating- and personality-related psychopathology. Prog Neuropsychopharmacol Biol Psychiatry. 2012;39(1):120-8. https://doi.org/10.1016/j.pnpbp.2012.05.019

84. Turecki G, Meaney MJ. Effects of the Social Environment and Stress on Glucocorticoid Receptor Gene Methylation: A Systematic Review. Biol Psychiatry. 2016;79(2):87-96. https://doi.org/10.1016/j.biopsych.2014.11.022

85. van den Bosch GE, van Dijk M, Tibboel D, et al. Thermal quantitative sensory testing in healthy Dutch children and adolescents standardized test paradigm and Dutch reference values. BMC Pediatr. 2017;17:77. https://doi.org/10.1186/s12887-017-0827-7

86. van der Venne P, Höper S, Koenig J, Kaess M. Pain sensitivity and plasma beta-endorphin in adolescent non-suicidal self-injury. J Affect Disord. 2020;264:471-8. https://doi.org/10.1016/j.jad.2019.11.073

87. van der Venne P, Mürner-Lavanchy I, Höper S, Koenig J, Kaess M. Physiological response to pain in female adolescents with nonsuicidal self-injury as a function of severity. J Affect Disord. 2023;339:6473. https://doi.org/10.1016/j.jad.2023.06.041

88. van Hoorn A, Mankee-Williams A, Lewis G, Mellili R, Eccles J, Ottaviani C, et al. The Feasibility of Ambulatory Heart Rate Variability Monitoring in Non-Suicidal Self-Injury. Healthc Technol Lett. 2025;12(1):e70007. https://doi.org/10.1049/htl2.70007

89. van Hoorn AC. Could affect regulation via vagal nerve self- stimulation be a maintaining factor in non-suicidal self-harm? Med Hypotheses. 2020;136:109498. https://doi.org/10.1016/j.mehy.2019.109498

90. Wadji DL, Tandon T, Ketcha Wanda GJM, Wicky C, Dentz A, Hasler G, et al. Child maltreatment and NR3C1 exon 1F methylation, link with deregulated hypothalamus-pituitary-adrenal axis and psychopathology: A systematic review. Child Abuse Negl. 2021;122:105304. https://doi.org/10.1016/j.chiabu.2021.105304

91. Wang P, Li C, Del Sol-Calderón P, Mallol L, Hernández-Álvarez E, Donoso-Navarro E, et al. Biosignature of self-injury behaviors in adolescence: Role of β-endorphin in an acute inpatient unit. Front Psychiatry. 2022;13:933275. https://doi.org/10.3389/fpsyt.2022.933275

92. Warrier V, Baron-Cohen S. Childhood trauma, life-time self-harm, and suicidal behaviour and ideation are associated with polygenic scores for autism. Mol Psychiatry. 2021;26(5):1670-84. https://doi.org/10.1038/s41380-019-0550-x

93. Weise S, Parzer P, Zimmermann R, Fürer L, Resch F, Kaess M, et al. Emotion dysregulation and resting-state autonomic function in adolescent borderline personality disorder — A multimodal assessment approach. Personal Disord. 2020;11(1):46-53. https://doi.org/10.1037/per0000367

94. Westlund Schreiner M, Klimes-Dougan B, Begnel ED, Cullen KR. Conceptualizing the neurobiology of non-suicidal self-injury from the perspective of the Research Domain Criteria Project. Neurosci Biobehav Rev. 2015;57:381-391. https://doi.org/10.1016/j.neubiorev.2015.09.011

95. Wu Y, Zhang Y, Wang C, Huang B. A meta-analysis on the lifetime and period prevalence of self-injury among adolescents with depression. Front Public Health. 2024;12:1434958. https://doi.org/10.3389/fpubh.2024.1434958

96. Zefferino R, Di Gioia S, Conese M. Molecular links between endocrine, nervous and immune system during chronic stress. Brain Behav. 2021;11(2):e01960. https://doi.org/10.1002/brb3.1960

97. Zheng D, Bi X, Zhang T, Han C, Ma T, Wang L, et al. Epigenetic Alterations of the Promoter Region of the POMC Gene in Adolescent Depressive Disorder Patients with Nonsuicidal Self-injury Behaviors. Psychol Res Behav Manag. 2020;13:997-1008. https://doi.org/10.2147/PRBM.S272445

98. Zheng Q, Liu J, Ji Y, Zhang Y, Chen X, Liu B. Elevated levels of monocyte-lymphocyte ratio and platelet-lymphocyte ratio in adolescents with non-suicidal self-injury. BMC Psychiatry. 2022;22(1):618. https://doi.org/10.1186/s12888-022-04260-z

99. Zhou Y, Yu R, Ai M, Cao J, Li X, Hong S, et al. A Resting State Functional Magnetic Resonance Imaging Study of Unmedicated Adolescents With Non-Suicidal Self-Injury Behaviors: Evidence From the Amplitude of Low-Frequency Fluctuation and Regional Homogeneity Indicator. Front Psychiatry. 2022;13:925672. https://doi.org/10.3389/fpsyt.2022.925672