| Popis: |
Non-suicidal self-injury (NSSI) defies the core purpose of the brain and body’s threat processing and response system: self-preservation and protection from harm. The hypothalamic-pituitary-adrenal (HPA) axis coordinates the endocrine response to threats. Preliminary evidence suggests that individuals who engage in NSSI demonstrate blunted cortisol responses to stressors and possibly elevations in basal cortisol. The neural threat system involves the amygdala, anterior cingulate cortex (ACC), prefrontal cortex (PFC), and insula. Individuals with a history of NSSI have been shown to have structural alterations in and between the ACC, insula, and amygdala. Functional connectivity between the amygdala and PFC has been shown to be altered in adolescents with a history of NSSI as well. Further, individuals with a history of NSSI have been shown to have increased amygdala activation in response to emotional stimuli. Work that integrates multiple modes of measuring stress response has shown discordance between the HPA axis response, experience of stress, and expression of stress among those with more severe NSSI. More work is needed to disentangle discordance within the threat processing system. Additionally, there is a need for more nuanced understanding of (a) environmental mechanisms of risk and protection, (b) implications of sustained engagement in NSSI, and (c) a broader array of pathology as it relates to biological threat-system disturbances for those who engage in NSSI. Future work on NSSI should explore ways to mitigate the impact of risk factors and leverage the protective factors and neurobiological and psychological underpinnings of NSSI to identify novel treatment modalities. |
