Emerging Methodology May Improve Mental Health Research

The concept of self-harm is nearly synonymous with suicide.

But mental health providers across the nation have seen a sharp rise in the number of people who participate in non-suicidal self-injury (NSSI). The most recent estimates show 1 in 5 Americans have experimented with hurting themselves in times of emotional stress, with no lethal intent. While some people may only behave this way once or twice, others can develop a hard-to-break habit. This severe type of NSSI is associated with impaired functioning, high rates of psychiatric hospitalizations and future suicide attempts.

Kathryn Cullen, M.D., assistant professor in the department of psychiatry at the University of Minnesota Medical School, says experts don’t fully understand what accounts for the spike, but suspect that mirroring behavior may be contributing, a phenomenon which has been greatly exacerbated by social media.

“Mental health issues like depression have been observed for many years,” Cullen said. “But the spike in NSSI may be a new outlet for, or manifestation of, mental health instability.”

What’s more, experts have little data that can explain the biological reasons for the behavior.

Cullen and her colleagues are launching a 5-year brain imaging study that will examine self-harm behavior among 152 adolescent girls, a subgroup that expresses this behavior more than other populations. These girls will have a range of NSSI symptoms, from non-existent to severe. In addition to quantifying NSSI in these adolescents, the study will collect data on brain and other biological metrics over the course of three years, with the goal of measuring how brain development may go awry in adolescents with NSSI.

The study will follow an emerging research paradigm in the psychiatry community called Research Domain Criteria Initiative, or RDoC for short. Unlike traditional psychiatry research, which has followed the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) criteria, Cullen’s RDoC research will try to link symptoms and behavior to biological metrics – things like neurocircuitry, hormones and other indicators.

“There has been a major gap in neuroscience research to understand the neurobiological underpinnings of NSSI,” said Cullen. “This has hindered the advancement of new, biologically-targeted interventions. We hope to uncover a meaningful understanding of the neural mechanisms driving NSSI, paving the way for developing new treatments to address NSSI.”

Cullen expects that she and her colleagues will find that abnormalities in brain circuitry will coincide with self harm. In addition to advancing understanding of NSSI and brain development, Cullen feels that her research may have a side-benefit: decreasing stigma. When this research is disseminated, it is possible that by connecting mental health behaviors to the brain using the RDoC methodology, people will view NSSI and other behaviors in mental illness with a completely different light.

“The foundation of our research always boils down to patients’ quality of life,” Cullen added. “It’s our responsibility to learn from our patients so that we can discover better ways to treat their condition and help them thrive.”

For more information about joining Cullen’s NSSI study, visit