Nonsuicidal self-injury in veterans with posttraumatic stress disorder: Current theory and implications for practice

Suicidality is a major area of concern for clinicians working with veterans. Nonsuicidal self-injury (NSSI) is associated with suicide risk, but research on NSSI in veteran populations is limited. Recent studies have found high rates of NSSI among veterans seeking treatment for posttraumatic stress disorder (PTSD). In addition, NSSI is a predictive factor for suicidal ideation and suicide attempts. Converging theories about NSSI, PTSD, and suicidality highlight possible connections between these serious mental health concerns. Specifically, NSSI may serve to relieve intense negative emotions, counteract feelings of numbness, and help manage difficult social interactions for veterans with PTSD. Reliance on NSSI for coping not only is maladaptive but also may increase veterans' acquired capability for suicide. Despite this, there is little guidance for clinicians working with veteran trauma survivors who present with NSSI. This article discusses existing therapeutic approaches with an emphasis on a functional rather than diagnostic perspective. Contributing factors such as military culture and combat exposure are also discussed. Additional research is needed to examine the functional relationship between NSSI, PTSD, and suicide, with the overarching goal of developing more effective interventions for the growing at-risk population of veterans.