Table 1.

The shared functional pool of adolescent self-harm behaviors.

Functional domain	Core purpose/goal	Manifestation in NSSI	Relevance/escalation to SA
Intrapersonal: affect regulation	To reduce/alleviate overwhelming negative emotional states	Cutting, burning, or hitting oneself to generate an immediate emotional shift or relief	Escalation pathway: NSSI fails to regulate extreme pain, leading to a shift toward the “ultimate escape” from feeling
Intrapersonal: anti-dissociation/grounding	To confirm reality or stop feeling numb through physical pain	Deep scratching, pinching, or hitting to counter dissociative and numb states	Implies severe underlying distress (e.g., trauma), which is a risk factor for severe suicidality
Intrapersonal: self-punishment/shame management	To punish the self, manage guilt, and cope with shame	Interfering with wound healing, minor overdoses	Suicide is framed as the ultimate punishment for, or permanent escape from, intolerable shame
Interpersonal: communication/influence	To express internal pain, seek help, or influence relationships	Superficial cutting in visible areas, often accompanied by emotional outbursts	May lead to overt or “performative” attempts intended to force a strong relational response