Beyond distress relief: the Anhedonic Subtype of nonsuicidal self-injury and the imperative for Positive Affect Treatment

When a new rewarding behavior is introduced, it creates a competing neural pathway that replaces existing reward patterns linked to maladaptive habits.

Some adolescents who harm themselves without intending to die have a brain pattern involving reduced pleasure response and underactive reward circuits; their self-injury triggers dopamine release when pain ends, creating a sensation they seek, rather than relieving emotional distress.

Adolescents who engage in nonsuicidal self-injury and have depression show reduced activity in the ventral striatum when expecting a reward.

For adolescents who engage in self-harm because they feel no pleasure or reward in life, Dialectical Behavior Therapy does not reduce self-harm because it does not target the underlying lack of reward system activity.

Adolescents who report feeling empty are 24% more likely to have thoughts of nonsuicidal self-injury, even when accounting for anxiety and loneliness.

When pain stops, the brain releases dopamine and natural opioid chemicals that activate reward pathways, replacing the reduced reward response seen in people with anhedonia.