# Situation: A 16-year-old female student is seen by the school nurse after a teacher notices fresh, shallow, parallel cuts on her left forearm. The wounds need only cleaning. She has no known medical illness. She says, "I cut when the pressure builds up. It calms me down. I do not want to die; I just want the feeling to stop." She has cut herself about once a week for 2 months and denies ever having thoughts of ending her life. Which NANDA International (NANDA-I) 2024–2026 label BEST fits these data?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630190  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A 16-year-old female student is seen by the school nurse after a teacher notices fresh, shallow, parallel cuts on her left forearm. The wounds need only cleaning. She has no known medical illness.

She says, "I cut when the pressure builds up. It calms me down. I do not want to die; I just want the feeling to stop." She has cut herself about once a week for 2 months and denies ever having thoughts of ending her life. Which NANDA International (NANDA-I) 2024–2026 label BEST fits these data?

## 보기

1. Risk for non-suicidal self-injurious behavior
2. Non-suicidal self-injurious behavior **✔ 정답**
3. Excessive anxiety
4. Risk for suicidal self-injurious behavior

**정답: 2**

## 해설

Deliberate self-injury without intent to die, done to relieve emotional tension, is non-suicidal self-injury. Because the behavior is already occurring, a problem-focused label fits; a risk label is used only when the problem has not yet occurred.

## 심화 해설

Core interpretation

The student describes cutting that occurs when emotional pressure builds, produces a calming effect, and is explicitly not intended to end her life. She has engaged in this behavior about once a week for two months, which means the problem is already present rather than merely possible. In NANDA-I terminology, an actual problem-focused diagnosis is therefore appropriate.

Non-suicidal self-injurious behavior is defined as deliberate self-inflicted damage to body tissue without suicidal intent, performed to relieve distressing affect or internal tension. The student's statement that cutting “calms me down” and her denial of wanting to die align directly with this label. Because the behavior is occurring now, the problem-focused label Non-suicidal self-injurious behavior fits better than a risk label, which is reserved for situations where the problem has not yet manifested.

Watch out! A risk diagnosis such as Risk for non-suicidal self-injurious behavior would be used only when the student shows vulnerability factors but has not yet engaged in the behavior. Here, the cutting is already active and recurrent, so the actual diagnosis takes priority.

Key point! The critical distinction between non-suicidal and suicidal self-injury is intent. This student denies any wish to die and describes the behavior as a coping mechanism for emotional pressure, which places her presentation firmly in the non-suicidal category.

| Diagnostic label | When it applies | Fits this case? |
| --- | --- | --- |
| Non-suicidal self-injurious behavior | Deliberate self-injury without suicidal intent is already occurring | Yes — cutting is active, weekly for 2 months |
| Risk for non-suicidal self-injurious behavior | Vulnerability factors exist but no self-injury has occurred yet | No — behavior is already present |
| Risk for suicidal self-injurious behavior | Risk factors for self-injury with intent to die are present | No — student denies suicidal ideation |
| Excessive anxiety | Primary problem is intense, persistent anxiety | No — anxiety-like tension is secondary to the self-injury pattern |

Pathophysiology and clinical reasoning

Non-suicidal self-injury is common among adolescents, with lifetime prevalence estimates ranging from 17% to 60% in community and clinical samples [1]. The behavior is driven by multiple interacting factors, including emotional dysregulation, interpersonal stressors, and adverse experiences [1]. In this student's case, the trigger is described as internal pressure that builds until cutting provides relief, which reflects the affect-regulation function central to NSSI.

The intent behind the behavior is the defining clinical feature. Wilkinson notes that in many adolescent cases there is no suicidal intent; rather, the purpose is to reduce distressing affect, inflict self-punishment, or signal distress to others [3]. This student's statement that she does not want to die and that cutting calms her down matches the affect-reduction pattern. The absence of suicidal ideation does not make the behavior benign, however. NSSI is associated with subsequent suicide attempts, suggesting that non-suicidal and suicidal self-injury may lie on a shared risk trajectory [3]. This means the school nurse should document the NSSI diagnosis accurately while also assessing for any emerging suicidal thoughts over time.

Why the other options are incorrect

Risk for non-suicidal self-injurious behavior is a risk diagnosis. In NANDA-I, risk labels describe vulnerability to developing a problem, not an existing one. Since the student has already cut herself weekly for two months, the problem is actual, not potential. Selecting a risk label would understate the clinical urgency and fail to capture the ongoing nature of the behavior.

Risk for suicidal self-injurious behavior requires evidence of suicidal intent or risk factors specifically pointing toward self-injury with a wish to die. The student explicitly denies thoughts of ending her life and describes the cutting as a calming strategy. Although NSSI and suicidal behavior can co-occur over time, the current data do not support a suicidal risk diagnosis.

Excessive anxiety may be present as an underlying emotional state, but it is not the priority problem. The observable, recurrent, and potentially harmful behavior is the self-injury itself. NANDA-I prioritizes the most accurate label for the defining data, and the cutting behavior with its described function is best captured by the NSSI diagnosis.

Nursing assessment considerations

When evaluating a student with suspected NSSI, the nurse should assess the frequency, method, location, and depth of injuries; the emotional states preceding and following the behavior; the presence of any suicidal ideation or plan; and available coping alternatives. The student's report of weekly cutting for two months with shallow, parallel wounds on the forearm is consistent with common NSSI presentations. The nurse should also explore interpersonal stressors and emotional regulation capacity, as these are known contributing factors in adolescent NSSI [1].

The priority nursing diagnosis is Non-suicidal self-injurious behavior because the defining characteristics — deliberate self-injury without suicidal intent, performed to relieve emotional tension — are fully present in the scenario.References (research sources)

- [1]Non-suicidal Self-Injury in Adolescence.Research articleBrown RC, Plener PL (2017) · DOI: 10.1007/s11920-017-0767-9

- [3]Non-suicidal self-injury.Research articleWilkinson P (2013) · DOI: 10.1007/s00787-012-0365-7

## 임상 시나리오

Non-Suicidal Self-Injury: Diagnosis SelectionActual vs. Risk Label in NANDA-I
When self-injury is already occurring, select the problem-focused diagnosis Non-suicidal self-injurious behavior. A risk label is reserved for patients who have vulnerability factors but have not yet engaged in the behavior.

The defining feature is intent. Cutting to relieve emotional pressure without a wish to die confirms the non-suicidal category, even when frequency is as high as weekly.

CautionDo not assume suicidal intent from self-injury alone. Ask directly about thoughts of ending life, and reassess intent at every encounter because non-suicidal self-injury can co-occur with or precede suicidal behavior.

## 핵심 개념

- **Non-suicidal self-injurious behavior** — Deliberate self-inflicted damage to body tissue without suicidal intent, often performed to relieve emotional tension or distressing affect.
- **Risk diagnosis** — A NANDA-I diagnosis used when vulnerability factors exist but the problem has not yet occurred.
- **Problem-focused diagnosis** — A NANDA-I diagnosis indicating an actual, currently present health problem.
- **Suicidal self-injurious behavior** — Self-inflicted injury with intent to end one's life, distinguished from non-suicidal self-injury by intent.
- **NANDA-I** — NANDA International, the organization that develops and maintains standardized nursing diagnoses.

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