Understanding how adolescents with non-suicidal self-injury experience communication with caregivers

Non-suicidal self-injury (NSSI) is common among adolescents and closely linked to emotional dysregulation, interpersonal stress, and challenges in navigating family relationships. Family communication plays a central role in adolescents’ emotional development, but little is known about how adolescents with NSSI understand and experience communication with their caregivers. Existing research has largely emphasized risk factors, overlooking adolescents’ subjective experiences and unmet relational needs. Using family systems theory as the conceptual framework, this study aimed to explore how adolescents with NSSI understand caregiver communication and what relational and emotional needs they identify within these interactions. A descriptive qualitative design was used. Nineteen adolescents aged 12–18 years who engaged in NSSI were recruited from a psychiatric specialty hospital in Hangzhou, China. Semi-structured interviews were conducted, audio-recorded, and transcribed verbatim. Data were analyzed using qualitative content analysis following Graneheim and Lundman’s approach. Four themes described adolescents’ communication experiences with caregivers. Most adolescents described emotional distance and strained caregiver–adolescent relationships, while a minority reported warm and supportive connections. Communication with caregivers was frequently marked by criticism, sarcasm, and escalating conflict, though occasional moments of warmth also emerged. Adolescents described anxiety, withdrawal, physiological distress, and self-injury following tense exchanges, alongside episodes of self-harm driven by internal emotional states rather than family interaction. They also articulated clear expectations for change, including a calmer tone, greater emotional attunement, more shared time with caregivers, and increased autonomy. Together, these themes illustrate significant communication challenges and adolescents’ distinct relational needs within the family system. This study indicates that patterns of family communication are closely associated with adolescents’ emotional functioning and their experiences related to NSSI. Patterns of emotional distance, criticism, and low responsiveness were linked to greater emotional strain, although NSSI also appeared in the presence of individual vulnerabilities and broader social pressures. Strengthening caregiver communication skills and emotional responsiveness may offer meaningful directions for interventions aimed at reducing self-harm risk among adolescents.