{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T06:15:55Z","timestamp":1778134555420,"version":"3.51.4"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:p>This perspective article argues that the theoretical landscape of nonsuicidal self-injury (NSSI) has long been stabilized by the \u201chydraulic\u201d model of Automatic Negative Reinforcement, which conceptualizes self-harm primarily as a mechanism to down-regulate aversive hyper-arousal. While this framework successfully elucidates the etiology of self-injury driven by high-intensity negative affect, it fails to account for a substantial, treatment-resistant phenotype: adolescents driven by profound anhedonia and ventral striatal hypofunction. This perspective article argues for the formal recognition of an \u201cAnhedonic Subtype\u201d of NSSI. Synthesizing recent epidemiological data identifying \u201cemptiness\u201d as a central symptom network bridge, alongside neurobiological evidence of reward blunting, we posit that for this subtype, NSSI functions not as a sedative, but as a mechanism of \u201cforced activation.\u201d We propose a preliminary differential diagnostic framework distinguishing defensive dissociation from anhedonic deficit and outline the theoretical rationale for exploring a shift in clinical intervention from distress tolerance toward positive affect up-regulation. The clinical utility of this framework remains to be evaluated in future empirical research.<\/jats:p>","DOI":"10.3389\/fpsyt.2026.1837385","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T05:41:34Z","timestamp":1778132494000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond distress relief: the Anhedonic Subtype of nonsuicidal self-injury and the imperative for Positive Affect Treatment"],"prefix":"10.3389","volume":"17","author":[{"given":"Cheng-Han","family":"Li","sequence":"first","affiliation":[{"name":"Third Affiliated Hospital of Wenzhou Medical University","place":["Wenzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Qian","sequence":"additional","affiliation":[{"name":"Third Affiliated Hospital of Wenzhou Medical University","place":["Wenzhou, 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