Motivations and triggers for non-suicidal self-injury among adolescents with alcohol use disorder in China: a qualitative descriptive study

Introduction: Alcohol use disorder (AUD) and non-suicidal self-injury (NSSI) frequently co-occur in adolescents. However, the underlying phenomenological mechanisms and the dynamic spatial-temporal evolution of this complex comorbidity remain significantly under-explored in current literature. Aim: This study aims to explore the perceived experiential processes of comorbid AUD and NSSI in adolescents and to dynamically map their disease journey across different physical and medical spaces. Methods: A qualitative descriptive study design was utilized. In-depth semi-structured interviews were conducted with eighteen adolescents formally diagnosed with AUD and comorbid NSSI. The interview transcripts were analyzed using rigorous inductive thematic analysis. A patient-reported disease journey map was subsequently constructed to visualize the phenomenological trajectory without researcher inference. Results: Three highly nested core themes emerged from the data encompassing the illusory pursuit of emotional numbing, the cognitive tunnel effect driven by alcohol disinhibition, and the pathological closed loop reinforced by secondary shame. The constructed disease journey map delineated three critical transitional phases including the covert pre-hospital incubation, the in-hospital emergency exposure with closed withdrawal, and the post-hospital isolated recovery. Participants experienced intense environmental deprivation during medical spatial transitions and highlighted a severe deprivation of continuous professional support during late-night emotional micro-crises upon returning home. Conclusion: The comorbidity of AUD and NSSI functions as a maladaptive survival strategy fueled by emotional avoidance and cognitive tunneling. Clinical psychiatric nursing urgently requires a paradigm shift towards trauma-informed care and is recommended to develop digital continuous networks to provide immediate psychological safety nets at high-risk relapse nodes.