A 15-year-old girl is brought by her parents after they discovered superficial cuts on her forearms. She admits to cutting 2-3 times per week for the past 6 months, describing it as 'the only thing that helps when I feel overwhelmed.' She denies suicidal ideation or intent to die and reports the cutting provides temporary relief from emotional distress. She has a history of bullying at school and conflict with her parents. The PMHNP must evaluate this presentation.