Bilateral Repetitive Transcranial Magnetic Stimulation for Emotion Regulation in Adolescents with Non-Suicidal Self-Injury: A Randomized Controlled Exploratory Clinical Trial

INTERVENTION: Active rTMS + Medication Group :Received rTMS combined with routine pharmacotherapy. rTMS was delivered using a sequential bilateral DLPFC protocol: high frequency stimulation over the left DLPFC (10 Hz, 600 pulses) followed by low?frequency stimulation over the right DLPFC (1 Hz, 1200 pulses), with a total of 1800 pulses per session.;Sham rTMS + Medication Group:Received sham rTMS combined with routine pharmacotherapy. The procedure, coil placement, treatment duration and frequency were identical to the active rTMS group, but a placebo coil was used without effective magnetic field output.;Medication Only Group:Received no rTMS intervention, only standardized pharmacotherapy and routine clinical follow?up.; CONDITION: Adolescent emotional disorders with non‐suicidal self‐injury PRIMARY OUTCOME: Difficulties in Emotion Regulation Scale‐16‐item version, DERS‐16;Columbia‐Suicide Severity Rating Scale (C‐SSRS) ‐ Self‐Injury Items; SECONDARY OUTCOME: Barratt Impulsiveness Scale‐11‐item version, BIS‐11;Hamilton Anxiety Rating Scale‐17‐item version, HAMA‐17;Hamilton Depression Rating Scale‐24‐item version, HAMD‐24;Event‐related potential data; INCLUSION CRITERIA: 1. Aged 12–18 years, with no gender restriction; 2. Meet the diagnostic criteria for Non‐Suicidal Self‐Injury (NSSI) in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM‐5), with at least one definite NSSI episode in the past 3 months without suicidal intent; 3. Total score of the Difficulties in Emotion Regulation Scale (DERS) is higher than the cutoff value of the Chinese adolescent norm, indicating significant emotion regulation difficulties; 4. Medication status: ‐ For participants already taking psychotropic medications before enrollment, a stable dosage for >=4 weeks is required, with no changes in medication type or dosage during the study to avoid confounding effects on outcomes; ‐ For medication‐naïve participants, routine pharmacotherapy will be initiated by clinicians according to the Chinese Guidelines for the Prevention and Treatment of Depressive Disorders (2025 Edition), with Selective Serotonin Reuptake Inhibi