Introduction

Non-suicidal self-injury (hereafter referred to as self-injury) is the intentional hurting of one’s body by oneself, done in a physical way without conscious suicidal intent but for the general purpose of relief. Acts of self-injury fall outside the realm of what is currently viewed as socially acceptable behaviour (Whitlock, Eckenrode & Silverman, 2006). The purpose of this article is to twofold. First, it is to provide readers with a brief overview of this clinically relevant behaviour. Second, it is to explore diagnostic issues as they relate to self-injury including a consideration of the potential usefulness of utilizing both symptoms of self-injury, as well as underlying processes involved for diagnostic conceptualizations.

Overview

Classification

A number of ways to classify self-injury have been proposed (see Walsh, 2006). Three general categories of self-injury include stereotypic, which is often associated with developmental disorders; major, which is associated with psychosis; and typical, which is the focus of the present article. Typical self-injury occurs for reasons not stemming from psychotic states or developmental disorders and appears to be linked to emotional distress. The most common form that typical self-injury appears to take is cutting. Other common forms include: hitting, bruising, scratching, scraping, burning, and picking. People who self-injure often report using more than one method. Body areas most commonly injured may include arms, hands, wrists, legs, and stomach. Although research is limited, the typical age of onset appears to be early adolescence (see Klonsky & Muehlenkamp, 2007).

Prevalence

Studies have found that anywhere from 2.5 to 46 percent of adolescents in community samples report having engaged in self-injury at least once with the majority of participants reporting having engaged in self-injury more often (Garrison et al., 1993; Lloyd-Richardson, Perrine, Dierker & Kelley, 2007; Patton et al., 1997; Ross & Heath, 2002). The wide range in prevalence rates reported may partly be due to what behaviours are included in a given study (Lloyd-Richardson et al., 2007).

Among college and university populations, Whitlock et al. (2006) found that 17 percent of students reported having self-injured at some point in time and 7.3 percent of students reported deliberately injuring themselves within the last year. In contrast, Gratz, Conrad, and Roemer (2002) found a substantially higher prevalence within a sample of undergraduate students where 38 percent reported a history of self-injury, 18 percent reported having harmed themselves more than 10 times in the past, and 10 percent reported having harmed themselves more than 100 times.

Among adults, approximately 2.2 to 4 percent of adults in general populations and 21 percent of adults in a clinical population have reported deliberately injuring themselves  (Akyuz, Sar, Kugu & Dogan, 2005; Briere & Gil, 1998; Klonsky, Oltmanns & Turkheimer, 2003).

Across large-scale studies, no gender differences or only very small gender difference are found (Klonsky & Muehlenkamp, 2007).

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