Is self-injury an impulse disorder?

If self-injury were to become a mental disorder in a future edition of the Diagnostic and Statistical Manual of Mental Disorders [DSM], where should it be included? Advocates for a repetitive self-injury syndrome have suggested it be listed in the class of disorders that are referred to in the DSM-IV-TR as “Impulse-Control Disorders Not Elsewhere Classified”. The essential feature of such disorders is  “the failure to resist an impulse, drive, or temptation to perform an act that is harmful to the person or to others”  (American Psychiatric Association, 2000, p. 675). Further, “for most of the disorders…, the individual feels an increasing sense of tension or arousal before committing the act and then experiences pleasure, gratification, or relief at the time of committing the act. Following the act, there may or may not be regret, self-reproach, or guilt” (p. 663).One rationale for self-injury to be included as an impulse-control disorder are the seeming parallels observed between this description and dynamics involved in self-injury. For example, Klonsky (2007) found in his research review a pattern whereby:

(a) acute negative affect precedes self-injury; (b) decreased negative affect and relief are present after self-injury; (c) most self-injurers identify the desire to alleviate negative affect as a reason for self- injuring; and (d) the performance of proxies for self-injury in the laboratory leads to reductions in negative affect and arousal. (p. 235)