Self-Injury Definition: The deliberate, direct destruction or alteration of
body tissue without conscious suicidal intent, but resulting in
injury severe enough for tissue damage (e.g., scarring) to occur.

References of self-injury have been noted through the Medieval ages when medical remedies consisted of bloodletting, blistering and purging, and during the 11th century there were reports of nuns and saints starving/purging, flagellating and scaring themselves. Although these are societal instances of self-injury rather than the individual kind performed alone and secretively, logic tells us that self-injury has been a part of the human condition since the beginning of time. In 1846 the first case of self-injury was published. In this case a guilt-ridden widow enucleated both of her eyes. The phenomenon of self-injury has perplexed the medical environment.

In 1938 Physician Karl Menninger wrote, “Local self-destruction is a form of partial suicide to avert total suicide.” This theory was expanded on by Norman Farberow into the classification of ‘indirect self-destructive behavior’ (direct self-destructive behavior being complete suicide or suicide attempts). Following this classification, “death results gradually rather than immediately, and in which the degree of intentionality is less obvious than in an overt suicide attempt.” Before the 1990′s self-injury was viewed as a failed suicide. In 1998 Armando Favazza, M.D. wrote, “…self-mutilation is distinct from suicide. Major reviews have upheld this distinction. . . A basic understanding is that a person who truly attempts suicide seeks to end all feelings whereas a person who self-mutilates seeks to feel better.”

Today the most widely accepted classification of self injury comes from Favazza and they are: major, stereotypic and moderate/superficial. Moderate/superficial is further broken-down into three sub-categories of compulsive, episodic, and repetitive. Major self-mutilation (including such things as castration, amputation of limbs, enucleation of eyes, etc) is rare and usually associated with psychotic states. Stereotypic self-injury comprises the sort of rhythmic head-banging, etc, seen in autistic, mentally retarded, and psychotic people. Moderate/superficial is the most common form of self-injury. This category includes cutting, burning, scratching, skin-picking, hair-pulling, bone-breaking, hitting, deliberate overuse injuries, interference with wound healing, and virtually any other method of inflicting damage on oneself.

The first sub-category of moderate/superficial self-injury is Compulsive. This is associated with Obsessive Compulsive Disorder and includes hair-pulling, skin picking, and excoriation when it is done to remove perceived faults or blemishes in the skin. The other two sub-categories of moderate/superficial self-injury, Episodic and Repetitive, are both impulsive in nature and differ only in the degree. Episodic behavior is engaged in every so often by people who don’t think about the act otherwise and don’t view themselves as ‘self-injurers’. In repetitive self-injury the person thinks about self-harm even when not doing it and identifies themselves as a self-injurer. Episodic self-harm can easily become repetitive self-harm.

Even with Favazza’s classifications researchers still use such terms as parasuicide, focal suicide, self-attack, self-mutilation, autoaggression, symbolic wounding and non-fatal deliberate self-harm. However most do recognize that self-injurers do not intend to die as a result of their acts.

And that’s the point. I only want to feel better…