Deliberate self-injury (DSI) is also known as self-mutilation (SM), self-injury (SI) and self-harm (SH). Sometimes DSI is done in a dissociative, or trans-like state that is seemingly out of the person’s awareness. Therefore, some authors do not use the term “deliberate self-injury”, because it is not necessarily believed to be “deliberate” (National Collaborating Centre, 2004). Although there has been much more research done on DSI in recent years, there are still conflicting terms and definitions that lead to confusion.

SI does not typically include “culturally sanctioned” behaviors, for example:  tattoos, piercings, body modifications, or smoking. DSI may include things like skin cutting, burning, interfering with wound healing, scratching, banging and hitting body parts. It might involve the use of objects such as razor blades, knives, scissors, fire, and other common tools to create damage to an individual’s own body tissue. The most general and globally accepted definition is things done to cause immediate physical damage in a deliberate manner.

Please note that some researchers and/or policy writers might include behaviors like overdosing or taking a chemical substance with or without suicidal intent. This is often called “self-poisoning”. Please see the next paragraph for more clarification.

Relationship to Suicide

There is a debate in the field of whether or not deliberate self-injury means that the person is suicidal. Lately, DSI has been described as superficial harm without suicidal intent. It has been my experience that DSI used to be more commonly called self-mutilation (SM), which demonstrates a shift from conceptualizing it as a more serious behavior to surface injury. DSI is often severe and has a strong relationship with suicidal thoughts. If left untreated, there is increased risk of depression and suicidal tendencies. This relationship must be taken seriously, as recent research has found that the rate of suicide increases to between 50 and 100 times the rate of the general population following an act of DSI (Hawton et al., 2003b; Owens et al., 2002 as cited in National Collaborating Centre, 2004).

Reasons for DSI

The motivation behind DSI varies.  DSI is a symptom of many diagnosed disorders; however, research has shown that DSI often continues after the other symptoms of the diagnosis have subsided (Favazza, 1996).  The reason someone might have for self-injurious behavior can be different each time, even if they regularly self-injure. DSI also has strong additive properties. However, there is often an underlying, primary function of the self-injurious behavior. Overall, it is a maladaptive coping mechanism for managing strong feelings. Common descriptions include, but are not limited to:

  • A release of the pressure of stress or strong anger.
  • An outward expression of inner pain.
  • A tool to feel more connected with the body when feeling numb and disconnected.
  • The belief that one deserves bad things and punishment.


Unfortunately, the research I have on the prevalence of DSI is a little outdated. However, current articles reflect similar numbers to those below and admit to large estimates of under reported incidences. Through conducted studies and compiled research, Favazza and Rosenthal (1993) cited an estimated 400 to 1400 per 100,000 engage in DSI at some point in their lifetime. DiClemente, Ponton, and Hartley (1991) found rates of 40%-61% in an adolescent psychiatric inpatient sample; adolescent community samples have found rates of 14%-39% (Ross & Heath, 2002).

Treatment Interventions

The treatment interventions used for DSI can vary and might include, counseling, psychiatric inpatient services, hospital triage, psychotropic medications, behavioral modifications, and stress management approaches. Many individuals who suffer from DSI do not seek out professional help. If you or someone you know suffers from DSI, please consider getting some extra support. This is one of my specialty areas, and I am happy to meet with you and discuss any of your goals, concerns, challenges, etc. There are options for you! – Rachael Miller, LCPC, NCC


DiClemente, R. J., Ponton, L. E., & Hartley, D. (1991). Prevalence and correlates of cutting behavior: Risk for HIV transmission. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 735-739

Favazza, A. R., & Rosenthal, R. J. (1993). Diagnostic issues in self-mutilation. Hospital and Community Psychiatry, 44(2), 134-140

Hawton, K., Zahl, D. & Weatherall, R. (2003). Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital. British Journal of Psychiatry, 182, 537–542

National Collaborating Centre for Mental Health, Royal College of Psychiatrists’ Research Unit (2004). Self-harm: The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. The British Psychological Society & The Royal College of Psychiatrists.

Owens, D., Horrocks, J. & House, A. (2002). Fatal and non-fatal repetition of self-harm. Systematicreview. British Journal of Psychiatry, 181, 193–199

Ross, S., & Heath, N. (2002). A study of the frequency of self-mutilation in a community sample of adolescents. Journal of youth and Adolescence, 31, 67-77

This is just a summary that briefly describes self-injury, and it is not  intended to be used to diagnose or treat someone. All diagnosis and treatment should only be done by a qualified clinician. If you or someone you know is struggling with anxiety please visit our contact page, or set-up an appointment in our client portal.

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