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Self-Injury and Associated Mental Health Conditions

Self-injury is a type of abnormal behavior and usually accompanies a variety of mental health disorders, such as depression or borderline personality disorder.

General Information About Self-Injury

In the DSM-IV, the only diagnoses that mention self-injury as a symptom or criterion for diagnosis are borderline personality disorder, stereotypic movement disorder (associated with autism and mental retardation), and factitious (faked) disorders in which an attempt to fake physical illness is present (APA, 1995; Fauman, 1994). It also seems to be generally accepted that extreme forms of self-mutilation (amputations, castrations, etc) are possible in psychotic or delusional patients. Reading the DSM, one can easily get the impression that people who self-injure are doing it willfully, in order to fake illness or be dramatic. Another indication of how the therapeutic community views those who harm themselves is seen in the opening sentence of Malon and Berardi's 1987 paper "Hypnosis and Self-Cutters":

Since self-cutters were first reported on in 1960, they have continued to be a prevalent mental health problem. (emphasis added)

To these researchers, self-cutting is not the problem, the self-cutters are.

However, self-injurious behavior is seen in patients with many more diagnoses than the DSM suggests. In interviews, people who engage in repetitive self-injury have reported being diagnosed with depression, bipolar disorder, anorexia nervosa, bulimia nervosa, obsessive-compulsive disorder, post-traumatic stress disorder, many of the dissociative disorders (including depersonalization disorder, dissociative disorder not otherwise specified, and MPD/DID), anxiety and panic disorders, and impulse-control disorder not otherwise specified. In addition, the call for a separate diagnosis for self-injurers is being taken up by many practitioners.

It is beyond the scope of this page to provide definitive information about all of these conditions. I will try, instead, to give a basic description of the disorder, explain when I can how self-injury might fit into the pattern of the disease, and give references to pages where much more information is available. In the case of borderline personality disorder (BPD), I devote considerable space to discussion simply because the label BPD is sometimes automatically applied in cases where self-injury is present, and the negative effects of a BPD misdiagnosis can be extreme.

Conditions in which self-injurious behavior is seen

  • Borderline Personality Disorder
  • Mood Disorders
  • Eating Disorders
  • Obsessive-Compulsive Disorder
  • Post-Traumatic Stress Disorder
  • Dissociative Disorders
  • Anxiety and/or Panic
  • Impulse-control Disorder Not Otherwise Specified
  • Self-injury as itself a diagnosis

As mentioned, self-injury is often seen in those with autism or mental retardation; you can find a good discussion of self-harm behaviors in this group of disorders at the website of The Center for the Study of Autism.


Last Updated: 01 April 2016
Reviewed by Harry Croft, MD

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