Self-injury is a common yet poorly understand behaviour. Educating ourselves about self-injury starts with being specific about what we mean when we talk about it. There are several key elements to our definition:
The harm is intentional or expected
Risky behaviors that could result in harm, such as not wearing a seatbelt while driving, or behaviors that can result in accidental harm, such as playing extreme sports, are typically excluded under our definition.
The injury results in immediate physical injury
Behaviors that do not directly result in physical injury are typically excluded under our definition, even though they may be harmful or dangerous. For instance, food restriction is typically not considered a form of NSSI since the associated physical damage tends to build up over time, instead of happening as soon as the behavior occurs.
Is not intended to cause death
While suicidal thoughts may be present when someone self-injures, the self-injury itself is not intended to cause death. Some people may use self-injury to manage suicidal urges or intense distress related to suicidal thoughts. Self-injury enacted with suicidal intent is not classified as NSSI.
Is not part of social or cultural practices
Behaviors that might cause physical damage but are acceptable in our society, or part of a recognized cultural, spiritual or religious ritual, are not considered self-injury. Behaviors such as body modification, body piercing, tattooing, and religious self-flagellation are not usually considered forms of self-injury.
A note on terminology
The term "NSSI" is often used interchangeably with self-injury - we do so throughout this site; however, it is important to bear in mind that someone may use the term 'self-injury' and be referring to suicidal behaviour. Likewise, while we do not use the term self-harm on this site, many people, including researchers, clinicians, and individuals with lived experience, use this term to refer to NSSI.
Regardless of the source, it is important to always ascertain whether the term is being used to refer to suicidal or non-suicidal behaviours. There are some other terms used throughout the field that may or may not refer to NSSI.
Often, when people think of 'self-harm', what comes to mind is NSSI. However, self-harm is an umbrella term that captures all self-directed injury regardless of intent. In some conceptualisations, self-harm includes indirect injury, such as that caused by reckless behaviours, or psychological injury, such as that caused by self-criticism. While NSSI falls under the self-harm umbrella, ISSS distinguishes NSSI from other behaviors due to the aetiological, functional, and predictive factors that are unique to NSSI.
Deliberate self-harm is a term usually used to refer to non-suicidal self-injury; however, it may also encompass any self-inflicted injury, regardless of intent. Determining what is meant when this term is used is important.
NSSI is sometimes referred to by focusing on particular methods (e.g., self-cutting). While cutting is among the most widely recognized forms of self-injury, the behavior can take many other forms, including burning, hitting, or scratching. Furthermore, many people who self-injure report using more than method during their lives. Therefore, we recommend avoiding this term when referring to self-injury more broadly, as it dismisses the experiences of many people.
These terms are no longer used in contemporary research and practice, but are occasionally still seen in news media. The term 'parasuicide' links injury to suicide, creating an assumption that self-injury is a suicide attempt. As we know, this is not always that case. The term 'self-mutilation' is stigmatising and harmful, characterising an individual's injury as negative due to its appearance and conjuring judgement and fear (Hasking & Boyes, 2018; Hasking et al., 2019).
Hasking, P., & Boyes, M. (2018). Cutting words: A commentary on language and stigma in the context of nonsuicidal self-injury. Journal of Nervous and Mental Disease, 206, 829-833. https://doi.org/10.1097/nmd.0000000000000899
Hasking, P., Lewis, S. P., & Boyes, M. E. (2019). When language is maladaptive: Recommendations for discussing self-injury. Journal of Public Mental Health, 18, 148-152. https://doi.org/10.1108/JPMH-01-2019-0014