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Defining deliberate self-harm

The language used to describe how and why people harm themselves can reflect the judgements that are often made about this client group: ‘self-abuse’ and ‘self-mutilation’ assume emotive aspects such as guilt or self-loathing, whereas purely descriptive terms such as ‘cutting’ or ‘blood letting’ convey neither the choice that the client has made nor the fact that the act is harmful. Weber cites several terms that have been used to describe such behaviour: self-injury, self-abuse, indirect self-destructive behaviour, parasuicide, self-inflicted injury, self-injurious behaviour, self-mutilation, as well as deliberate self-harm.

The terms used often reflect the theoretical standpoint of the clinician using them rather than the client who harms himself or herself. Self-abuse, self-destructive behaviour or self-mutilation suggest a psychodynamic understanding of the motivation for the behaviour, whereas self-injury or deliberate self-harm convey some sense that the person has chosen to act in this way and that it is a behaviour rather than an illness per se. This distinction is further emphasized if definitions of deliberate selfharm are considered. House et al. define deliberate self-harm as ‘intentional self poisoning or self injury (such as cutting), irrespective of the apparent purpose of the act’ Weber, however, goes on to exclude suicidal intent as a possible purpose or meaning of the act: ‘I used the term selfdestruction as the broad encompassing category of behaviours that are self-inflicted, of which self-abuse, or the deliberate harm to one’s own body without suicidal intent, is one type’ Gallop and Tully expand further on the meaning of the behaviour in their definition, ‘Self-injury is often an attempt to communicate distress, relieve pain and maintain connection to oneself and others. Suicide attempts, on the other hand are directed at discontinuing all connections and ending consciousness’.

Deliberate self-harm can include a wide range of behaviours that damage an individual’s body, either externally or internally, with a meaning or purpose that can vary for any one client on each occasion that they self-harm, and from person to person. The act might be impulsive or planned, with immediate or long-term effect. The term only describes the behaviour and is not an illness. This does not mean that the person who self-harms will not benefit from treatment, rather that there are likely to be coexisting mental health needs which will also need to be addressed in order to help that person change their self-harming behaviour.

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