804 Conditions for Further Study
Diagnostic Features
The essential feature of nonsuicidal self-injur y is that the individual repeatedly inflicts
shallow, yet painful injuries to the surface of  his or her body. Most commonly, the purpose
is to reduce negative emotions, such as tensio n, anxiety, and self-reproach, and/or to re-
solve an interpersonal difficulty. In some cases, the injury is conceived of as a deserved
self-punishment. The individual will often report  an immediate sensation of relief that oc-
curs during the process. When the behavior o ccurs frequently, it mi ght be associated with
a sense of urgency and craving, the resultant behavioral pattern resembling an addiction.
The inflicted wounds can become deeper and more numerous. 
The injury is most often inflicted with a knif e, needle, razor, or other sharp object. Com-
mon areas for injury include the frontal area of the thighs and the dorsal side of the forearm.
A single session of injury might involve a se ries of superficial, parallel cuts—separated by
1 or 2 centimeters—on a visible or accessible location. The resulting cuts will often bleed and
will eventually leave a characteristic pattern of scars.
Other methods used include stabbing an area , most often the upper arm, with a needle
or sharp, pointed knife; inflicti ng a superficial burn with a lit cigarette end; or burning the
skin by repeated rubbing with an eraser. En gagement in nonsuicidal self-injury with mul-
tiple methods is associated with more severe  psychopathology, including engagement in
suicide attempts. 
The great majority of individuals who engage in nonsuicidal self-injury do not seek
clinical attention. It is not known if this re flects frequency of engagement in the disorder,