2. To resolve an interpersonal difficulty.
3. To induce a positive feeling state.
Note:  The desired relief or response is experienced during or shortly after the self-
injury, and the individual may display patterns of behavior suggesting a dependence
on repeatedly engaging in it.
C. The intentional self-injury is associated with at least one of the following:
1. Interpersonal difficulties or negative feelings or thoughts, such as depression, anx-
iety, tension, anger, generalized distress, or self-criticism, occurring in the period
immediately prior to the self-injurious act.
2. Prior to engaging in the act, a period of preoccupation with the intended behavior
that is difficult to control.
3. Thinking about self-injury that occurs frequently, even when it is not acted upon.
D. The behavior is not socially sanctioned (e.g., body piercing, tattooing, part of a religious
or cultural ritual) and is not restricted to picking a scab or nail biting.
E. The behavior or its consequences cause clinically significant distress or interference in
interpersonal, academic, or other important areas of functioning.
F. The behavior does not occur exclusively during psychotic episodes, delirium, sub-
stance intoxication, or substance withdrawal. In individuals with a neurodevelopmental
disorder, the behavior is not part of a pattern of repetitive stereotypies. The behavior
is not better explained by another mental disorder or medical condition (e.g., psychotic
disorder, autism spectrum disorder, intellectual disability, Lesch-Nyhan syndrome, ste-
reotypic movement disorder with self-injur y, trichotillomania [hair-pulling disorder], ex-
coriation [skin-picking] disorder).