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Defining and Refining Self-Harm: A Historical Perspective on Nonsuicidal Self-Injury

Angelotta, Cara MD

Journal of Nervous & Mental Disease: February 2015 - Volume 203 - Issue 2 - p 75–80
doi: 10.1097/NMD.0000000000000243
Original Articles

Abstract: Nonsuicidal self-injury (NSSI) is a newly proposed diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Some contemporary historiography dismisses NSSI as a fiction of modern psychiatry. Although the exact definition and psychological meaning attributed to self-harm has not been static over history, there is a clear thread that connects Western asylum psychiatrists’ thinking about self-harm to the current stand-alone diagnostic category of NSSI. Nineteenth-century psychiatrists identified a clinically meaningful difference between self-harm with and without the intent to die, between self-injurers who were psychotic and those who were not, and between self-injurers who made a single, serious mutilation and those who repetitively self-injured without causing permanent bodily damage. These same distinctions are apparent in the definition of NSSI. Thus, NSSI is a formalization of long-held observations about a category of people who repetitively self-injure without suicidal intent.

DeWitt Wallace Institute for the History of Psychiatry and Department of Psychiatry, Cornell University New York Presbyterian Hospital, New York, NY.

Send reprint requests to Cara Angelotta, MD, DeWitt Wallace Institute for the History of Psychiatry and Department of Psychiatry, Cornell University New York Presbyterian Hospital, 525 East 68th St, Box 140, New York, NY 10065. E-mail: caa9044@nyp.org.

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