Non-suicidal Self Injury: An Entity in Need of Validation?

The motivation to avoid pain and injury is a fundamental instinct, crucial to the survival of human beings and other living species. However, for the last 1 to 2 decades, there is an increasing number of individuals presenting to clinicians with self-injurious behavior but “without an intent to die.” This phenomenon of harming oneself without the intent to die is referred to as Non-suicidal Self Injury (NSSI). NSSI is defined as “the direct and deliberate destruction of one’s own bodily tissue in the absence of lethal intent and for reasons not socially sanctioned.”1 Accidental and indirect self-injurious behaviors such as disordered eating, drug abuse, suicidal behaviors, and socially accepted behaviors (tattooing, piercing, or religious rituals) do not form part of NSSI. The recognition of this behavior led researchers to include NSSI in section III of DSM 5 as a “condition in need of further study.” ICD-10 included NSSI either as a symptom of borderline personality disorder or as “intentional selfinjury with a sharp object (X78),” whereas, ICD-11 does not include it as a diagnostic entity. While some researchers criticize the defined dichotomy between NSSI and suicidal behaviors, others are of the view that NSSI and suicide should be understood as lying on a continuum of self-harming behaviors.