Defining and refining self-harm: a historical perspective on nonsuicidal self-injury

Area of Science:

• Psychiatry
• Psychology
• Medical History

Background:

• Nonsuicidal self-injury (NSSI) is a recent diagnostic category.
• Some scholars view NSSI as a modern psychiatric construct.
• Historical perspectives on self-harm are often overlooked.

Observation:

• Historical psychiatric records from the 19th century reveal distinctions in self-harm behaviors.
• Psychiatrists differentiated between self-harm with and without suicidal intent.
• Classifications also considered psychosis and the nature of self-injurious acts (single vs. repetitive, permanent vs. non-permanent damage).

Findings:

• The definition of NSSI mirrors historical distinctions made by 19th-century psychiatrists.
• Key differences noted historically—intent to die, psychosis, and injury pattern—are reflected in the NSSI diagnosis.
• NSSI formalizes long-standing clinical observations of repetitive self-harm without suicidal intent.

Implications:

• NSSI is not a novel psychiatric construct but a formalization of enduring clinical observations.
• Historical analysis supports the validity and clinical relevance of the NSSI diagnostic category.
• This understanding aids in refining diagnostic criteria and treatment approaches for self-harm behaviors.