Non-suicidal self-injury: proposal to shift designation from disorder to a clinical specifier

After strong scientific advocacy from experts in the field, non-suicidal self-injury disorder was listed within the DSM-5 as a condition requiring further study. Over the past decade, numerous studies of the proposed non-suicidal self-injury disorder criteria have called into question their validity and reliability, raising questions regarding the clinical utility of non-suicidal self-injury disorder, and suggesting that the disorder criteria would require extensive diagnostic revision to be viable. The high co-occurrence of non-suicidal self-injury with a variety of other established psychiatric disorders, combined with evidence that few individuals meet criteria for non-suicidal self-injury disorder in the absence of comorbid conditions, suggests that non-suicidal self-injury could be better conceptualised as a transdiagnostic behaviour. As a result of the growing scientific evidence calling into question non-suicidal self-injury disorder as a diagnosis, we are proposing reclassifying non-suicidal self-injury as a clinical specifier. In this Personal View, we outline the rationale for a shift from a disorder to a non-suicidal self-injury specifier, introduce proposed specifier criteria grounded in the scientific literature and lived experience research, and explore potential risks and benefits of a shift to a specifier.