Non-suicidal self-injury.

Self-injury is a relatively common phenomenon in adolescence. Often there is no suicidal intent; rather, the action is used for one or more reasons that relate to reducing distressing affect, inflicting self-punishment and/or signalling personal distress to important others. Non-suicidal self-injury (NSSI) is both deliberate and contains no desire to die and therefore aetiology is likely to be at least partly different to suicidal behaviour per se. Interestingly, NSSI is associated with subsequent suicide attempts suggesting that these behaviours and their related psychology may lie on the same risk trajectory. NSSI neither appears in DSM-IV or ICD 10 as a disorder nor does it constitute a component of any current anxious or depressive syndrome. This lack of nosological recognition coupled with clear psychopathological importance is to be recognised in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), with NSSI being classified as a syndrome in its own right. We agree that this is appropriate and is likely to have several positive consequences including: (1) improving communication between professionals and patients; (2) informing treatment and management decisions; (3) increasing research into the nature, course and outcome of NSSI. We agree with the proposed DSM-5 diagnostic criteria, although believe the impairment criterion would be better phrased if it stated that self-injury is associated with, rather than causal for, intense distress.