Non-suicidal self-injury.

More than 20 % of adolescents may self-injure. Often there is no suicidal intent; rather the intent is to reduce distressing affect, inflict self-punishment and/or signal 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 does not, however, appear in DSM-IV or ICD-10 as a disorder; and does not 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, 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 improving communication between professionals and patients, informing treatment and management decisions and increasing research into the nature, course and outcome of NSSI. We agree that while suicidal and non-suicidal self-harm are often seen together, they are not the same behaviour and that it is both valid and useful to separate them.