The topic of self-injury is gaining increasing attention these days, from news media, from educational and mental health systems, from concerned parents and even from fictional media such as television and film. This new-found visibility of a subject that has been kept under wraps for untold years has caused the usual furor, flutter and fluster over the proper definitions for the condition and associated terminology. While once common, the phrase self-mutilation is gradually falling out of favor, still used by the less-informed but discarded by self-identifiers and mental health experts alike. A google fight reveals a close competition between self-harm and self-injury for the most-used term, with the former winning. The ensuing Wikipedia article is named accordingly; self-injury redirects to self-harm 1.
Does the term self-mutilation not accurately define the phenomenon of teenagers and youths cutting themselves with razors? Well, now that you mention it, no, it doesn't. Webster's dictionary defines mutilation as, "cutting up or altering radically so as to make imperfect," and in the physiological context, "cutting off or permanently destroying a limb or essential part of." It is linked with other words such as cripple and maim.
Self-injury represents a complex range of behaviors, only the minority of which can be defined as mutilation. Self-mutilation is typical for people suffering from acute psychosis. Most youths who practice self-injury are not psychotic. Calling all self-injurious behavior patterns by such a blanket term relegates them to the most extreme end of the spectrum, creating an unnecessary and misleading impression of the extent of physical harm that can be expected in cases of self-injury.
As I said above, the term self-harm is now commonly in use to describe the type of mild to moderate self-injurious behavior that is common among youths, especially teenaged females. The problem with self-harm is that it's a very ambivalent term that can be used to describe a huge range of behaviors that, if not benign, still do not share the psychological pattern of self-injury, a pattern defined first and foremost by its volition.
It is easy to describe eating disorders, substance abuse, irregular sleeping patterns, reckless driving etc. as types of self-harm. More confusingly still, these are behavioral patterns common to the same demographic that self-injury most flourishes in, that can even be said to be definitive of it. In the broadest sense, eating disorders and substance abuse can be included under the self-harm term. This, again, creates blanket terminology that is confusing and counter-productive to an accurate definition of self-injurious behavior. While self-mutilation was too narrow, self-harm is too broad.
As was said, there is a wide range of behaviors that can be described as self-harm, without sharing the attributes of deliberate self-injury. These can broadly be characterized as addictive, self-destructive behavior patterns, and they seem to exist on a scale. Just as mental health professionals distinguish disordered eating from eating disorder, these behaviors can be distinguished by the level of physical damage they can cause, as well as by the extremity of emotional condition they stem from and the volition that drives them.
If self-harm is a scale, it can be said to start with such "sympoms" as skipping meals, not exercising, sleep deficiency and ignoring known health risks in such a manner as almost all people do, now and then. Can we be said to be engaging in self-harm when we choose a less nutritious meal because it's quicker to make, cheaper or tastier? When we smoke, as many people do even as they state the well-publicised health risks? When we ride in a car without buckling the seatbelt? When we cross a busy street not at the pedestrian crossing? These can all be termed risk-taking behaviors, if the term is stretched wide enough. Certainly there are gray areas, but most people would agree that jaywalking is very different than picking up a knife and cutting yourself.
Self-injury is farther on the scale of self-harm than long-term self-negligence because it's defined by the deliberate need to cause injury in order to relieve, however temporarily, an unbearable emotional pain or stress. It is not so far as anorexia and bulimia if defined by the degree of long-term physical damage that usually results; cases of self-injury that cause serious long-term damage are rare by comparison, whereas any sustained period of anorexia and bulimia is likely to cause degradation to several systems in the body, such as the digestive tracts, the immune system and even the skeleton. In terms of emotional dependence, though, eating disorders and self-injury are very close on the scale, one reason why they're prevalent in similar demographic groups.
Farthest on the scale are the psychotic symptoms sometimes termed self-mutilation and injuries leading or connected to suicide. Suicidal behavior is different from other types of self-harm in that its intent is to cause death, not to relieve pain. Although these two terms are often connected to each other, not least because of the prevalence of cutting as an instrument of both, they are distinct behaviors. Someone might self-injure for years and never intend to commit or even attempt suicide, and conversely, someone may attempt suicide without ever having shown signs of obvious self-abuse.
There is one more term related to self-injuring behavior without which a discussion of the subject could never be complete. Strictly speaking, cutting is one of the most common methods of self-injury2. More importantly, it's a self-identification term that can commonly be seen on message boards, in chat rooms and in other social networking spheres where people who self-injure interact with each other openly and on a regular basis. The protective anonymity of the internet combined with the knowledge that one is not alone in the behavior foster freer and more honest discussion of first-hand experiences.
Cutting is the behavior, the lifestyle, the mechanism or the drug, however it may be referred to. Those who use it are cutters. Personal accounts, prose, poetry or art that depicts self-injury in a way that can evoke the need to cut is labeled triggering in warning to readers who want to avoid explicit imagery.
The advantage of the term is that it's self-coined and self-labeled, in keeping with the growing demand for self-identification in identity politics, an ever-expanding field that spans ethnicity, religion, gender, sexual orientation and, increasingly, conditions diagnosed as psychiatric disorders. The disadvantage of the term is obvious: it is exclusive, rather than inclusive. Cutting is a common form of self-injury, but not the only form. Scratching, hitting, pinching, biting or any other kind of deliberate, self-inflicted violence are not included, regardless of the degree of physical damage, emotional dependence or any other factor that might determine the severity of self-injuring behavior patterns.
To many, the emotional relief that motivates self-injury is dependent on the specific characteristics of cutting, including the bleeding that usually ensues. Yet, this colloquial term implies a hierarchy wherein to cut to bleeding is "real" self-injury and any other form, especially the less damaging ones, is only "building up" to the real thing. Perhaps the separation is only meant to single out those with similar experiences with which one can identify, but to be aware of the implications of the words one uses is to use them accurately, and therefore powerfully.
Cutting is one form of self-injury. Self-harm is a blanket term that includes self-injury among other self-destructive behavior patterns. Self-mutilation is a symptom of extreme psychosis. Attempted suicide is an extreme form of self-harm, which may sometimes be preceded by self-injury.