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Self-injury, the deliberate infliction of damage on one's own body, has been a feature of many cultures for centuries in such forms as self-flagellation as an atonement for sin, trepanation, footbinding, circumcision (both male and female) and numerous other practices. Present-day socially-sanctioned western variations include earpiercing and tattooing. However, in recent years there has been growing professional recognition of some forms of self-injury as a psychiatric problem, and there has been a parallel increase in books and articles on the subject. From a hidden, apparently rare, phenomenon it has emerged as widespread, especially among women: the current best estimate of 1 in 600 of the population harming themselves sufficiently to need hospital treatment, is considered to be an underestimate (Tantam and Whittaker, 1992).

How are these distressing actions to be understood? The treatment (in the …