Direct and Indirect Self-Injury

Abstract This chapter provides an overview of different forms of self-injurious behavior (SIB). A general distinction is made between direct and indirect SIB. Direct SIB is a deliberate intentional harmful behavior such as cutting or burning oneself while indirect SIB, such as overeating or substance abuse, is in itself not immediately harmful but increases the risk of harm occurring subsequently. Indirect SIB consists of various behaviors, and it does not make sense to describe indirect SIB as a uniform phenomenon. The authors propose a categorization of indirect non-suicidal SIB and review examples of behaviors that belong in each of the three categories proposed: (1) indirect self-injury (active or passive), (2) self-injury by proxy, and (3) risk-taking behavior. Persons who use direct and/or indirect SIB do so because they achieve a positive effect (benefit) here and now (e.g., in the form of emotion regulation) although it can have negative consequences in the short and/or long term. A positive correlation between direct and indirect SIB is found, but this varies for different types of indirect SIB. Barriers to different forms of SIB also vary and are more often lower in indirect SIBs that border on normal cultural behaviors (e.g., tobacco or alcohol use), than in more serious forms such as eating disorders. Further research is needed on the relationship between the different forms of direct and indirect SIBs to gain a better understanding of development trajectories and mediators to be able to make preventative and therapeutic efforts.