In a study of bulimics who self-harm, Favaro and Santonastaso (1998), used a statistical technique known as factor analysis to try to distinguish between which kinds of acts were compulsive in nature and which were impulsive. They report that vomiting, severe nail biting, and hair pulling loaded on the compulsive factor, whereas suicide attempts, substance abuse, laxative abuse, and skin cutting and burning loaded on the impulsive factor.
Should self-injurious acts be considered botched or manipulative suicide attempts? Favazza (1998) states, quite definitively, that . . . self-mutilation is distinct from suicide. Major reviews have upheld this distinction. . . A basic understanding is that a person who truly attempts suicide seeks to end all feelings whereas a person who self-mutilates seeks to feel better. p. 262. Although these behaviors are sometimes referred to "parasuicide," most researchers recognize that the self-injurer generally does not intend to die as a result of his/her acts. "[S]uicide attempts are reported not to provide relief, to be repeated less frequently, and to have less communicative value" (van der Kolk et al., 1991). "Patients with the [proposed Deliberate Self-Harm Syndrome] often suffer social ostracism and, in desperation, may attempt suicide (Favazza et al, 1989) [emphasis added]. Thus, although self-injurious behavior is not suicidal in intent, it can easily lead to suicidal ideation or even, when a self-harmer goes too far, suicide itself. Herpertz (1995) notes that self-injurers distinguish between self-injurious acts and suicidal ones, and Solomon and Farrand (1996) say "Although the [self-injurious and suicidal] acts themselves may blur, their meaning does not. What does emerge, though, is a link between the two acts in that one (self-injury) is an alternative to the other (suicide), and is preferable." In a review of the literature on self-injury, Favazza (1998) notes that only recently has it become generally recognized that self-harm is a morbid form of coping, one which is often turned to when suicide seems inescapable. He writes that "traditionally it has been trivialized ([delicate] wrist cutting), misidentified (suicide attempt) and regarding solely as a symptom [of borderline personality disorder.
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