As an introduction to my comments on the Whitlock et al study1 (in this issue of Pediatrics ), I would like to present some of my understandings about self-injurious behavior (SIB, the politically correct term for self-mutilation [SM]) based on 25 years of studying and treating self-injurers. Up until the late 1980s most psychiatrists and psychologists (the pediatric literature was conspicuously silent) regarded SM as a singular, horrific, and senseless behavior that was somehow linked with suicidality either symbolically or in fact. Only a few researchers attempted to truly understand this phenomenon. In 1987, my book Bodies Under Siege ,2 which was broadly and favorably reviewed, brought a measure of order to SM by dividing it into 2 major categories that I labeled “culturally sanctioned” and “pathologic.” By examining deep-seated mutilative rituals, some going back to the stone age, I determined that they primarily served 3 purposes: (1) to attain grace and improve relationships with God; (2) to maintain social stability; and (3) to achieve physical healing. This finding led me to consider self-injury as a morbid form of self-help. By examining patients I devised a phenomenological classification of deviant SM that I refined in the 1996 second edition of my book and in collaborative publications. Deviant SM may be divided into … Address correspondence to Armando R. Favazza, MD, Department of Psychiatry, University of Missouri, 3 Hospital Dr, Columbia, MO 65201. E-mail: favazzaa{at}health.missouri.edu