Recent research has differentiated several distinct classes of self-destructive behavior. This paper describes the clinical characteristics of one class, the deliberate self-harm syndrome. Analysis of 56 published case reports of self-harm revealed a typical pattern of onset in late adolescence, multiple recurrent episodes, low lethality, harm deliberately inflicted upon the body, and extension of the behavior over many years. Since the clinical characteristics of the deliberate self-harm syndrome differ substantially from those of other classes of self-destructive behavior, the authors propose that DSM-IV classify deliberate self-harm as a separate diagnostic syndrome.

Self-destructive behavior is a major clinical problem in psychiatry. A review of the literature reveals the existence of enough clinical data to identify a diagnostic entity, "The Deliberate Self-Harm Syndrome" (DSH). The authors present a diagnostic formulation of the DSH syndrome (in the DSM-III format) which consists of four essential clinical features, a group of associated features, clinical features, a group of associated features, a clinical course of typical onset in late adolescence, with multiple recurrent episodes, with multiple methods of low lethality physical self-injury, extending over many years. On the basis of relatively exclusive association of clinical signs and symptoms a heuristic clinical entity is proposed.

The amorphous concept of social support systems merits construction of a conceptually coherent theoretical model linked to social theory and amenable to empirical investigation. The social network paradigm is presented as such a model. The model is further defined in terms of the intimate psychosocial network, which has been empirically studied with the Pattison Psychosocial Kinship Inventory. The characteristics of the normal network are shown to differ substantially in the schizophrenic network. The structure and functions of the schizophrenic network are illustrated in a case study analysis. The schizophrenic network is shown to exhibit dynamics that generate and perpetuate psychotic behavior. A strategy for network intervention is described, based on the model of structural change in the network social system.

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