There has been documented evidence of self-injury being used as a regulatory practice since Ancient Egypt. It has been turned to for thousands of years to depict grief, release overwhelming emotions, and bring ourselves back to homeostasis.

In the past two hundred years, however, clinical depictions of young women who self-harm have differed from historical understandings of self-injury. Young women who self-harm began to be depicted as 'hysterical', 'manipulative', and 'malingering'-- their contextual distress was separated from the behavior of self-injury, and their actions were viewed as insane in isolation.

This perspective of young women who self-injure was furthered in the twentieth century, when doctors depicted 'attractive young women' engaging in 'delicate self-cutting', an incomprehensible practice as it was done seemingly entirely for attention-- the cuts were superficial, they left no lingering scars, and they occurred after seemingly unrelated incidents.

What primarily male physicians were missing for over a century was this: over twenty percent of individuals self-harm in their lifetime, and well over half of neurodivergent individuals will self-harm. This number is higher for neurodivergent young women, who often experience higher levels of empathetic disequilibrium, and therefore high levels of somatic overwhelm.

Self-injury is, for many neurodivergent young women, a key tool that is utilised not to manipulate, nor to malinger, but to regulate their somatic experience of emotions in a world that is often too loud.

Being able to understand the neurology behind self-injury and its historical roots will help us understand the human impulse behind it instead of the biased representation we have been shown for the past two hundred years.

This understanding will allow us as clinicians to better understand the reasons behind our neurodivergent girls' self-injury, find safe and effective replacement behaviors, and successfully educate their families.