1. Denise, a 19-year-old woman with a diagnosis of borderline personality disorder, has been admitted to an inpatient psychiatric unit because of serious self-mutilation behaviors. In the course of giving her history, the client describes her mother’s three marriages and the family’s moving to five different states. In each new state, the client says that she had to reinvent herself, trying to fill a sense of emptiness, but without success. She says, “I just feel like there is a big hole inside me, and I am so angry because I think nobody loves me. When I cut myself, it gives me relief from the pain.” What is self-mutilation, and why is it not considered a suicide attempt?