ABSTRACT
My subject in this chapter is the phenomenon of `self-harm by omission' and its relationship to disturbances of psychic skin functioning. The term `self-harm by omission' refers to avoidable injury or damage to health arising from signi®cant lapses in self-care, rather than from acts of selfdirected violence. The term is not without complications, since perfect selfcare is neither normal nor desirable. Living a full life involves a readiness to take risks and, where appropriate, to prioritise emotional self-care over physical self-care. It is not my intention to pathologise behaviour that falls within the normal domain in this regard. Nevertheless, I have encountered in my clinical work lapses in self-care that go far beyond the usual compromises associated with endeavours to ®nd and maintain a workable balance. It is in relation to such examples and their serious consequences for health and functionality that I employ the term `self-harm by omission'.
