The charts of 660 consecutive admissions to a university psychiatric hospital were examined. After excluding those with mental retardation, 32 patients who had mutilated themselves and 88 patients admitted for unsuccessful suicide attempts were identified. Women were significantly overrepresented among the mutilators, but the groups did not differ with respect to age. Most analyses were restricted to women, of whom 27 were self-mutilators and 51 were nonmutilating suicide attempters. Mutilators were less likely to receive diagnoses of major depression or adjustment disorder but were more likely to have a history of substance abuse and receive Axis II diagnoses. The mutilative behavior was generally repetitive. The most common form was superficial cutting of the arms and wrists. Reports of lifetime sexual or physical abuse were more common among mutilators. Mutilators also had frequent histories of suicide attempts distinct from their mutilation behavior, multiple hospitalizations, and transfer to state hospitals for longer-term care. These findings suggest a chronic course with significant morbidity and associated features which may be of clinical significance.