This study examined and compared adolescent suicide attempters with a history of self-mutilative behavior (SMB) to those with no history of SMB on psychiatric diagnoses; cognitive/affective measures of depression, hopelessness, loneliness, and anger; behavioral dysfunction, including risk taking, reckless behavior, and drinking; and family functioning. Participants of the study included 95 adolescents, 12 to 18 years old evaluated after a suicide attempt that occurred between 1996 and 2000. Results indicated the carving on the skin and picking at a wound were the most commonly reported SMBs. The SMB group was significantly more likely to be diagnosed with oppositional defiant disorder, major depression, and dysthymia and had higher scores on measures of hopelessness, loneliness, anger, risk taking, reckless behavior, and alcohol use than did the non-SMB. Loneliness seemed to significantly increase the odds of SMB. The research suggested several implications for treatment including routine screening for SMB on all suicide attempters and direct treatment for those individuals engaging in SMB for the underlying disorder associated with suicidality and SMB and than assessing its effect on SMB. Tables and references