The author distinguishes a variety of self-destructive activities from attempts at suicide. In the former, there is no intention of self-injury or death. As examples of indirect self-destruction, he mentions psychosomatic illness, overeating, neglect of health, smoking, drug abuse, and alcoholism. As possible motives, he mentions impulse gratification without regard to consequence, counterphobic attempts at mastering anxiety, self-punishment, and masochistic gratification.