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In this article we build on a previous work to develop a critique of the notion of the supposedly deliberate or intentional quality of acts of self-harm and self-neglect. We suggest the term reflexive violence as a way to understand how some of us harm or neglect our-selves and become ‘identified’ as casualties (though not necessarily victims) of processes of inclusion/exclusion, oppression and colonisation played out between in-groups and socially constructed out-groups. We deploy this construct of reflexive violence to review shifting attitudes toward what constitutes deviance from the norm in modern societies, particularly the social and historical fluidities in the contested definitions of ‘personality disorder’ reflected in the American Psychiatric Association's periodic redrafting and updating of the Diagnostic and Statistical Manual. We also draw on philosophical, sociological and historical sources to develop a psychosocial and systems-psychodynamic commentary on discourses of power whose modalities of domination may be perceived in this violent attribution of intent into the excluded out-group.