That was the biggest dillema I had while making this image, whether to say mutilation or self-mutilation. Piercings, lip plates and earrings most certainly are self-mutilation. Others may or may not be.
I also considered whether to include tatoos or not. In the end, I didn't because to me, exposing your skin to some infections does not sound like as much of an injury like deforming one's skull, cutting one's foreskin or putting a piece of metal through one's flesh.
I don't have a problem if people do these things to themselves, either. Their choice, not mine. I'm just calling these practices what they really are.