Deliberate self-harm represents a significant, yet it can be argued, a poorly theorized area of concern with respect to women who have learning disabilities particularly in the context of secure service provision. Utilizing ideas from social constructionism we explore how some ways of understanding dominate the professional literature and, thereby, restrict how such women can be understood. We recognize that despite this, multiple understandings about why women with learning disabilities self-harm do exist and are drawn upon by practitioners and the women themselves. In order to identify how women with learning disabilities who self-harm are understood a Q-methodological study was conducted with patients and professionals in a medium secure unit. Six distinct accounts of why women self-harm emerged. These accounts emphasized that self-harming behaviour is meaningful and that women with learning disabilities are understood to have complex needs and a range of strategies for coping with these. The study, therefore, suggests that when working with such women consideration should be given to how they understand and manage their experiences, cognitions and emotions.