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Samways B, Heslop P, Dowling S. Self-reported explanations for self-injury by people with intellectual disabilities: a systematic review of qualitative studies. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 70:382-396. [PMID: 38699488 PMCID: PMC11062260 DOI: 10.1080/20473869.2022.2098665] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 07/01/2022] [Indexed: 05/05/2024]
Abstract
Background Emotional distress has received less attention as an explanatory factor for self-injury in people with intellectual disabilities, with research and practice primarily focusing on biobehavioural factors. This systematic review examines the self-reported explanations for self-injury by people with mild or moderate intellectual disabilities, and discusses how the findings contrast with those from self-reported studies of people within the general population who self-harm. Methods Five databases (PsychINFO, IBSS, CINAHL, Web of Science and Medline) were systematically searched to find qualitative, empirical research since 2000 about self-reported reasons for self-injury. Results Four studies were found which conducted research with people with intellectual disabilities. Three primary themes are discussed: relief from overwhelming emotions; trauma and loss; and difficulty in articulating emotions. Conclusion This review found a paucity of research asking people with intellectual disabilities about their own self-injury. However, the research available suggests that explanatory factors for self-injury typically reported in the general population should be considered for those with mild or moderate intellectual disabilities.
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Affiliation(s)
| | - Pauline Heslop
- Professor of Intellectual Disabilities Studies, University of Bristol, Bristol, UK
| | - Sandra Dowling
- Senior Lecturer, School, for Policy Studies, University of Bristol, Bristol, UK
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A Qualitative Study of Understanding Reasons for Self-Harm in Adolescent Girls. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073361. [PMID: 33805082 PMCID: PMC8037877 DOI: 10.3390/ijerph18073361] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/22/2021] [Indexed: 11/21/2022]
Abstract
Objective: Self-harm is an important public health issue in the UK. Young people who self-harm frequently feel misunderstood, and unable to access help. Improving understanding is key to informing the development and delivery of effective treatments and services. Methods: In this qualitative study, we interviewed nine adolescent girls (13–17 years old) with recurrent self-harm, recruited from NHS specialist child and adolescent mental health services. Data were analysed using Interpretative Phenomenological Analysis (IPA). Results: Findings revealed that self-harm is experienced as powerful mental and physical urges, sated only by self-harming, suggesting that self-harm could be considered a compulsive rather than impulsive disorder, representing a new perspective on the behaviour. Five themes emerged: emotion regulation; an addictive urge; self-harm to survive; interpersonal triggers; interpersonal relationships, not mechanical distractors, reduce self-harm. Conclusions: This study provides further evidence that non-suicidal self-injury may be engaged in to reduce suicidal risk. Seeking the company of helpful friends or family members may reduce the urge to self-harm. Repetitive self-harm may be a compulsive behaviour.
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Hemming L, Bhatti P, Shaw J, Haddock G, Pratt D. Words Don't Come Easy: How Male Prisoners' Difficulties Identifying and Discussing Feelings Relate to Suicide and Violence. Front Psychiatry 2020; 11:581390. [PMID: 33362602 PMCID: PMC7758448 DOI: 10.3389/fpsyt.2020.581390] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/11/2020] [Indexed: 11/16/2022] Open
Abstract
Suicide and violence are prevalent within male prisons in the UK. It has been suggested that alexithymia may be associated with both suicide and violence. Alexithymia can be defined as an inability to identify or discuss emotions. The present study aimed to qualitatively explore male prisoners' experiences of alexithymia and how these experiences may relate to suicide and violence. Fifteen male prisoners were recruited from two prisons in the North West of England. All participants had experienced suicidal and/or violent thoughts and/or behaviors in the past 3 months, and all screened positive on an established measure of alexithymia. Participants took part in a qualitative interview during which they were also given the opportunity to provide drawings of their emotions. Data were transcribed and analyzed using thematic analysis, with a collaborative approach taken between researchers and an individual with lived experience of residing in prison. The results indicated that male prisoners tended not to talk about their emotions with others, due to external pressures of residing in prison in addition to internal difficulties with recognizing and articulating emotions. Not discussing emotions with others was associated with a build-up of emotions which could result in either an emotional overload or an absence of emotions. Both experiences were perceived to be associated with hurting self or others, however, participants also identified a "safety valve" where it was acknowledged that using more adaptive approaches to releasing emotions could prevent harm to self and others. These findings suggest three main clinical implications; (1) a cultural shift in male prisons is needed which encourages open communication of emotions (2) individualized support is needed for those identified as experiencing a difficulty in recognizing and articulating emotions and (3) prison staff should encourage alternative ways of releasing emotions such as by using harm minimization or distraction techniques.
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Affiliation(s)
- Laura Hemming
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Peer Bhatti
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Jennifer Shaw
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom.,Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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Smith HP, Power J, Usher AM, Sitren AH, Slade K. Working with prisoners who self-harm: A qualitative study on stress, denial of weakness, and encouraging resilience in a sample of correctional staff. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2019; 29:7-17. [PMID: 30609122 DOI: 10.1002/cbm.2103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 03/23/2018] [Accepted: 11/27/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Rates of self-harm are high among prisoners. Most research focuses on the vulnerable prisoner, and there is little on the impact of these behaviours on staff. AIMS To investigate staff perceptions of self-harming behaviours by prisoners, including their views on its causes, manifestation, prevention in institutions, and impact on them. METHODS Semistructured interviews were conducted with 20 administrative and 21 therapeutic prison staff who are responsible in various ways for prisoners who self-harm. Their narratives were explored using interpretative phenomenological analysis. RESULTS Despite prison staff being experienced with prisoners' self-harming behaviours, including severe acts of self-harm, they were apt to reject any negative impact on their own mental health or well-being. This denial of negative impact was accompanied by perceptions of the inmate's actions being manipulative and attention seeking. Prison staff also perceived institutional responses to self-harming behaviours by prisoners as being mixed, ambiguous, or showing preference for relying on existing suicide protocols rather than task-specific guidance. CONCLUSIONS Although staff gave explanations of prisoner self-harm in terms of "manipulative behaviour," prisoners' self-harm is, in fact, complex, challenging, and often severe. This staff perception may reflect denial of impact of often distressing behaviours on them personally and their own coping mechanisms. This could be feeding in to a perceived lack of clear and effective institutional responses to the self-harm, so further research is needed to determine how staff could broaden their views, and respond more effectively to prisoners. Psychologically informed group work and/or reflective practice are among the candidates for such help for staff.
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Affiliation(s)
- Hayden P Smith
- Department of Criminology & Criminal Justice, University of South Carolina, Columbia, SC, USA
| | - Jenelle Power
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada
| | - Amelia M Usher
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Alicia H Sitren
- Department of Criminology & Criminal Justice, University of North Florida, Jacksonville, FL, USA
| | - Karen Slade
- College of Business Law and Social Sciences, School of Social Sciences, Nottingham Trent University, Nottingham, UK
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Wadman R, Armstrong M, Clarke D, Harroe C, Majumder P, Sayal K, Vostanis P, Townsend E. Experience of Self-Harm and Its Treatment in Looked-After Young People: An Interpretative Phenomenological Analysis. Arch Suicide Res 2018; 22:365-379. [PMID: 28786765 DOI: 10.1080/13811118.2017.1355286] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We report the first Interpretative Phenomenological Analysis examination of self-harm and experience of clinical services in young people in the public care system. Qualitative interviews with 24 looked-after young people were completed. Prevalent themes were 1) Changes in care placement, 2) Feelings of anger, 3) Not wanting/feeling able to talk, 4) Developing coping techniques, 5) Clinical services: A relational mixed bag (subthemes: feeling (i) patronized, not listened to, (ii) nothing being done, (iii) comfortable/able to talk). Placement change and anger were highly salient to self-harm in this group and experiences of clinical services depended on individual relationships with clinicians. Implications include increasing compassion in therapeutic relationships, recognizing and managing emotional dysregulation, and increasing support during placement changes.
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Chapman AL, Gratz KL, Turner BJ. Risk-related and protective correlates of nonsuicidal self-injury and co-occurring suicide attempts among incarcerated women. Suicide Life Threat Behav 2014; 44:139-54. [PMID: 24138178 DOI: 10.1111/sltb.12058] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 07/05/2013] [Indexed: 11/25/2022]
Abstract
Individual and environmental correlates of nonsuicidal self-injury (NSSI) and co-occurring suicide attempts (SA) among incarcerated women (N = 104) were examined. Participants completed measures of putative risk and protective factors, including coping styles, childhood maltreatment, and hopelessness. Results indicated that active coping was uniquely, negatively associated with the presence and frequency of NSSI, whereas avoidant coping and childhood physical/emotional abuse were positively associated with NSSI frequency. Conversely, among women with a history of NSSI, hopelessness was uniquely, positively associated with the presence and frequency of SA. Further, childhood sexual abuse was associated with the presence of SA, while physical/emotional abuse was associated with SA frequency. Hopelessness was more strongly related to SA frequency than NSSI frequency. These findings help disentangle the unique risk and protective factors for NSSI and co-occurring SA in incarcerated samples.
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Baker A, Wright K, Hansen E. A qualitative study exploring female patients' experiences of self-harm in a medium secure unit. J Psychiatr Ment Health Nurs 2013; 20:821-9. [PMID: 23216978 DOI: 10.1111/jpm.12031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2012] [Indexed: 11/27/2022]
Abstract
This study utilized a social constructivist model and reports upon interviews conducted with five female patients in a medium secure service. Their perception of self-harm is considered. Six themes emerged from the data, 'the traumatized individual', 'interrupted maturation process', 'the hidden experience', 'crossing the line', 'individual and systemic repercussions', 'nascent potential protection'. In addition to the six themes that emerged, we concluded that, although individual perceptions of self-harm varied, commonalities existed across accounts and that individual formulation may assist both patients and staff to gain a personalized understanding, thus, enabling less harmful ways of coping to be established.
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Affiliation(s)
- A Baker
- Bronte House, Ashworth Hospital, Liverpool, Merseyside, UK
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Hedjazi A, Hoseinzadeh A, Zarenezhad M, Hassanzadeh R, Mahmoudi D, Ghadipasha M. A report of five cases of self-mutilation for the purpose of insurance fraud. J Forensic Leg Med 2013; 20:640-3. [DOI: 10.1016/j.jflm.2013.03.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 01/02/2013] [Accepted: 03/17/2013] [Indexed: 11/16/2022]
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Buser TJ, Buser JK. Conceptualizing Nonsuicidal Self-Injury as a Process Addiction: Review of Research and Implications for Counselor Training and Practice. JOURNAL OF ADDICTIONS & OFFENDER COUNSELING 2013. [DOI: 10.1002/j.2161-1874.2013.00011.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Ward J, Bailey D. A participatory action research methodology in the management of self-harm in prison. J Ment Health 2013; 22:306-16. [PMID: 23323726 DOI: 10.3109/09638237.2012.734645] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Self-harm in custody is a well-researched phenomenon. This is particularly true for women in prison who demonstrate disproportionately high rates of self-harm. Despite the growing body of prison research, there has been a lack of service user involvement (SUI). Aims To outline the first use of SUI in a custodial setting in developing care pathways for self-harm. METHODOLOGY A participatory action research approach was used to engage women prisoners and staff. RESULTS Participants were able to identify strengths and weaknesses of current care pathways and offer suggestions for service development based upon their experience of receiving and delivering care. CONCLUSION The authors conclude that despite participatory approaches being in their infancy in prisons the engagement of service users when aimed at effecting positive change can be successful.
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