Why do people injure themselves?

Using photo-elicitation to understand reasons for repeated self-harm: a qualitative study

BACKGROUND

Reasons for self-harm are not well understood. One of the reasons for this is that first-hand accounts are usually elicited using traditional interview and questionnaire methods. This study aims to explore the acceptability of using an approach (photo-elicitation) that does not rely on solely verbal or written techniques, and to make a preliminary assessment of whether people can usefully employ images to support a discussion about the reasons why they self-harm.

METHOD

Interviews with eight participants using photo elicitation, a method in which photographs produced by the participant are used as a stimulus and guide within the interview.

RESULTS

Participants responded positively to using images to support a discussion about their self-harm and readily incorporated images in the interview. Four main themes were identified representing negative and positive or adaptive purposes of self-harm: self-harm as a response to distress, self-harm to achieve mastery, self-harm as protective and self-harm as a language or form of communication.

CONCLUSIONS

Employing this novel approach was useful in broadening our understanding of self-harm.

Non-suicidal reasons for self-harm: A systematic review of self-reported accounts

BACKGROUND

Self-harm is a major public health problem yet current healthcare provision is widely regarded as inadequate. One of the barriers to effective healthcare is the lack of a clear understanding of the functions self-harm may serve for the individual. The aim of this review is to identify first-hand accounts of the reasons for self-harm from the individual's perspective.

METHOD

A systematic review of the literature reporting first-hand accounts of the reasons for self-harm other than intent to die. A thematic analysis and 'best fit' framework synthesis was undertaken to classify the responses.

RESULTS

The most widely researched non-suicidal reasons for self-harm were dealing with distress and exerting interpersonal influence. However, many first-hand accounts included reasons such as self-validation, and self-harm to achieve a personal sense of mastery, which suggests individuals thought there were positive or adaptive functions of the act not based only on its social effects.

LIMITATIONS

Associations with different sub-population characteristics or with the method of harm were not available from most studies included in the analysis.

CONCLUSIONS

Our review identified a number of themes that are relatively neglected in discussions about self-harm, which we summarised as self-harm as a positiveexperience and defining the self. These self-reported "positive" reasons may be important in understanding and responding especially to repeated acts of self-harm.

Nonsuicidal self-injury: an emotion regulation perspective

BACKGROUND

Nonsuicidal self-injury (NSSI) is widely thought to serve an emotion-regulatory function.

METHOD

The focus of the present paper is to provide a conceptual framework for understanding how NSSI might modify a person's emotions.

RESULTS

Drawing upon the process model of emotion regulation, we argue that 5 families of emotion regulation strategies may be engaged by NSSI. Individuals may engage in NSSI as an alternative to more distressing situations. They also may use NSSI to modify their social environment. Individuals may shift their attention away from unpleasant emotions or thoughts via NSSI. NSSI may change cognitions about the self via self-punishment or transformation of the self from higher-order to lower-order awareness. NSSI may also bring about various physiological effects, such as changes in endogenous opioids or parasympathetic nervous system activation, as a way of modulating emotional responses.

CONCLUSION

Simply labeling NSSI as 'emotion regulatory' does not tell us precisely what is going on. This is because at any given moment, NSSI can serve to regulate emotions in many different ways. One key challenge is to clarify the precise functions NSSI may be serving for a given individual in a particular context.

Non-suicidal self-injury and eating pathology in high school students

Although past research has explored self-injurious behaviors and disordered eating among adults in clinical settings, little research has been conducted examining nonsuicidal self-injury (NSSI) and eating pathology in community samples of adolescents. Four hundred and 40 students were screened for the presence of NSSI; a prevalence rate of 13.9% was found. Those who indicated that they engaged in NSSI (n = 59) and a comparison group of non-self-injurers (n = 57) completed the Eating Disorders Inventory. Results indicate that students who engage in NSSI display significantly more eating pathology than their non-NSSI peers, including poor interoceptive awareness; difficulties with impulse regulation; an increased sense of ineffectiveness, distrust, and social insecurity; and increased bulimic tendencies and body dissatisfaction. Relationships were found between increased lifetime frequency of NSSI behaviors and poor impulse control and deficits in affective regulation. In addition, adolescents who had stopped self-injuring reported comparable rates of eating pathology as did adolescents who continued to self-injure. The theoretical connection between NSSI and eating pathology are discussed with reference to enhancing knowledge regarding the characteristics of NSSI.

Personality and coping in young inmates: a cluster typology

OBJECTIVE

Firstly, to identify groups of inmates according to personality. Secondly, to differentiate types of personality through coping strategies, psychopathology, criminal records and social factors.

METHOD

A cross-sectional design was used to study psychosocial, correctional, personality and clinical characteristics in inmates. The group was composed of 106 male inmates. The measures used to evaluate personality, clinical and psychosocial variables were a standard protocol and three self-report questionnaires: the Millon Clinical Multiaxial Inventory-II, the Minnesota Multiphasic Personality Inventory-2 and the Coping Responses Inventory-Adult Form. A cluster analysis, ANOVA and Kruskall-Wallis test were conducted.

RESULTS

Four clusters were identified. The secondary type was characterized by an impulsive, suspicious, hostile personality, by anxiety, a low tolerance of frustration, and by the use of cognitive avoidance coping. The controlled-healthy type showed a less pathological and more self-controlled personality. The primarytype was similar to secondary, but with lower tendency to impulsivity. The inhibited-affected type was shown to have an avoidant personality, greater tendency to symptomatology and also to use acceptance-resignation and emotional discharge coping.

CONCLUSION

The four groups of young inmates identified showed profiles with different degrees of psychopathological risk and also different coping profiles.