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.
Highlights
Accepted: 22 March 2021Prevalence of self-harm is high, estimated at 17% in adolescents in a recent metaanalysis [1]
Self-harm was expressed as an interpersonal means to express and communicate mental distress, to make internal pain visible to self and others, or to quell mental anguish by focusing instead on a physical pain; for example, the pain of cutting and watching the blood flow enabled a participant ‘to feel’—which was preferable to a state of ‘nothingness’
All participants experienced a beneficial reduction in their urges to self-harm in the company of people who understood, tolerated or accepted them
Summary
Prevalence of self-harm is high, estimated at 17% in adolescents in a recent metaanalysis [1]. Sornberger et al (2012) [20] found that females tend to use methods that result in bleeding; for some people, seeing blood is an important aspect of NSSI, a feature identified in this study These potential gender differences suggest that it would not be appropriate to ignore gender of participants in a qualitative study of self-harm. Qualitative research can facilitate an understanding of the complexity of phenomena, informing clinical practice (Boyle, 1991, cited in [21]) We suggest that paying attention to the lived experiences of self-harm could provide insights which contribute to the body of literature, help us to understand why people do (and do not) self-harm and further inform clinical intervention These factors are implicated in our choice to adopt a qualitative approach to research and in selecting Interpretative Phenomenological Analysis (IPA) as our methodological choice, to gain a deeper understanding of participants’ lived experience of self-harm and to explore their sense-making of decisions to self-harm and not to selfharm, when they typically would. How does an adolescent female make sense of her choice to self-harm on some occasions, while choosing not to on others, when she otherwise might?
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