How Do Young People Understand Their Own Self-Harm? A Meta-synthesis of Adolescents’ Subjective Experience of Self-Harm
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What makes young people—most often young women—inflict damage on their own bodies? Epidemiological studies drawing on surveys have estimated incidence and identified risk factors, but studies that explore the individuals’ experience and understanding of self-harm, which typically comprise a small series of persons, are omitted in many reviews. We conducted a systematic database search of studies on adolescents’ (12–18 years of age) first-person experience of self-harm in clinical and non-clinical populations, and included 20 studies in a meta-synthesis. Four meta-themes were associated with the participants’ subjective experiences of self-harm: (1) to obtain release, (2) to control difficult feelings, (3) to represent unaccepted feelings, and (4) to connect with others. The meta-themes support self-harm as a function of affect-regulation, but also highlight how the action of self-harm may contain important emotional and relational content and an intention or wish to connect and communicate with others. Our findings underline the importance of relating self-harm to developmental psychological needs and challenges in adolescence, such as separation, autonomy and identity formation. Self-harm in adolescence may be a result of a conflict between a need to express affective experiences and a relational need for care.
KeywordsAdolescence Meta-synthesis Self-harm Subjective experience Qualitative research
The authors wish to thank Glenn Karlsen Bjerkenes and Hege Ringnes at the University of Oslo, Norway for their assistance with the literature search, and Caryl Gay, PhD at the University of California, San Francisco for proof reading the manuscript.
LIS conceived of the study, participated in its design and coordination and drafted the manuscript; HH participated in the design and interpretation of the data; SEG participated in the design and interpretation of the data. All authors read, helped to draft, and approved the final manuscript.
The Norwegian Extra Foundation for Health and Rehabilitation and The Norwegian Council for Mental Health provided funding for this study, FO4115. They had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the article for publication.
Compliance with Ethical Standards
Conflict of Interest
The authors report no conflict of interests.
Research Involving Human and Animal Participants
This article does not contain any studies with human participants or animals performed by any of the authors.
References marked with * are included in the meta-synthesis
- *Abrams, L. S., & Gordon, A. L. (2003). Self-harm narratives of urban and suburban young women. Affilia-Journal of Women and Social Work, 18(4), 429–444. https://doi.org/10.1177/0886109903257668.
- *Adams, J., Rodham, K., & Gavin, J. (2005). Investigating the ‘self’ in deliberate self-harm. Qualitative Health Research, 15(10), 1293–1309. https://doi.org/10.1177/1049732305281761.
- Adler, P. A., & Adler, P. (2011). The tender cut. Inside the hidden world of self-injury. New York: New York University Press.Google Scholar
- Althoff, R. R., Hudziak, J. J., Willemsen, G., Hudziak, V., Bartels, M., & Boomsma, D. I. (2012). Genetic and environmental contributions self-reported thoughts of self-harm and suicide. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 159B(1), 120–127. https://doi.org/10.1002/ajmg.b.32010.CrossRefGoogle Scholar
- *Ayerst, S. (2005). The autobiographical construction of self-harm: A discourse-analytic study of adolescent narratives. (Doctoral dissertation). Available from ProQuest Dissertations and Thesis database. (UMI No. MR01787).Google Scholar
- *Bedenko, W. E. (2001). A qualitative analysis of the function and intent of self-mutilative behavior in an adolescent female. (Doctoral dissertation). Retrieved from ProQuest Dissertations Publishing. (UMI No. 2001. 3024540).Google Scholar
- Bouchard, M. A., & Lecours, S. (2008). Contemporary Approaches to Mentalization in the Light of Freud´s project. In F. Busch (Ed.), Mentalization: Theoretical Considerations, Research Findings, and Clinical Implications. New York: Taylor and Francis.Google Scholar
- Campbell, R., Pund, P., Pope, C., Britten, N., Pill, R., Morgan, M., & Donovan, J. (2003). Evaluating meta-ethnography: A synthesis of qualitative research on lay experiences of diabetes and diabetes care.. Social Science & Medicine, 56, 671–684. https://doi.org/10.1016/S0277-9536(02)00064-3.CrossRefGoogle Scholar
- *Crouch, W., & Wright, J. (2004). Deliberate self-harm at an adolescent unit: A qualitative investigation. Clinical Child Psychology and Psychiatry, 9(2), 185–204. https://doi.org/10.1177/1359104504041918.
- Emerson, L. E. (1913). The case of Miss A: A preliminary report of a psychoanalytic study and treatment of a case of self-mutilation. Psychoanalytic Review, 1(1), 41–54.Google Scholar
- Erikson, E. H. (1980). Identity and life cycle. New York: WW Norton.Google Scholar
- Favazza, A. R. (2011/1987). Bodies under siege. Self-mutilation, nonsuicidal self-injury, and body modification in culture and psychiatry (Third edn.). 2011. Baltimore: The John Hopkins University Press.Google Scholar
- *Gulbas, L. E., Tyler, T. R., & Zayas, L. H. (2015). An exploratory study of nonsuicidal self-injury and suicidal behaviors in adolescent Latinas. American Journal of Orthopsychiatry, 85(4), 302–314. https://doi.org/10.1037/ort0000073.
- Gvion, Y., & Fachler, A. (2015). Traumatic experiences and their relationship to self-destructive behavior in adolescence. Journal of Infant, Child, and Adolescent Psychotherapy, 14(4), 406–422. https://doi.org/10.1080/15289168.2015.1090863.
- *Holley, E. E. (2016). The lived experience of adolescents who engage in nonsuicidal self-injury (Doctoral dissertation). Retrieved from Open Access Thesis and Dissertations. (Record No. oai:etd.ohiolink.edu:antioch1434043151).Google Scholar
- *Lesniak, R. G. (2010). The lived experience of adolescent females who self-injure by cutting. Advanced Emergency Nursing Journal, 32(2), 137–147. https://doi.org/10.1097/TME.0b013e3181da3f2f.
- *Lewis, S. P., & Mehrabkhani, S. (2017). Every scar tells a story: Insight into people’s self-injury scar experiences. Counselling Psychology Quarterly, 29(3), 296–310. https://doi.org/10.1080/09515070.2015.1088431.
- *Machoian, L. (2001). Cutting voices. Journal of Psychosocial Nursing & Mental Health Services, 39(11), 22–29. ISSN: 02793695.Google Scholar
- Maciejewski, D. F., Creemers, H. E., Lynskey, M. T., Madden, P. A., Heath, A. C., Statham, D. J., Martin, N. G., & Verweij, K. J. (2014). Overlapping genetic and environmental influences on nonsuicidal self-injury and suicidal ideation: different outcomes, same etiology? JAMA Psychiatry, 71(6), 699–705. https://doi.org/10.1001/jamapsychiatry.2014.89.CrossRefPubMedPubMedCentralGoogle Scholar
- *Magagna, J. (2008). Attacks on life: suicidality and self-harm in young people. In S. Briggs & S. Lemma, A. & W. Crouch (Eds.), Relating to self-harm and suicide: Psychoanalytic perspectives on practice, theory and prevention (pp. 109–127). New York, NY: Routledge/Taylor & Francis Inc.Google Scholar
- *Marshall, H., & Yazdani, A. (1999). Locating culture in accounting for self-harm amongst asian young women. Journal of Community & Applied Social Psychology, 9(6), 413–433. https://doi.org/10.1002/(SICI)1099-1298(199911/12)9:6<413::AID-CASP543>3.0.CO;2-U.
- *McAndrew, S., & Warne, T. (2014). Hearing the voices of young people who self-harm: Implications for service providers. International Journal of Mental Health Nursing, 23(6), 570–579. https://doi.org/10.1111/inm.12093.
- *McDermott, E., Roen, K., & Piela, A. (2015). Explaining self-harm: Youth cybertalk and marginalized sexualities and genders. Youth and Society, 47(6), 873–889. https://doi.org/10.1177/0044118X13489142.
- Menninger, K. (1938). Man against himself. New York: Harcourt, BraceWorld, Inc. (/1966. .Google Scholar
- Morgan, C., Webb, R. T., Carr, W. J., Kontopantelis, E., Green, J., Chew-Graham, C. A., Kapur, N., & Ashcroft, D. M. (2017). Incidence, clinical management, and mortality risk following self-harm among children and adolescents: cohort study. BMJ, 359, j4351. https://doi.org/10.1136/bmj.j4351.CrossRefPubMedPubMedCentralGoogle Scholar
- *Moyer, M., & Nelson, K. W. (2007). Investigating and understanding self-mutilation: The student voice. Professional School Counseling, 11(1), 42–48. ISSN: 1096–2409.Google Scholar
- *Nice, T. (2012). Troubled minds and scarred bodies: A grounded theory study of adolescent self-harm (Unpublished doctoral dissertation). The University of Kent.Google Scholar
- *Parfitt, A. (2005). On aggression turned against the self. Psychoanalytic Psychotherapy, 19, 160–173. https://doi.org/10.1080/02668730500115127.
- *Privé, A. A. (2007). An existential-phenomenological investigation of self-cutting among adolescent girls (Doctoral Dissertation). Available from ProQuest Dissertations Publishing (UMI No. 3292573).Google Scholar
- *Rissanen, M.-L., Kylmä, J., & Laukkanen, E. (2008). Descriptions of self-mutilation among Finnish adolescents: A qualitative descriptive inquiry. Issues in Mental Health Nursing, 29(2), 145–163. https://doi.org/10.1080/01612840701792597.
- Siegel, D. J. (2015). Brainstorm: The power and purpose of the teenage brain. New York: Jeremy P. Tarcher/Penguin.Google Scholar
- Swannell, S. V., Martin, G. E., Page, A., Hasking, P., & John, St, N. J (2014). Prevalence of nonsuicidal self-injury in nonclinical samples: systematic review, meta-analysis and meta-regression. Suicide and Life-Threatening Behavior, 44(3), 273–303. https://doi.org/10.1111/sltb.12070.CrossRefPubMedGoogle Scholar
- Whitlock, J. L., & Selekman, M. (2014). Non-suicidal self-injury (NSSI) across the lifespan. In M. Nock (Ed.), Oxford Handbook of Suicide and Self-Injury. Oxford Library of Psychology: Oxford University.Google Scholar
- World Health Organization (2004). The ICD – 10 Classification of Mental and Behavioral Disorders. Diagnostic criteria for research. 10th ed.Google Scholar
- *Yip, K.-S., Ngan, M.-Y., & Lam, I. (2004). Adolescent self-cutters in Hong Kong. Asia Pacific Journal of Social Work and Development, 14(2), 33–51. https://doi.org/10.1080/21650993.2004.9755953.