How Do Young People Understand Their Own Self-Harm? A Meta-synthesis of Adolescents’ Subjective Experience of Self-Harm

Abstract

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.

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Acknowledgements

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.

Funding

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.

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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.

Corresponding author

Correspondence to Line Indrevoll Stänicke.

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Research Involving Human and Animal Participants

This article does not contain any studies with human participants or animals performed by any of the authors.

Appendix

Appendix

The electronic search strategy was developed in liaison with information specialists at the University of Oslo in December 2016. The methodological search terms were informed by technical guidance and worked examples.

MEDLINE 19.12.16

Database: Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R) < 1946 to Present>.

Search strategy  
1 exp Self-Injurious Behavior/or (self-injur* or “self injur*” or selfinjur*).tw,kw. (65,471)
2 exp Self-Mutilation/or (self-mutilat* or “self mutilat*” or selfmutilat*).tw,kw. (3901)
3 (Self-harm* or selfharm* or (self adj2 harm*)).tw,kw. (4481)
4 (self-poison* or “self poison*” or selfpoison*).tw,kw. (1693)
5 (self-injur* or “self injur*” or selfinjur*).tw,kw. (3744)
6 ((self-destruct* or “self destruct*” or selfdestruct*) adj2 behav*).tw,kw. (545)
7 (self-cut* or “self cut*” or selfcut*).tw,kw. (164)
8 (self-inflict* or “self inflict*” or selfinflict*).tw,kw. (2005)
9 (non-suicid* or “non suicid*” or nonsuicid*).tw,kw. (1723)
10 parasuicid*.tw,kw. (638)
11 or/1–10 (69,568)
12 exp Qualitative Research/or qualitative*.tw,kw. (222,264)
13 exp Grounded Theory/or “grounded theor*”.tw,kw. (8895)
14 exp Interviews as Topic/or (interview* adj3 psychol*).tw,kw. (56,676)
15 exp Interview, Psychological/(15,644)
16 exp Focus Groups/or “focus group*”.tw,kw. (38,728)
17 exp Anecdotes as Topic/or anecdote*.tw,kw. (5997)
18 exp Personal narratives as topic/(170)
19 exp Narration/or narrative*.tw,kw. (28,585)
20 ethnograph*.tw,kw. (8408)
21 phenomenol*.tw,kw. (20,859)
22 “discourse analysis*”.tw,kw. (1333)
23 “thematic analysis*”.tw,kw. (8765)
24 (case adj3 stud*).tw,kw. (197,179)
25 or/12–24 (534,727)
26 exp Motivation/or motiv*.tw,kw. (244,813)
27 exp Intention/or intent*.tw,kw. (96,531)
28 (reason* or meaning*).tw,kw. (470,186)
29 driv*.tw,kw. (344,497)
30 caus*.tw,kw. (2,232,491)
31 purpose*.tw,kw. (1,084,654)
32 function*.tw,kw. (3,248,983)
33 explanation*.tw,kw. (114,577)
34 subjectiv*.tw,kw. (117,108)
35 or/26–34 (6,813,738)
36 exp Adolescent/or adolescen*.tw,kw. (1,945,129)
37 teen*.tw,kw. (27,277)
38 youth*.tw,kw. (64,761)
39 exp Minors/or minor*.tw,kw. (267,028)
40 exp Young Adult/or “young adult*”.tw,kw. (678,157)
41 or/36–40 (2,504,108)
42 11 and 25 and 35 and 41 (709)

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Stänicke, L.I., Haavind, H. & Gullestad, S.E. How Do Young People Understand Their Own Self-Harm? A Meta-synthesis of Adolescents’ Subjective Experience of Self-Harm. Adolescent Res Rev 3, 173–191 (2018). https://doi.org/10.1007/s40894-018-0080-9

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Keywords

  • Adolescence
  • Meta-synthesis
  • Self-harm
  • Subjective experience
  • Qualitative research