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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
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.
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.
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th ed. American Psychiatric Association: Washington, DC.
*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).
*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).
Bentley, K. H., Nock, M. K., & Barlow, D. H. (2014). The four-function model of nonsuicidal self-injury: Key directions for future research. Clinical Psychological Science, 2(5), 638–656. https://doi.org/10.1177/2167702613514563.
Borschmann, R. J., Hogg, R., Phillips, P., & Moran, P. (2011). Measuring self-harm in adults: A systematic review. European Psychiatry. https://doi.org/10.1016/j.eurpsy.2011.04.005.
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.
Brady, M. T. (2014). Cutting the silence: Initial, impulsive self-cutting in adolescence. Journal of Child Psychotherapy, 40(3), 287–301. https://doi.org/10.1080/0075417X.2014.965430.
Britten, N., Campbell, R., Pope, C., Donovan, J., Morgan, M., & Pill, R. (2002). Using meta-ethnography to synthesize qualitative research: A worked example. Journal of Health Services Research & Policy, 7(4), 209–215. https://doi.org/10.1258/135581902320432732.
Brown, T. B., & Kimball, T. (2012). Cutting to Live: A phenomenology of Self-Harm. Journal of Marital and Family Therapy, 39, 2,195–208.
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.
Casey, B. J., Jones, R. M., & Hare, T. A. (2008). The adolescent brain. Annals of the New York Academy of Sciences, 1124, 111–126. https://doi.org/10.1196/annals.1440.010.
*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.
Edmondson, A. J., Brennan, C. A., & House, A. (2016). Non-suicidal reasons for self-harm: A systematic review of self-reported accounts. Journal of Affective Disorders, 191, 109–117. https://doi.org/10.1016/j.jad.2015.11.043.
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.
Erikson, E. H. (1980). Identity and life cycle. New York: WW Norton.
Evans, R., & Hurrell, C. (2016). The role of schools in children and young people’s self-harm and suicide: Systematic review and meta-ethnography of qualitative research. BMC Public Health, 16, 401–416. https://doi.org/10.1186/s12889-016-3065-2.
Favazza, A. R. (1998). The coming of age of self-mutilation. The Journal of Nervous & Mental Disease, 186(5), 259–268. ISSN: 0022–3018.
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.
Gardner, F. (2001). Self-harm: A psychotherapeutic approach. New York: Taylor & Francis Inc.
*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.
Hamza, C. A., Willoughby, T., & Heffer, T. (2015). Impulsivity and nonsuicidal self-injury: A review and meta-analysis. Clinical Psychology Review, 38, 13–24. https://doi.org/10.1016/j.cpr.2015.02.010.
Hawton, K., Saunders, K. E. A., & O’Connor, R. C. (2012). Self-harm and suicide in adolescents. Lancet, 379, 2373–2382. https://doi.org/10.1016/S0140-6736(12)60322-5.
*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).
Hooley, J. M., & St. Germain, S. A. (2014). Nonsuicidal self-injury, pain, and self-criticism: Does changing self-worth change pain endurance in people who engage in self-injury? Clinical Psychological Science, 2(3), 297–305. https://doi.org/10.1177/2167702613509372.
Jacobson, C. M., & Gould, M. (2007). The epidemiology and phenomenology of non-suicidal self-injurious behavior among adolescents: A critical review of the literature. Archives of Suicide Research, 11(2), 129–147. https://doi.org/10.1080/13811110701247602.
Kirtley, O. J., O’Carroll, R. E., & O’Connor, R. C. (2016). Pain and self-harm: A systematic review. Journal of Affective Disorders, 203, 347–363. https://doi.org/10.1016/j.jad.2016.05.068.
Klonsky, E. D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review, 27, 226–239. https://doi.org/10.1016/j.cpr.2006.08.002.
Klonsky, E. D., Oltmanns, T. F., & Turkheimer, E. (2003). Deliberate self-harm in a nonclinical population: Prevalence and psychological correlates. American Journal of Psychiatry, 160, 1501–1508. https://doi.org/10.1176/appi.ajp.160.8.1501.
Klonsky, E. D., Victor, S. E., & Saffer, B. V. (2014). Nonsuicidal self-injury: What we know, and what we need to know. The Canadian Journal of Psychiatry, 59(11), 565–568. https://doi.org/10.1177/070674371405901101.
*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.
Levitt, H., Pomerville, A., & Surace, F. I. (2016). A qualitative meta-analysis examining clients’ experiences of psychotherapy: A new agenda. Psychological Bulletin, 142(8), 801–830. https://doi.org/10.1037/bul0000057.
*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.
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.
*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.
*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. .
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.
Motz, A. (2010). Self-harm as a sign of hope. Psychoanalytic Psychotherapy, 24(2), 81–92. https://doi.org/10.1080/02668731003707527.
*Moyer, M., & Nelson, K. W. (2007). Investigating and understanding self-mutilation: The student voice. Professional School Counseling, 11(1), 42–48. ISSN: 1096–2409.
*Nice, T. (2012). Troubled minds and scarred bodies: A grounded theory study of adolescent self-harm (Unpublished doctoral dissertation). The University of Kent.
Noblit, G. W., & Hare, R. D. (1988). Meta-ethnography. London: SAGE Publications, Inc.
Nock, M. K. (2014). The Oxford Handbook of Suicide and Self-injury. New York: Oxford University Press.
Nock, M. K., & Prinstein, M. J. (2004). A functional approach to the assessment of self-mutilative behavior. Journal of Consulting and Clinical Psychology, 72(5), 885–890. ISSN: 0022-006X.
Nock, M. K., & Prinstein, M. J. (2005). Contextual features and behavioral functions of self-mutilation among adolescents. Journal of Abnormal Psychology, 114(1), 140–146. https://doi.org/10.1037/0021-843X.114.1.140.
Panksepp, J. (2010). Affective neuroscience of the emotional BrainMind: Evolutionary perspectives and implications for understanding depression. Dialogues in Clinical Neuroscience, 12(4), 533–545. ISSN: 1294–8322.
*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).
*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.
Soyemoto, K. L. (1998). The functions of self-mutilation. Clinical Psychology Review, 18(5), 531–554. https://doi.org/10.1016/S0272-7358(97)00105-0.
Straker, G. (2006). Signing with a scar: Understanding self-harm. Psychoanalytic Dialogues, 16(1), 93–112. https://doi.org/10.2513/s10481885pd1601_6.
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.
Timulak, L. (2009). Meta-analysis of qualitative studies: A tool for reviewing qualitative research findings in psychotherapy. Psychotherapy Research, 19(4–5), 591–600. https://doi.org/10.1080/10503300802477989.
Walsh, D., & Downe, S. (2004). Meta-synthesis method for qualitative research: A literature review. Journal of Advanced Nursing, 50(2), 204–211. https://doi.org/10.1111/j.1365-2648.2005.03380.x.
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.
World Health Organization (2004). The ICD – 10 Classification of Mental and Behavioral Disorders. Diagnostic criteria for research. 10th ed.
*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.
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.
Author information
Authors and Affiliations
Contributions
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
Ethics declarations
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.
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) |
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40894-018-0080-9