Self-harm

• We conducted a meta-analysis of the association between LGBT status and NSSI • Sexual and gender minorities are at elevated risk for NSSI • Transgender and bisexual individuals are at greatest risk for NSSI • General and LGBT-specific factors likely account for this greater risk • Longitudinal and treatment studies are needed A R T I C L E I N F O Keywords: LGBT Meta-analysis Non-suicidal self-injury Self-harm Sexual minority A B S T R A C T The current review presents a meta-analysis of the existing empirical literature on the prevalence of non-suicidal self-injury (NSSI) among lesbian, gay, bisexual, and transgender (LGBT) individuals, as well as on correlates of NSSI within sexual and gender minority populations. Eligible publications (n = 51) were identified through a systematic search of PsycINFO, MEDLINE, and Embase, supplemented by a search of references of prior reviews on this topic. NSSI prevalence rates were quite elevated among sexual (29.68% lifetime) and gender (46.65% lifetime) minority individuals compared to heterosexual and/or cisgender peers (14.57% lifetime), with trans-gender (46.65% lifetime) and bisexual (41.47% lifetime) individuals being at greatest risk. Even among these group findings, sexual minority youth emerged as an especially vulnerable population. Moreover, current evidence suggests these rates and differences between LGBT and heterosexual and/or cisgender peers have not declined over time. These findings may in some measure be due to the existence of LGBT-specific risk correlates combined with general risk correlates being more severe among sexual and gender minority populations. Additional research, particularly employing a longitudinal design, is needed in this area to advance efforts to reduce risk for NSSI among sexual and gender minority individuals.

Individuals suffering from depression consistently report experiencing a lack of connectedness with others. David Karp (2017, p. 73), in his memoir and study of depression, has gone so far to describe depression as “an illness of isolation, a disease of disconnectedness”. It has become common, in phenomenological circles, to attribute this social impairment to the depressed individual experiencing their body as corporealized, acting as a barrier between them and the world around them (Fuchs, 2005, 2016). In this paper, I offer an alternative view of the experience of social disconnectedness in depression, suggesting that rather than necessarily experiencing their body as object-like, the depressed individual’s bodily is saturated with experiences of lethargy, tiredness, heaviness, sadness, hopelessness and so on, to the exclusion of being able to bodily connect to others. I suggest that depression does not involve a complete social impairment but a specific impairment of affective forms of interpersonal experience.

Purpose: This study aims to investigate the emotional perspective of having Dyslexia, a specific learning difficulty that not only affects literacy but many aspects of an individual’s life, from childhood into adulthood. This paper investigates negative emotional coping which took place, which included self-harming with: alcohol, food, body injury, suicide thoughts and suicidal attempts.
Method: The sample of N=29 diagnosed developmental dyslexics (N=22 with prior diagnosis of depression) were interviewed with a semi-structured script with a wide ranging script spanning childhood and adulthood experience. Interpretative Phenomenological Analysis (IPA) was used to analyse the data into themes.
Results: Self-harm was greater in the depressive to non-depressive sample; however, the type of self-harm varied. Males and non-depressives tended to predominantly self-harm with alcohol, followed by food and then rarely with bodily harm, whereas females in general, tended to predominantly self-harm with food, then bodily harm and lastly alcohol. Overall depressives self-harmed predominantly with food and then equally between alcohol and bodily-harm.
Conclusion: Each group had their own profile and suggests that self-harm is a complex issue, with self-harm activities happening both in child and adulthood.

Respond to each numbered item in the short list here as either True or False for you. A “True” response may identify a potential area for training. Reflect on whether an item identifies a problem or issue in the way you manage your anger. Anger requires boundaries, and a moral value (e.g. OK or not OK) can be assigned to ways of expressing anger.

This book is open access under a CC BY license and charts the rise and fall of various self-harming behaviours in twentieth-century Britain. It puts self-cutting and overdosing into historical perspective, linking them to the huge changes that occur in mental and physical healthcare, social work and wider politics.

This article presents a sociologically informed critique of a range of academic literatures relating to self-injury. It is noted how a lack of consensus on definitional issues, together with the inaccurate portrayal of the “typical self-injurer” in the clinical literature, has impeded the development of a sound understanding of self-injury. Some of the more problematic explanations for self-injury are explored. The individualistic focus of existing research is found to be inadequate, since it fails to account for the social context in which self-injury occurs. Social scientific approaches critically examine psychiatric and psychological constructions of self-injury, explore wider social and cultural meanings of the behavior, and examine its distribution across different social groups. The inclusion of social scientific perspectives into current debates will greatly improve understanding of self-injury.

Drawing on narrative research conducted in the UK about self-injury and embodiment, this article presents a novel sociological analysis of self-injury, utilizing the concept of emotion work. By focusing explicitly on embodied methods of ‘doing’ emotion work, the article highlights the under-recognized importance of examining the practical, corporeal practices that can be involved in emotion work. I reflect on the sociological and theoretical significance of examining self-injury as embodied emotion work – both as an analytic concept and as a narrative resource.

This study was conducted to determine the predictive effect of the features (scale scores) related to the factors that affect social exclusion, friendship quality, social competence and emotional management skills in adolescents on adolescent problem behaviors such as smoking, alcohol use, unhappiness, hopelessness and self-harm behaviors. This research was carried out on 422 students studying at 9 th , 10 th and 11 th grades in 11 high schools randomly selected among the state Anatolian high schools of Kadıköy with the permission of Istanbul Governorship MNE No: 59090411-20-E.4519169 dated 21.04.2016. Data were collected through Social Exclusion, Friendship Quality, Social Competence and Emotional Management Scales and personal information form prepared by the researcher. The data were analyzed with SPSS 23 statistical software, two-way ANOVA (univariate) and logistic regression techniques. The findings showed that on the features related to social exclusion, social competence, friendship quality and emotional management skills, the following were effective: having smoker friends, having friends with negative behaviors towards others, dissatisfaction with physical appearance, perception of self-efficacy, getting along with friends, being sensitive towards daily events, having smoker family members and alcohol use the family, experiencing less economic problems in the family and participating in activities such as cinema with the family. The quality of friendship intimacy had an increasing effect on smoking and alcohol use, while the security dimension had a reducing effect on alcohol use, feeling unhappy, feeling hopeless and self-harm (bodily damage). The social exclusion, emotional management and coping with the problem dimensions had a diminishing effect on alcohol use, while negative emotions and the ability to control negative bodily reactions had a diminishing effect on self-harm behaviors. The findings suggest that, especially emotional management skills, friendship quality and social exclusion are dynamics that can determine the psycho-social risk susceptibility of adolescents. The results of the research reveal the importance of getting adolescents to gain the skills to manage friendship selection and friendship relations through studies aimed at supporting the emotional development of adolescents.

This research report presents findings about the extent and nature of digital self-harm among New Zealand teens. Digital self-harm is broadly defined here as the anonymous online posting or sharing of mean or negative online content about oneself. The report centres on the prevalence of digital self-harm (or self-cyberbullying) among New Zealand teens (aged 13-17), the motivations, and outcomes related to engaging in this behaviour. The findings described in this report are representative of the teenage population of New Zealand by gender, ethnicity and age. Key findings are: Overall, 6% of New Zealand teens have anonymously posted mean or negative content online about themselves in the past year. Teenagers’ top reasons for this behaviour were: making a joke, wanting to show resilience, looking for friends’ sympathy, and seeking reassurance of friendship. By exploring the nature and extent of this behaviour, we are providing the online safety community, schools and parents with insights about a complex and, to some extent, hidden phenomenon involving New Zealand teens.

Resumo: Neste artigo trago uma analise que tem como ponto central o crescimento entre adolescentes e jovens do fenomeno conhecido como automutilacao (fazer cortes no proprio corpo para aliviar problemas sentimentais), um comportamento autolesivo e que muitas vezes tem conduzido a pesquisas ou interpretacoes estritamente na area medica e psicologica. Por esta razao, o termo subcultura, associado a um gosto musical, comecou a aparecer nao somente em pesquisas sobre moda, midia ou consumo. Estudos sobre saude mental e comportamento jovem vinham relacionando de muitas maneiras a automutilacao e o suicidio a determinadas modas urbanas e seus gostos musicais subjacentes. Assim, os aspectos que serao aqui discutidos, derivados de trabalho de campo desenvolvido e inspirado no metodo etnografico, têm o intuito de revelar conexoes mais abrangentes, de natureza cultural e historica, a respeito do desenvolvimento de movimentos jovens urbanos, sua estetica e formas de representacao de dilemas que sao inerentes a cada geracao, fornecendo outras possibilidades de compreensao acerca da relacao entre comportamento autodestrutivo e musica alternativa. Podemos concluir que e justamente neste contexto de descobertas e de transgressoes no mundo da juventude que a musica, desde o jazz ate o pos-hardcore, ganha especial importancia nos processos de construcao de identidade, de interacao e, inclusive, como mecanismo de lidar com sentimentos, como uma especie de apoio e alivio para suportar frustracoes e outras dificuldades de cunho emocional.

Abstract: This article presents an analysis that focuses on the growth of a phenomenon known as self-mutilation (cuts in the body to relieve emotional problems), seen among adolescents and young people; a self-injuring behavior that has often led to research or interpretation mostly restricted to the medical or psychological field. On the other hand, as a result of this, the term subculture, associated with a musical taste, began to appear in researches involving fashion, media or consumption. Studies on mental health and young behavior had in many ways related self-mutilation and suicide to certain urban fashions and their underlying musical tastes. Thus, the aspects discussed here, derived from field work developed and inspired by the ethnographic method, aims at showing broader cultural and historical connections related to developing young urban movements, their aesthetics and representation of dilemmas inherent to each generation, providing other possibilities for understanding the relationship between self-destructive behavior and alternative music. This article concludes that it is precisely in this context of discoveries and transgressions in the youth world that music, from jazz to post-hardcore, gains special importance in the processes of identity construction, interaction and even as a mechanism to deal with feelings, as a kind of support and relief to endure frustrations and other emotional difficulties.

Extant research has examined the emotional contexts within which self-harm occurs (e.g., Klonsky, 2009), and research suggests that thoughts and acts of NSSI in adolescents are often preceded by worry, or having a bad memory (Nock, Prinstein & Sterba, 2010).  Although research has examined the emotional and internal states in which NSSI occurs, there is a lack of research examining the external environment that precipitates self-harm. In suicide research, 50.2% of adolescents presenting to a local hospital in Norway report relational conflicts as the most common trigger for a suicide attempt (Dieserud, Gerhardsen, Van den Weghe, & Corbett, 2010). Expanding research from suicide research into the realm of non-suicidal self-injury (NSSI) has implications for improving patient awareness of environmental states that trigger self-harm. Thus, the current study (1) describes environmental precipitants of self-harm and (2) examines the relationship between environmental precipitants and functions of self-harm.

Participants (N=465; Mage = 21.34, SD = 5.40; 81% female) who have engaged in self-harm were recruited from online communities (N=150; Mage = 22.38, SD = 7.15; 93% female) and from university campus (N=315; Mage = 20.8, SD = 4.19; 76% female), and completed the Questionnaire for Non-Suicidal Self-Injury (QNSSI; Schmahl, Bohus, Stieglitz & Reicherzer, 2008; developed for Kleindienst et al., 2008) in exchange for an entry into a draw to win one of five $150CAD prizes or research participation credits for undergraduate psychology courses. The QNSSI measures environmental antecedents (interpersonal rejection, interpersonal conflict, treatment factors, intrapersonal stressors, and other’s self-harm behavior), and functions of self-harm. To examine environmental antecedents of self-harm, frequencies are reported. To examine the relationship between environmental antecedents and functions of self-harm, we conducted correlational analyses.

In the 24 hours prior to engaging in self-injury, the most commonly reported environmental precipitant of self-harm was interpersonal conflict (93.5%), followed by interpersonal rejection (88%), other’s self-harm behaviour (57.2%), intrapersonal stressors (49.9%), and treatment factors (30.6%). Correlation analyses to examine the relationship between environmental precipitants and functions of self-harm indicate that environmental precipitants of self-harm most strongly correlated with self-harm to provide emotional relief, to generate feelings, and to punish the self (all ps < 0.02). Self-harm to influence others was not significantly correlated with treatment factors or intrapersonal stressors, and self-harm to communicate to others was not significantly correlated with intrapersonal stressors (ps= 0.159 - 0.702).

Research in this area can help illuminate specific environmental triggers of self-harm, such that treatment can be targeted to increase emotion regulation/distress tolerance skills in such situations. Furthermore, the recognition of environmental triggers can help clinicians and their clients develop prevention strategies to help decrease self-harm behaviours. The identification of environmental triggers is especially relevant for DBT clients, who can be trained to be aware of, and identify relevant environmental triggers, which would facilitate the use of DBT skills in the moment. Additionally, telephone skills consultation can be utilized more effectively when clinicians are aware of environmental triggers and how they relate to self-harm behaviours. Understanding the environmental antecedents of NSSI behaviours can lead to improved identification of NSSI triggers, and consequently improve therapeutic outcomes.

Background: The Turkish community living in Europe has an increased risk for suicidal ideation and attempted suicide.
Online self-help may be an effective way of engagement with this community. This study will evaluate the effectiveness of
a culturally adapted, guided, cognitive behavioural therapy-based online self-help intervention targeting suicidal ideation
for Turkish adults living in the Netherlands and in the UK.
Methods and design: This study will be performed in two phases. First, the Dutch online intervention will be adapted to
Turkish culture. The second phase will be a randomized controlled trial with two conditions: experimental and waiting-list
control. Ethical approval has been granted for the trials in London and Amsterdam. The experimental group will obtain
direct access to the intervention, which will take 6 weeks to complete. Participants in the waiting-list condition will obtain
access to the modules after 6 weeks. Participants in both conditions will be assessed at baseline, post-test and 3 months
post-test follow-up. The primary outcome measure is reduction in frequency and intensity of suicidal thoughts. Secondary
outcome measures are self-harm, attempted suicide, suicide ideation attributes, depression, hopelessness, anxiety, quality
of life, worrying and satisfaction with the treatment.

It is clear from other chapters in this book how crucial the exercise of power and control is to peoplewho self-harm. For example, young people have been very clear that any support should respect theirautonomy and not undermine their sense of control (Spandler, 1996). A consistent theme has been:how we develop responses which support young people to remain in control whilst not merelycondoning self-harm and effectively ignoring their pain and distress? One of the ways that self-harmsurvivors have begun to address this themselves is through direct payments, a funding mechanismbased on the key tenets of choice and control. In the previous chapter Louise Pembroke argues thatmore mechanisms need to be developed which support survivors to work within their ownunderstandings and frames of reference so they are able to direct their own support. The organisationSurvivors Speak Out is one of the few mental health organisations to have explicitly endorsed theexpansion of direct payments to people who use mental health services. Therefore, this chapterexplores the possibilities and limitations of using direct payments to facilitate greater choice andcontrol, in relation to support around self-harm.

Background: In Ghana, rates of self-harm in young people are as high as they are in high income countries. Self-reported interpersonal, familial and societal stressors form the most important background, and self-harm is seen by young people as a way of responding to that stress. In the present study, we obtained the views of key adult informants about self-harm among adolescents in Ghana-what they thought as possible reasons for self-harm in young people and what actions might be needed at an individual or population level to respond to the problem. Methods: We interviewed face-to-face 11 adults, using a semi-structured interview guide. We used an experiential thematic analysis technique to analyse the transcribed interviews. Results: The analysis identified five themes: "underestimating the prevalence of self-harm in adolescents", "life on the streets makes self-harm less likely", "self-harm in adolescents is socially and psychologically understandable", "ambivalence about responding to adolescent self-harm", and "few immediate opportunities for self-harm prevention in Ghana". Adolescent self-harm was acknowledged but its scale was underestimated. The participants offered explanations for adolescent self-harm in social and psychological terms that are recognisable from accounts in high income countries. Low rates among street-connected young people were explained by their overarching orientation for survival. Participants agreed that identification was important, but they expressed a sense of inadequacy in identifying and supporting adolescents at risk of self-harm. Again, the participants agreed that self-harm in adolescents should be prevented, but they recognised that relevant policies were not in place or if there were policies they were not implemented-mental health and self-harm were not high on public or political priorities. Conclusions: The adults we interviewed about young people who self-harm see themselves as having a role in identifying adolescents at risk of self-harm and see the organisations in which they work as having a role in responding to individual young people in need. These are encouraging findings that point to at least one strand of a policy in Ghana for addressing the problem of self-harm in young people.

The increasing prevalence of suicide in the Philippines necessitates the utilization of various disciplines to understand the phenomenon. This article attempts to contribute to this endeavor from a Sociological perspective. The paper starts with a review of the wealth of theories that Sociology has to offer in explaining suicide from centuries past to the present, covering pre-Durkheimian theories all the way to Durkheim's contemporaries and those coming from the Interpretivist paradigm. The paper then proceeds to propose a new framework with which to explain the phenomenon borne from the synthesis of two theories not of suicide but rather of criminology: Agnew's General Strain theory and Hirschi's Social bonds theory.

Clients who make repeat suicide attempts have complex needs, are at high risk of completed suicide and pose a range of challenges for clinicians. Targeted interventions are required. Acceptability, the perceived appropriateness of an intervention, is associated with successful implementation, engagement and effectiveness of interventions. Despite the advantages of group interventions, there is limited research into the acceptability of groups with this population. Using Interpretative Phenomenological Analysis, this paper reports on facilitators’ experiences (n = 9) of the acceptability of a therapeutic group intervention (PISA – a Psychoeducational/psychosocial Intervention for persons who make recurrent Suicide Attempts). Analysis of focus group data revealed how involvement with the intervention profoundly influenced facilitators’ perceptions of and approach to their work with this client group. They embraced the model, developed a deeper appreciation of clients’ resources and became unburdened from sole responsibility for the clients, the therapeutic process and outcomes. PISA provided a model that helped facilitators to work in a focused, compassionate and creative manner as they addressed the central concern of these clients, their suicidal desire, with newly found confidence and eagerness. PISA was experienced as acceptable to facilitators as it was useful to them and deemed appropriate and beneficial to the target population.

Background: Repeated self-harm represents the single strongest risk factor for suicide. To date no study with full national coverage has examined the pattern of hospital repeated presentations due to self-harm among young people.
Methods: Data on consecutive self-harm presentations were obtained from the National Self-Harm Registry Ireland. Socio-demographic and behavioural characteristics of individuals aged 10–29 years who presented with self-harm to emergency departments in Ireland (2007–2014) were analysed. Risk of long-term repetition was assessed using survival analysis and time differences between the order of presentations using generalised estimating equation analysis.
Results: The total sample comprised 28,700 individuals involving 42,642 presentations. Intentional drug overdose was the most prevalent method (57.9%). Repetition of self-harm occurred in 19.2% of individuals during the first year following a first presentation, of whom the majority (62.7%) engaged in one repeated act. Overall, the risk of repeated self-harm was similar between males and females. However, in the 20–24-year-old age group males were at higher risk than females. Those who used self-cutting were at higher risk for repetition than those who used intentional drug overdose, particularly among females. Age was associated with repetition only among females, in particular adolescents (15–19 years old) were at higher risk than young emerging adults (20–24 years old). Repeated self-harm risk increased significantly with the number of previous self-harm episodes.
Time differences between first self-harm presentations were detected. Time between second and third presentation increased compared to time between first and second presentation among low frequency repeaters (patients with 3 presentations only within 1 year following a first presentation). The same time period decreased among high frequency repeaters (patients with at least 4 to more than 30 presentations).
Conclusion: Young people with the highest risk for repeated self-harm were 15–19-year-old females and 20–24-year-old males. Self-cutting was the method associated with the highest risk of self-harm repetition. Time between first self-harm presentations represents an indicator of subsequent repetition. To prevent risk of repeated self-harm in young people, all individuals presenting at emergency departments due to self-harm should be provided with a risk assessment including psychosocial characteristics, history of self-harm and time
between first presentations.

Dispositional anxiety is a well-established risk factor for the development of psychiatric disorders along the internalizing spectrum, including anxiety and depression. Importantly, many of the maladaptive behaviors characteristic of anxiety, such as anticipatory apprehension, occur when threat is absent. This raises the possibility that anxious individuals are less efficient at gating threat’s access to working memory, a limited capacity workspace where information is actively retained, manipulated, and used to flexibly guide goal-directed behavior when it is no longer present in the external environment. Using a well-validated neurophysiological index of working memory storage, we demonstrate that threat-related distracters were difficult to filter on average and that this difficulty was exaggerated among anxious individuals. These results indicate that dispositionally anxious individuals allocate excessive working memory storage to threat, even when it is irrelevant to the task at hand. More broadly, these results provide a novel framework for understanding the maladaptive thoughts and actions characteristic of internalizing disorders.

Background: Self-harm, whether attributed to suicidal or non-suicidal motives, is associated with several poor outcomes in young people, including eventual suicide. Much of our understanding of self-harm in young people is based on literature from Europe (particularly, the UK), North America, and Australia. We aimed to synthesise the available evidence on prevalence, the commonly reported self-harm methods, correlates, risk and protective factors, and reasons for self-harm, in adolescents (aged 10-25 years) in sub-Saharan Africa. Method: We searched MEDLINE, PsycINFO, PubMed, African Journals OnLine, and African Index Medicus for records from 1950 through August 2019, without language restrictions. We supplemented the database searches by searching relevant portals for postgraduate theses, reference harvesting, contacting authors for unpublished studies, and hand searching relevant print sources. We applied narrative synthesis to the evidence. Results: Seventy-four studies from 18 sub-Saharan African countries met the inclusion criteria. The median lifetime prevalence estimate was 10·3% (interquartile range [IQR] 4·6%-16·1%); median 12-month prevalence estimate was 16·9% (IQR: 11·5%-25·5%); median 6-month prevalence estimate was 18·2% (IQR: 12·7%-21·8%); and the median 1-month prevalence estimate was 3·2% (IQR: 2·5-14·8%). Studies from Western sub-Saharan Africa reported the highest 12-month prevalence estimates (median = 24·3%; IQR = 16·9%-27·9%). Clinical samples commonly reported overdose, whereas self-cutting was most commonly reported in non-clinical samples. Academic failure, sexual, emotional, and physical abuse, romantic relationship problems, family conflict, depression, and previous self-harm were identified as key correlates of self-harm. No study reported protective factors against self-harm. Conclusion: Variation in estimates was explained by small sample sizes and variation in definitions and measures used. Exploration of associations, risks and protective factors was based upon concepts and measures derived from high income countries. More detailed and culturally sensitive research is needed to understand the context-specific risks and protective factors for self-harm in adolescents in sub-Saharan Africa.

There is a great deal of research concerning self-harm behaviour in youths, but few sociological investigations of the manner in which community formation and identity may encourage, valorise, and sacralise this behaviour. Online communities provide a large amount of support for self-harmers, and can also be a place in which they retreat from negative social environment and express themselves in an authentic and meaningful manner. In this presentation, I will be exploring the case study of ‘soft grunge’ blogs on Tumblr and their very particular aesthetic representations of the self-harm process. Soft grunge is a contemporary aesthetic trend that focuses on motifs including vintage imagery, soft focus, pale flesh, flowers, and bruises. It combines the gentle with the grotesque, providing a space in which feminine-identifying teenagers can explore beauty within fresh wounds and broken skin.

Extant research has examined the versatility (number of methods; Whitlock et al., 2006), functions (Turner, Layden & Chapman, 2012), and emotional contexts (Klonsky, 2009) of non-suicidal self-injury (NSSI), but there is a lack of research examining how frequency of NSSI and borderline personality (BP) features may interact to affect this relationship.  Research suggests that the relationship between NSSI and negative emotionality is moderated by BPD (Gratz, Breetz & Tull, 2009), and that functions of NSSI are related to characteristics associated with BPD, such as emotional vulnerability, impulsivity, and interpersonal difficulties (Turner et al., 2012). Thus, we hypothesize that the relationship between NSSI frequency, and NSSI versatility, functions and emotional contexts will differ across levels of BP features. Thus, the current study aims to examine the interaction of BP features and NSSI frequency as predictors of NSSI outcomes, including versatility, functions (emotion relief, feeling generation, interpersonal influence, interpersonal communication, self-punishment), and emotional contexts (4 categories of emotions based on high/low arousal, and positive/negative valence).

In the current study, participants (N=451; Mage = 21.34, SD = 5.40; 81% female) who have engaged in lifetime or current NSSI were recruited from online and university samples to complete a battery of questionnaires, including the Personality Assessment Inventory-Borderline module (PAI-BOR; Morey, 1991), and Questionnaire from Non-Suicidal Self-Injury (QNSSI; Schmahl, Bohus, Stieglitz & Reicherzer, 2008; developed for Kleindienst et al., 2008), which measures lifetime NSSI frequency, versatility, functions, and emotional context of NSSI. BP features, lifetime NSSI frequency, and a BP features x lifetime NSSI frequency interaction term were then entered hierarchically into multiple regression analyses to examine moderating effects.

BP features were positively related to NSSI versatility, all functions, and changes in positively valenced low arousal emotions following NSSI (all ps < .02), and negatively related to changes in negatively-valenced emotional following NSSI (all ps < .001). Lifetime NSSI frequency, controlling for BP features, was positively related to NSSI versatility, as well as functions related to emotion relief, feeling generation, and self-punishment (all ps < .001), and was negatively related to functions related to interpersonal influence (p = .003). Lifetime NSSI frequency also was also related to greater increases in positively valenced emotions following NSSI (all ps < .001) and decreases in negatively valenced emotions following NSSI (all ps < .05). The interaction of BP features and NSSI frequency was negatively related to functions of interpersonal influence (p=.01) and increases in positively valenced low arousal emotional contexts (p=.02). Specifically, the relationship between NSSI frequency and functions of interpersonal influence is stronger for people with more BP features (r=-.36, p=.002) compared to those with less BP features (r=.04, p=.75), and the relationship between NSSI frequency and changes in low arousal, positively valenced emotional contexts is stronger for people with more BP features (r=-.42, p<.001) compared to those with less BP features (r=.06, p=.59).

The findings of this study suggest the relationship between NSSI frequency and the use of NSSI for the purposes of influencing others, and changes in low arousal, positively valenced emotions contexts (e.g., feeling relief, calm, content, relaxed) is dependent on the level of BP features such that this relationship is most prominent in individuals with high levels of BP features. These results allow us to further understand how BP features influence the use of NSSI, and emphasizes the importance of interpersonal effectiveness and emotion regulation skills training for individuals with high BP features engaging in self-harm.

This book is about supporting young people who use self-harm as a way of coping with distress. It aims to move practice towards more empowering ways of supporting young people which doesn't focus on trying to stop them harming themselves. It includes chapters on informal support, group work, legal rights, direct payments, harm minimsation, couselling; work in prisons; housing support and activism.

Self-harm can be viewed as a contradictory and ambivalent activity. The concepts of ambivalence (to take a term from psychoanalysis) or contradiction (to take a term from dialectics) may be critical exploratory devices to look at the expression and treatment of ...

Psychiatric hospitalization can cause significant distress for patients. Research has shown that to cope with the stress, patients sometimes resort to self-harm. Given the paucity of research on self-harm among psychiatric inpatients, a better understanding of transdiagnostic processes as predictors of self-harm during psychiatric hospitalization is needed. The current study examined whether coping styles predicted self-harm after controlling for commonly associated factors, such as age, gender and borderline personality disorder. Participants were 72 patients (mean age = 39.32 years, SD = 12.29, 64% male) admitted for inpatient treatment at a public psychiatric hospital in Sydney, Australia. Participants completed self-report measures of coping styles and
ward-specific coping behaviors, including self-harm, in relation to coping with the stress of acute hospitalization. Results showed that younger age, diagnosis of borderline personality disorder, and higher emotion-oriented coping were associated with self-harm. After controlling for age
and borderline personality disorder, higher levels of emotion-oriented coping were found to be a significant predictor of self-harm. Findings were partially consistent with hypotheses; emotion oriented but not avoidance-oriented coping significantly predicted self-harm. This finding may help to identify and provide psychiatric inpatients who are at risk of self-harm with appropriate therapeutic interventions.

Background: Recent prevalence studies suggest that self-harm among adolescents in sub-Saharan Africa is as common as it is in high income countries. However, very few qualitative studies exploring first-person accounts of adolescent self-harm are available from sub-Saharan Africa. We sought to explore the experiences and first-person perspectives of Ghanaian adolescents reporting self-harm-for deeper reflections on the interpretive repertoires available in their cultural context for making sense of self-harm in adolescents. Methods: Guided by a semi-structured interview protocol, we interviewed one-to-one 36 adolescents (24 in-school adolescents and 12 street-connected adolescents) on their experiences of self-harm. We applied experiential thematic analysis to the data. Results: Adolescents' description of the background to their self-harm identified powerlessness in the family context and unwanted adultification in the family as key factors leading up to self-harm among both in-school and street-connected adolescents. Adolescents' explanatory accounts identified the contradictory role of adultification as a protective factor against self-harm among street-connected adolescents. Self-harm among in-school adolescents was identified as a means of "enactment of tabooed emotions and contestations", as a "selfish act and social injury", as "religious transgression", while it was also seen as improving social relations. Conclusions: The first-person accounts of adolescents in this study implicate familial relational problems and interpersonal difficulties as proximally leading to self-harm in adolescents. Self-harm in adolescents is interpreted as an understandable response, and as a strong communicative signal in response to powerlessness and family relationship difficulties. These findings need to be taken into consideration in the planning of services in Ghana and are likely to be generalisable to many other countries in sub-Saharan Africa.

Background: Observation is an important approach to care that is commonly used in in-patient learning disability services to prevent self-harming behaviours. It is often implemented when there is a perceived increase risk of self-harm. Most nurses who implement observation have little or no training in the use of this practice. The literature on this subject is also biased towards mental health settings with learning disability services much neglected.
Aim: To explore nurses’ knowledge and understanding of the use of observation on patients who self-harm in a learning disability service in the United Kingdom.
Design and methods: This study adopted a qualitative approach, and utilised interpretative phenomenological analysis as a design and as a tool of analysis. The study was conducted in a secure learning disability service in the United Kingdom. Data were obtained from registered nurses using individual interviews (n=20) and focus groups (n=3x5=15).
Data were analysed thematically using the principles of interpretative phenomenological analysis.
Results: Three superordinate themes emerged from data analysis: 1) observation: its meaning, 2) observation: does it prevent self-harm? 3) Observation: making it work.
Conclusion: Observation is a useful practice in in-patient learning disability services, which can be used to prevent or reduce the incidence of self-harm in these settings. This approach should therefore be an integral part of nurses’ daily therapeutic activities in in-patient learning disability services.

Keywords: learning disability; interpretative phenomenological analysis; nurse; observation; self-harm.