Deliberate Self-Harm at an Adolescent Unit: A Qualitative Investigation

Abstract

This investigation aimed to identify some of the personal and interpersonal processes involved in deliberate self-harm at a residential treatment setting for adolescents with mental health problems. A qualitative approach was used, which included interviews and participant observation. Six adolescents with a history of deliberate self-harm were interviewed about their perceptions of deliberate selfharm. The interviews were analysed using interpretative phenomenological analysis. Process notes from observations at the unit community meeting were used to provide support for the themes generated in the interviews. Deliberate selfharm was identified as a response to conflict or feeling distressed or angry. It left other patients feeling angry, upset and burdened with a sense of responsibility. Subgroups of 'self-harming for genuine reasons' and 'self-harming for attention' emerged as a central theme. Adolescents competed to be a genuine self-harmer: this led to feeling a need to cause a certain level of damage when self-harming and to harm in secret. Seeking help was difficult. The study concluded that group treatment methods were indicated, as well as challenging the traditional response to deliberate self-harm of not giving attention.

Remitted depression moderates self-injurious behavior in personality-disordered research volunteers

“…This finding is consistent with research showing that self-aggressive models in the social environment increase the incidence of SIB (Crouch and Wright, 2004). These results should not be interpreted to mean that SIB is not possible in PD individuals during a major depressive episode.…”

“…For example, it is possible that an acute depressive episode may inhibit, rather than exacerbate, SIB due to decreased initiation of goal-directed activity and reduced motivation to change a negative mood state. Also, social cues that could prompt self-injury (McCloskey and Berman, 2003;Crouch and Wright, 2004) may be less salient during a depressive episode due to attention and concentration deficits. However, recurrent depressive episodes may have a long-term effect on neurobiologic functioning that could increase risk for impulsive acts and responsiveness to self-aggressive cues during remission.…”

Exploring the Reciprocal Relations between Nonsuicidal Self-Injury, Negative Emotions and Relationship Problems in Chinese Adolescents: A Longitudinal Cross-Lag Study

“…While NSSI may serve certain interpersonal functions in the short run, this behavior may also elicit negative reactions from others. NSSI is often viewed as attentionseeking (Crouch and Wright 2004;Gilbertson and Wilson 2008), especially if not kept secret, and is regarded as manipulative in nature (Harris 2000;Wilstrand et al 2007). In one study with adolescent inpatients, Crouch and Wright (2004) reported that adolescent self-injurers who used NSSI for attention were hated by their peers and seen as "stupid".…”

The long sleep-over: the lived experience of teenagers, parents and staff in an adolescent psychiatric unit

“…When other studies incorporate a qualitative lens, again the focus tends to be restricted to one type of phenomenon such as Crouch and Wright's (2004) investigation into self-harm in an adolescent unit. Six adolescents were interviewed as to their reasons for self-harm.…”

“…His response is not unusual. Deliberate self-harm by an adolescent inpatient often leaves the other teenagers feeling angry or with a burdened sense of responsibility (Crouch & Wright, 2004).…”