Discovering One’s Own Way: Adolescent Girls’ Different Pathways Into and Out of Self-Harm

Abstract

Self-harm is associated with mental illness and suicide risk. The present study aims to increase knowledge of adolescent girls’ pathways into and out of self-harm. The participants were 19 girls, 13 to 18 years of age, who were strategically selected from an outpatient care unit. A naturalistic multiple case study was done with personal interviews. The interviews were analyzed using Interpretative Phenomenological Analysis, and the capacity for “mentalization”—representation of behavior in terms of mental states—was measured with the Reflective Functioning Scale. The analysis of the topic “beginning self-harm” resulted in two meta-themes: (a) beginning self-harm as a way to handle difficult feelings and relational problems and (b) becoming influenced by peers to experiment with self-harm. The analysis of the topic “quitting self-harm” resulted in three meta-themes: (a) ambivalence toward help, treatment, and ending self-harm; (b) finding one’s own way of quitting self-harm; and (c) exploring self-harm together with the therapist. Three case stories illustrate variations in trajectories of change and capacity for mentalization. The findings suggest that self-harm may be a way of handling developmental challenges in autonomy and identity formation during adolescence. Adolescents need an opportunity to discover their own way of quitting self-harm. Variations in mentalization may provide for different pathways.

The Punished Self, the Unknown Self, and the Harmed Self – Toward a More Nuanced Understanding of Self-Harm Among Adolescent Girls

“…They found several subjective experienced precipitating factors and triggers for self-harm which may increase knowledge of their need to self-harm, such as distressing emotions, sense of isolation, exposure to self-harm, relationship difficulties, social comparison, and school/work difficulties. Another recent qualitative study, Stänicke et al ( 2019 ) highlights how young girls in a clinical sample experience common aspects and different pathways into and out of self-harm. All girls began self-harming because of difficult feelings and relational problems but described their problems differently – as a way to handle self-criticism, diffuse stress, or earlier traumatic events.…”

“…Interestingly, regarding autonomy as a possible developmental challenge during adolescence, they underlined how they discovered their own way out of self-harm. Further, they described different ways out of self-harm – by being understood and developing self-supporting monologs, by sharing experiences and trying coping-strategies, or by being respected and receiving practical support (Stänicke et al, 2019 ).…”

Behandling av selvskade – hva virker, og hva virker ikke?

“…I en kvalitativ studie med en fortolkende fenomenologisk analyse (Interpretativ phenomenological analysis) (Smith, 2008) ble 19 ungdommer (12-18 år) intervjuet om deres opplevelse av egen selvskading. Selv om alle fikk poliklinisk behandling var det ingen som uttrykte at de begynte i behandling fordi de selv ønsket å slutte å skade seg (Stänicke et al, 2019). For ungdommene var det ikke selvskadingen som var problemet.…”

‘I chose the bad’: Youth's meaning making of being involved in self‐harm content online during adolescence

“…Qualitative research can complement context-independent results from quantitative studies by exploring with open questions how youths' make sense of everyday life and how self-harm and mental health problems are related to involvement in self-harm content online. The present study follows up with a group of young people (aged 18-23), 5 years after participating in a qualitative interview study exploring their ways into and out of self-harm (Stänicke et al, 2020). Having previously identified that they were influenced by peers and self-harm content online in their choice to self-harm as adolescents, the now young adults reflect on their lived experience of online self-harm activities.…”