Adults who self-harmed in adolescence: advice for the next generation

Scope: Self-harm is a common behaviour in both clinical and non-clinical community populations. A large body of research has focused on the reasons for, and functions of, self-harm. Current models suggest there are both interpersonal and intrapersonal reasons why people engage in self-harm (Klonsky & Glenn, 2009). However, little is known about how individuals make sense of their self-harm. Many people cease self-harming, and the prevalence rates for self-harm significantly reduce in adulthood. Current research findings suggest that, similar to the reasons for engaging in self-harm, there are multiple reasons for self-harm cessation. A small body of research has identified that people who self-harm seek support and advice from others, often via online forums. However, to date this research has explored the perspectives of the help-seeker and little is known about the experience of the individuals with a lived experience whom are providing advice and support. Purpose: The purpose of the study was to explore the lived experience of adults who self-harmed in adolescence. It also aimed to explore the self-reported reasons for engaging in self-harm. For those participants who had ceased self-harm, the study aimed to investigate their reasons for stopping. The final aim was to understand what advice those with a lived experience would offer to adolescents currently engaging in self-harm. This study appeared to be the first to explore retrospective appraisals of adolescent self-harm, and how this lived-experience informs the advice given to adolescents currently engaging in self-harm. Methodology: Participants were adults aged between 18 and 61 years (M = 26.54, SD = 7.11) Participants included 173 females (93.5%), 11 males (6%) and one participant identifying their gender as other (.5%). Participants had self-harmed as an adolescent, and the act(s) of self-harm were not part of a suicide attempt. Participants completed an online questionnaire, which contained several psychometric scales. Pertinent to the current study, participants also responded to four qualitative questions: (1) What were your main reasons for self-harming in adolescence?, (2) How did you feel about your self-harm when you were an adolescent?, (3) If you have stopped self-harming, what were your main reasons for stopping?, and (4) What advice would you give to an adolescent who is currently self-harming? A directed content analysis method was used to analyse the responses to question one. A conventional content analysis method was used to analyse the responses to questions two, three and four. Results: For the majority of participants, there were multiple reasons why they engaged in self-harm as an adolescent. In line with Klonsky and Glenn’s (2009) interpersonal and intrapersonal model, the current study found support for affect regulation, self-punishment and managing dissociation as the most frequently reported reasons for self-harm. Many participants described feelings of ambivalence about their self-harm; they experienced feelings of shame, but also recognised the functionality and the necessity of the behaviour as a coping mechanism. Changes in relationships, frustration with shame, receiving professional treatment and an improvement in mental health were the most frequently reported reasons for ceasing self-harm. The majority of participants encouraged adolescents currently self-harming to seek help and support and to develop alternative coping mechanisms or emotion regulation strategies. Conclusions and Implications: The findings support seven of the thirteen factors identified in Klonsky and Glenn’s (2009) interpersonal and intrapersonal model. Self-harm is a complex experience, and factors such as shame can be a reason for self-harm, form part of self-appraisal and be a motivator to cease the behaviour. This study was the first to explore what advice people with a lived experience of self-harm would give to adolescents currently engaging in the behaviour. Future research should aim to explore how for some factors, such as shame or interpersonal relationships, they were both a reason for engaging in self-harm and a reason for stopping the behaviour. Perhaps understanding how this mechanism transitions from being a trigger to a motivator to stop the behaviour could assist with the development of evidence-based interventions. Future research should endeavour to replicate these findings in gender-balanced. Furthermore, future research should explore the similarities and differences (if any) in the experience of self-harm for individuals with different mental health diagnoses.