The Social Processes Maintaining Engagement in Repetitive Self-Harm

Abstract

Background: Epidemiological studies evidence increasing rates of self-harm within the United Kingdom and pressure on the National Health Service to adequately support individuals who engage in repetitive self-harm. Repetitive self-harm is defined as five or more occurrences of SH within a one-year period. There is a developing evidence base to suggest that repetitive self-harm can be conceptualised as an addictive behaviour, but results are conflicting. Methodology: This research aimed to qualitatively explore whether repetitive self-harm is experienced as an addictive behaviour, using existing theories and knowledges about addiction and addictive behaviours. Semi-structured interviews were completed with 15 adults aged 20-61 years with current or past experience of repetitive self-harm. Constructivist Grounded Theory methodology was used to guide the collection and analysis of data. Findings: A conceptual model illustrating the addictive processes within repetitive self-harm was co-constructed, highlighting the dynamic and interacting factors that maintain engagement. Categories were identified that depicted participants journeys with self-harm over time: ‘Starting’ and soon ‘Needing to punish myself’ led on to self-harm ‘Feeling addictive’. Once they had engaged with repetitive self-harm ‘Having the urge to self-harm’ and a ‘Conflicting relationship with self-harm and self’ was ongoing. Throughout each incidence of SH, participants experienced a cycle of processes that interacted, describing this as the “Cycle of SH” involving: ‘Managing emotions’, ‘Allowing me to function’, ‘Caring for myself’, ‘Controlling’ and ‘Feeling guilt and shame after self-harm’. It was constructed that ‘Responding to others’ reactions’ interacted with the “Cycle of SH” but also led to ‘Breaking the cycle’. For some, this led to ‘Relapsing’ and returning to the cycle. Conclusions and implications: This work evidences the potential benefits of conceptualising RSH as an addictive behaviour, in particular drawing upon the wealth of models to understand, treat and recover. The findings have generated new knowledges with the potential to influence clinical understanding, treatment and seek to reduce misconceptions and stigma around SH. Clinical, policy and research invitations are discussed.