A Necessary Pain: A Literature Review of Young People’s Experiences of Self-Harm

Figures & data

Figure 1. Flow chart of paper selection.

Table 1. Overview of articles included in the literature review.

Authors Year Country	Title	Aim	Participants	Method	Results
Bheamadu, Fritz, & Pillay 2012 South Africa	The experiences of self-injury amongst adolescents and young adults within a South African context	To explore the experiences of self-injury among adolescents and young adults in the South African context	12 participants (11 female and 1 male) aged 18 to 22 years	Qualitative methodology Individual interviews, personal writings, and collages Thematic phenomenological analysis	Three major thematic experiences of self-injury emerged: Biological experiences concerning physical and psychological pain Psychological experiences concerning affective and cognitive experiences Social experiences concerning family experiences, peer relations, and social roles
Hill & Dallos 2011 UK	Young people’s stories of self-harm: A narrative study	To look at the stories of six adolescents who engaged in self-harm to make meaning of their self-harm and life experiences	6 participants (5 female and 1 male) aged 15 to 18 years	Qualitative methodology Narrative individual interviews in three phases: a life story interview, a reflective interview, and a member validation process. Narrative analysis	Four common themes with a focus on affect/evaluation are presented: “People just don’t understand, self-harm is my way of coping; it doesn’t mean that I’m weird or crazy” “Talking is difficult, so I keep it all inside” Turning the anger inwards The findings also present how the adolescents told their stories with focus on structure, coherence, integration, resolution, defensive processes, and their further defence of aspects of their stories
Klineberg, Kelly, Stansfeld, & Bhui 2013 UK	How do adolescents talk about self-harm?: A qualitative study of disclosure in an ethnically diverse urban population in England	To investigate how an ethnically diverse sample of adolescents living in an urban community spoke about self-harm and their experiences of disclosure and help-seeking	30 participants (24 female and 6 males), with and without experience of self-harm, aged 15 to 16 years	Qualitative methodology Semi-structured individual interviews Framework approach analysis The parts of this study that report the experiences of those who had never hurt themselves were not included in this literature review	Six thematic categories are presented: Talking about self-harm Suicide and self-harm Self-harm in other people Disclosure and secrecy about self-harm Help-seeking Response to self-harm without help being sought
Kokaliari & Berzoff 2018 USA	Non-suicidal self-injury among nonclinical college women. Lessons from Foucault	To address the social dimensions of women’s self-injury using Foucault’s theory	10 participants (all female), aged 18 to 23 years	Grounded theory In-depth individual semi-structured interviews	Four themes are presented: Autonomy, self-reliance, and the denial of feelings Needing to be perfect, just like men Self-injury as a Western form of personal and social control Self-injury as a quick fix
Lesniak 2010 USA	The lived experience of adolescent females who self-injure by cutting	To explore the experiences of adolescent females who self-injure by cutting	6 participants (all female) aged 15 to 19 years	Qualitative methodology Open ended individual interviews Phenomenological approach	Nine themes are presented: Living with childhood trauma Feeling abandoned Being an outsider Loathing self Silently screaming Releasing the pressure Feeling alive Being ashamed Being hopeful for self and others The general structure that emerged from a synthesis of these themes was that the adolescent females’ experiences of self-injury by cutting was part of their struggle for well-being and hope for more by using their skin as a canvas upon which to express their internal pain as tangible and real.
McAndrew & Warne 2014 UK	Hearing the voices of young people who self-harm: Implications for service providers	To elicit the narratives of young people who engage in self-harm and suicidal behaviour to identify what was helpful and/or unhelpful, and what their future needs might be, from a diverse range of statutory and non-statutory services.	7 participants (all female), aged 13 to 17 years	Qualitative methodology Narrative individual interviews Interpretative phenomenological analysis	Three themes are presented: Cutting out the stress Stepping onto the path of help Cutting to the chase These themes show which factors trigger or sustain self-harming behaviour and what functions the behaviour fills. The results also show what the young people thought was important in seeking help and what they thought needed to be done to help others who hurt themselves
Moyer & Nelson 2017 USA	Investigating and understanding self-mutilation: The student voice	To explore the meanings that self-mutilating behaviours have for adolescents.	6 participants (4 female and 2 male), aged 12 to 18 years	Qualitative methodology Semi-structured interviews on three occasions with each participant Phenomenological approach	Six common themes emerged: The first cut ‘A tape recorder in the head’ A way to handle life situations and cope with emotions Feelings of guilt, shame, and regret Not wanting to hurt others How they wish to be treated
Rissanen, Kylmä, & Laukkanen 2008 Finland	Descriptions of self-mutilation among Finnish adolescents: A qualitative descriptive inquiry	To describe self-mutilation from the perspectives of self-mutilating adolescents	70 participants (69 female and 1 male) aged 12 to 21 years	Qualitative descriptive design Written reflections Inductive content analysis	Three main categories emerged: Descriptions of factors contributing to self-mutilation Descriptions of the self-mutilation act Descriptions of the sequels of self-mutilation
Tan, Tam & Bonn 2019 Malaysia	Feeling better or worse? The lived experience of non-suicidal self-injury among Malaysian University students	To explore subjective experiences and motivations related to non-suicidal self-injury	7 participants (6 female and 1 male), aged 18 to 22 years	Qualitative methodology Semi-structured face-to-face interviews Interpretative phenomenological analysis	Four major themes were identified: Emotional dysregulation NSSI as emotion regulation strategy Negative self-perception Struggling with the adverse consequences of self-injury
Tillman, Prazak & Obert 2018 USA	Understanding the experiences of middle school girls who have received help for non-suicidal self-injury	To understand the lived experiences of middle school girls who have engaged in NSSI and who have received professional help for those behaviours. More specifically (a) motivations to engage in NSSI, (b) methods of engaging in NSSI, (c) perceived consequences of NSSI, and (d) attitudes towards seeking treatment for NSSI.	6 participants (all female), aged M = 13.8; SD = 0.41	Qualitative methodology Open-ended questions using Survey Monkey, an online data collection programme Interpretative phenomenological analysis	Seven master themes were found: Self-injury history Reasons for self-injury Consequences of self-injury Perception of self and self-injury Reactions of others to self-injury help-seeking for self-injury what professionals should know about self-injury

NSSI: non-suicidal self-injury.

Table 2. Overview of sub-categories, categories, and theme revealed in the analysis.

Sub-categories	Categories	Theme
Control Relief and security Overwhelming feelings	Coping	A necessary pain
Self-punishment Addiction Shame and guilt	Suffering
Loneliness Hiding oneself Judged	Alienation
Speaking without words Cry for help	Communication

*Bheamadu, C., Fritz, E., & Pillay, J. (2012). The experiences of self-injury amongst adolescents and young adults within a South African context. Journal of Psychology in Africa, 22(2), 263–268. https://doi.org/https://doi.org/10.1080/14330237.2012.10820528

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*Hill, K., & Dallos, R. (2012). Young people’s stories of self-harm: A narrative study. Clinical Child Psychology and Psychiatry, 17(3), 459–475. https://doi.org/https://doi.org/10.1177/1359104511423364

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*Klineberg, E., Kelly, M. J., Stansfeld, S. A., & Bhui, K. S. (2013). How do adolescents talk about self-harm: A qualitative study of disclosure in an ethnically diverse urban population in England. BMC Public Health, 13(1), 572. https://doi.org/https://doi.org/10.1186/1471-2458-13-572

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*Kokaliari, E., & Berzoff, J. (2008). Non-suicidal self-injury among nonclinical college women: Lessons from Foucault. Affilia, 23(3), 259–269. https://doi.org/https://doi.org/10.1177/0886109908319120

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*Lesniak, R. G. (2010). The lived experience of adolescent females who self-injure by cutting. Advanced Emergency Nursing Journal, 32(2), 137–147. https://doi.org/https://doi.org/10.1097/TME.0b013e3181da3f2f

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*McAndrew, S., & Warne, T. (2014). Hearing the voices of young people who self-harm: Implications for service providers. International Journal of Mental Health Nursing, 23(6), 570–579. https://doi.org/https://doi.org/10.1111/inm.12093

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*Moyer, M., & Nelson, K. W. (2007). Investigating and understanding self-mutilation: Student voice. Professional School Counseling, 11(1), 42–48. https://doi.org/https://doi.org/10.1177/2156759X0701100106

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*Rissanen, M., Kylmä, J., & Laukkanen, E. (2008). Descriptions of self-mutilation among Finnish adolescents: A qualitative descriptive inquiry. Issues in Mental Health Nursing, 29(2), 145–163. https://doi.org/https://doi.org/10.1080/01612840701792597

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*Tan, S. C., Tam, C. L., & Bonn, G. (2019). Feeling better or worse? The lived experience of non-suicidal self-injury among Malaysian university students. Asia Pacific Journal of Counselling and Psychotherapy, 10(1), 3–20. https://doi.org/https://doi.org/10.1080/21507686.2018.1541912

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*Tillman, K. S., Prazak, M., & Obert, M. L. (2018). Understanding the experiences of middle school girls who have received help for non-suicidal self-injury. Clinical Child Psychology and Psychiatry, 23(4), 514–527. https://doi.org/https://doi.org/10.1177/1359104517743784

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