Crazy, Weak, and Incompetent: A Directed Content Analysis of Self-Injury Stigma Experiences

ABSTRACT

Despite significant impacts to mental health and support-seeking, non-suicidal self-injury (NSSI) stigma remains under-studied and poorly understood. Recently, the NSSI Stigma Framework was proposed, conceptualizing NSSI stigma as comprising six constructs (origin, concealability, course, peril, aesthetics, disruptiveness) that manifest across four perspectives (public, self, anticipated, enacted). The present study investigated the extent to which this framework can account for individuals’ NSSI stigma experiences using a directed content analysis. Written responses from 99 university undergraduates (M^age = 21.5, SD = 3.7; 83.8% female) generated 731 data units for analysis, of which 299 (40.9%) were coded. Results demonstrated support for the public and enacted perspectives, with participants describing stigma experiences within friendships, families, schools, and workplaces. Data pointed to both direct and indirect experiences of public stigma, suggesting a more nuanced understanding of this perspective is required. While there was sufficient support for a majority of elements, more work is needed to verify the applicability of the self and anticipated perspectives. Our findings contribute to a growing body of research investigating NSSI stigma, and provide preliminary support for the utility of the NSSI Stigma Framework in identifying multiple facets of NSSI stigma. Implications for intervention and future research are discussed.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data Availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy and ethical restrictions.

Notes

¹ Intercoder reliability was first assessed using Cohen’s Kappa (κ; Cohen 1960), calculated with the irr package for R (version 0.84.1; Gamer et al. 2019). Despite high percentage agreement, intercoder reliability remained low after round three of cross-coding, likely due to the Kappa paradox (Feinstein and Cicchetti 1990). Gwet’s AC₁ was subsequently used.

² While the term “self-harm” may refer to both suicidal and nonsuicidal behaviors, it tends to be used to refer to nonsuicidal self-injury in Australia.

³ See supplemental materials for classifications of reported emotions

Additional information

Funding

Lexy Staniland is supported by the Australian Government RTP Research Training Program stipend. Mark Boyes is supported by the National Health and Medical Research Council Australia (Investigator Grant 1173043).

Notes on contributors

Lexy Staniland

Lexy Staniland is a PhD Candidate and Sessional Academic in the School of Population Health at Curtin University. Her research interests span mental illness, neurodiversity, non-suicidal self-injury (NSSI), suicidality, and stigma. She is also interested in science communication and is currently sitting on the Executive Board for the International Society for the Study of Self-Injury.

Penelope Hasking

Penelope Hasking is a Professor in the School of Population Health at Curtin University. Her research focuses on high risk behaviors, particularly alcohol abuse and NSSI.

Stephen P. Lewis

Stephen Lewis is a Professor in Clinical Child and Adolescent Psychology at the University of Guelph. His research program examines NSSI and related mental health difficulties among youth and emerging adults.

Mark Boyes

Mark Boyes is an Associate Professor in the School of Population Health at Curtin University and was recently awarded an Emerging Leader Fellowship through the National Health and Medical Research Council (NHMRC) to investigate mental health and well-being among children with reading and literacy difficulties. His research interests span health, development, and clinical psychology, with a focus on emotional experiences and emotion regulation.

Sylvanna Mirichlis

Sylvanna Mirichlis is a PhD Candidate in the School of Population Health and an Assistant Program Coordinator and Specialist Mentor in the Counselling and Disability Services at Curtin University. Her main research interest lies in the disclosure of NSSI.