How do adolescents experience their ways in and out of self-harming? This is a follow-up study of a multiple case study on adolescents’ (13-18 years of age) experience of self-harm. In the present study, the now young adults (18-23 years of age) are interviewed five years later with a personal interview and structured interviews on self-harm and mental illness to enhance understanding of different trajectories of self-harm into adulthood regarding mental illness and socio-cultural involvement.
About the project
A recent multiple case-study of adolescents (13-18 years of age) who self-harm and receive treatment (a clinical sample) has increased and nuanced our knowledge on the experience of self-harm (Stänicke, Haavind, Rø, & Gullestad, 2020), and identified different sub-types among the self-harming youths – the punished self, the unknown self, and the harmed self (Stänicke, 2021, 2022). The findings illustrate how close self-harm is to transitory developmental challenges like formation of self-identity.
The present study explores the following questions: How do these adolescents live their life and manage difficulties as young adults? Is self-harm, mental illness and the tendencies of sub-types still present? How is digital media part of their life? How was music helpful in ending self-harm?
Aims
The aim of the proposed follow-up multiple case-study is to increase knowledge of the diversity in trajectories of self-harm into adulthood related to developmental disturbances and mental illness. Further, this study aims to explore self-harm as a cultural sanctioned behavior to handle developmental transformations of self-identity and gender, as a way to establish a community with peers through digital media use, and as a destructive coping mechanism which may be changed by music activity. Differentiation between sub-types and trajectories of self-harm increase knowledge on the diversity of the phenomenon of self-harm, which may help the patient, their families, and their clinicians to better understand their problems, and inform adjustment of treatment interventions to increase self-tolerance, replacing self-harm and practical support.
Background
“Self-harm” refers to intentional self-poisoning or self-injury, irrespective of type of motive or extent of suicidal intent (Hawton et al., 2015). Self-harm has an estimated prevalence of 13-17% among adolescents and young adults in community samples (Swannell et al., 2014), and is associated with a range of mental illnesses and several risk factors (Hawton et al., 2015). As adolescents, these young girls and boys struggle to verbalize inner states and problems and often feel misunderstood in encounters with health workers (Brown & Kimball, 2012). Some adolescents end self-harming after a few attempts, some harm themselves for a period of time, and others continue with excessive self-harm into adulthood. Different treatment methods have been shown to reduce self-harm, depression, and suicidal ideation, but no treatment-models helps all self-harming adolescents (Hawton et al., 2015). Their family and health workers often describe feeling insecure and being overwhelmed by this topic (Johnsen, Ferguson, & Copley, 2017). There is a need for more knowledge on what supports adolescents to quit self-harm, and to understand the diversities in ways out of self-harm. Especially, we need more knowledge on personal and sociocultural resources to find ways to handle their difficulties in less destructive ways.
Financing
The project is a follow up study of «Adolescents’ experience of self-harm – a multiple case study" from 2015-2019. The present study is organized at the Department of Psychology, University of Oslo, Norway.
Cooperation
A user perspective is included in this follow-up study by cooperating with a user organization, Landsforeningen for forebygging av selvskading og selvmord (LFSS), led by Lena-Maria Haugerud. This project also includes a resource group consisting of three user representants, Åse-Line Baltzersen, Mona Skjeklesæther Pettersen, and Tonje Storhaug, who have personal experience of self-harm and extensive treatment and are recruited from the network of LFSS and a nation recourse center on personality disorders (NAPP).
Tools
Personal interviews. The participants will participate in a qualitative in-depth interview, called a Life-mode interview (Haavind, 2011) to get close to the young adults’ perspective and life context.
Structured Interviews. They will be invited to participate in structured interviews to collect data on frequency and methods of self-harm (Linehan Parasuicide History, LPH; Linehan & Comtois, 1996), symptom disorders/ mental illness (International Neuropsychiatric Interview, MINI; Sheehan et al., 1998), personality disorder (Structured Interview for DSM-IV Personality, SIDP-IV; Pfohl, Blum, & Zimmerman, 1997), and social adjustment (The Work and Social Adjustment Scale, WSAS; Mundt, Marks, & Greist, 2002) with the aim of describing the sample. An interview on attachment (Adult Attachment interview; George, Main, & Kaplan, 1984) will be included to rate attachment-related memories with the Reflective Functioning (RF) Scale (Fonagy, Steele, Steele, & Target, 1998) as an operationalization of their ability to understand mental states (scored from -1 to 9).
The empirical data will be analyzed through Interpretative phenomenological analysis (IPA) (Smith, 2015). The data-analysis consists of several phases which are described in an earlier publication (Stänicke et al., 2021). Importantly, the main researcher collaborates with the research group in consensus meetings to secure research triangulation and to increase validity, reflexivity, and trustworthiness of the developed concepts (methodological integrity; Levitt et al. 2016).
Ethics Approval
The Norwegian Regional Committees for Medical and Health Research Ethics (REK) approved the initial study (2014/832). In 2018, REK approved the application of the 5-year follow-up study for further data collection. The project will comply to the research guidelines described by the Norwegian National Research Ethics Committees.