Concerns about suicide and self-harm in English prisons are not new (Third report of the commissioners of prisons, 1880, cited in Liebling, 1992). However, a distinct system of intervention and custody for children (as established by the Crime and Disorder Act 1998) is relatively modern, and as such contextual studies about self-harm have largely, to date, overlooked children as a discrete group existing within a separate framework from adults. Similarly, large-scale research exploring self-harm among children in community settings has largely excluded the group of marginalised young people who come to the attention of youth justice services. This study presents a unique analysis of 181 youth justice assessments (‘Assets’) for boys who were remanded or sentenced to custody in under-18 Young Offender Institutions during 2014-15, tracing the subjects of the assessments from the communities they offended in through to a period in custody, using incident reports completed whilst they were there. What results is a contextual study examining the characteristics of the boys and their behaviour in custody. The study considers two central hypotheses: first, that to result in meaningful and supportive interventions, a definition of self-harm among the boys in the research sample often needs to include the harm they have done to their own lives (what the middle classes might call their ‘prospects’) through offending, and, second, that children who display the common traits of self-harming behaviour in custody may be identifiable by a different set of characteristics and needs from those who self-harm in the community. The author concludes that there is a previously undefined set of risk factors which can be applied to children who self-harm in custody for the first time, moving beyond the known risks associated with adolescent self-harm in the general population. Furthermore, it is found that boys who self-harm in custody are often oing so to exercise agency in an environment where they have very limited power, in circumstances defined not only by the restriction of liberty they are experiencing, but by the difficulties they experienced before coming to custody. Recommendations are made as to how policy-makers, through the current reforms to the youth justice system and a revised approach to assessments upon entry to custody, and practitioners, through increased awareness and improved recording of children’s views can more appropriately intervene in these boys’ lives to benefit them and society more widely.

This research deals with the issue of self-harm, the relationship between self-harm and the Internet, and the relationship between self-harm and subculture. The theoretical part characterizes the age of adolescence, as well as describing self-harm and the emo and gothic subcultures. The aim of the research was to discover the motivations that lead young people to write blogs about self-harm, whether they have their own experiences with self-harm, and if so, what are their experiences, their manner of self-harm, how they experience self-harming, and what are the causes. Another aim was to determine the role that social contagion plays in self-harm and how young people perceive the relationship between self-harm and culture-subculture. The research results showed that the causes of the respondents' self-harm are individual and that there are always several factors at play. As a trigger for self-harm the respondents stated stressful situations, annoyance, surging anger and hatred, depression, and feelings of inferiority. The causes of self-harm were diverse among respondents; they included family problems, parental divorce, death of a loved one, trouble at school, bullying, anorexia, abortion, and rape. Respondents indicated that self-harming served as a release, where mental pain was transformed into physical pain. In this way it provided relief from internal tension and anxiety. i have not found a direct link between emo subculture and self-harming among respondents. There was also an effort to understand the issue of self-harm, as such, more deeply.

Background: Individuals with Borderline Personality Disorder [BPD] symptomatology have high rates of self-harm (50-80%). Limited information exists on the most appropriate interventions to prevent recurrent self-harm in this population. Recent reviews on BPD interventions have suggested more research needs to be conducted looking at how individuals experience interventions with the aim of identifying the effective components of interventions. Objectives: The aim of the present study was to examine how individuals with BPD symptomatology experience interventions to prevent self-harm using a qualitative methodology. Methodology: Twelve individuals with BPD symptomatology and past or current self-harm were recruited through therapeutic services, and took part in a semi-structured interview. The interviews were analysed using a grounded theory approach. Findings: The grounded theory identified a core category, an alternative path to self-harm, and two sub-categories, established beliefs and causal factors, and the time course of self-harm. The results were presented using a process model which was indicative of the participants' experiences of interventions. Conclusions: The findings suggest individuals with BPD symptomatology perceive interventions as helping to reduce self-harm when interventions are long-term, consistent, and instant, and the intervention's outcome matches the purpose for the self-harm. The use of interventions appears to be context dependent, specifically being affected by the individual's level of emotional tension, and their cognitive processing during the decision to seek help. For long-term self-harm prevention, multiple interventions are required, and individuals need to be actively maintaining and evaluating these alternative strategies. It is suggested adoption of such a holistic approach could be one avenue for developing collaborative and effective self-harm interventions in clinical practice.

Understanding the self-harm behavior can help to explain how difficult or easy is the engagement in risk behaviors, included that unhealty. We see that self-harm behavior and the bullying have emerged and researchers have been give attention for it, mainly at adolescence and in the scholar context, the place where we observe more prevalence of it. In this sense, we aimed to investigate the possible relationships between self-harm behaviors and bullying victimization at adolescents of Sergipe. We did three studies: first, a theoretical article that brings the concept, classification and description the self-harm behavior about the development phases, associated factors, diagnostic, treatment/intervention and prevention; second, a empirical article about social distribution of bullying at adolescentes of Sergipe; and third, the main study, a empiral article that investigated possible relationships between self-harm behavior and bullying, as well between self-harm behavior and sociodemographic perfil of a adolescent sample of Sergipe. Mainly, we add knowledge to the literature about self-harm behavior, what contributes for thematic studies because get together the literature findings. At second place, the screening of bullying in Sergipe confirmed the phenomenon prevalence with a rapid diagnostic scale and for this we can use this variable in the third study. At the end, we identified the self-harm occurrence, as well precipitators or reinforcement factors, being possible doing the classification by specific groups of population, our main objective. / Entender as condutas autolesivas ajuda a explicar o que facilita o engajamento das pessoas em outros comportamentos que trazem perigo a si mesmas, inclusive não saudáveis. Vê-se que o comportamento autolesivo e o bullying são fenômenos que têm emergido e chamado atenção de pesquisadores, principalmente no período da adolescência e no contexto escolar, que têm sido apontado como local em que se observa a maior prevalência. Nesse sentido, o presente trabalho buscou investigar as possíveis relações entre condutas autolesivas e bullying em adolescentes sergipanos. Foram realizados 3 Estudos: o primeiro estudo trata-se de um artigo teórico que conceitua, classifica e descreve as condutas autolesivas em relação aos períodos desenvolvimentais, principais fatores associados, formas de avaliação, tratamento/intervenção e prevenção; o segundo estudo se trata de um artigo empírico de rastreio e distribuição social do bullying em adolescentes sergipanos; por fim, o terceiro e principal estudo investigou possíveis relações entre condutas autolesivas e bullying, bem como entre condutas autolesivas e o perfil sociodemográfico de uma amostra do Estado de Sergipe composta por adolescentes. A presente dissertação, em geral, atendeu todos os objetivos. Primeiramente, agregou à literatura sobre condutas autolesivas, o que contribui para o estudo da temática ao reunir os principais achados da literatura. Em segundo lugar, com o rastreio do bullying no Estado de Sergipe, foi possível confirmar a prevalência do fenômeno por meio de uma escala de rápido diagnóstico, tornando possível usá-lo como variável no Estudo 3. Por fim, ao se identificar a ocorrência da prática autolesiva, bem como fatores precipitadores ou reforçadores do ato, tornou-se possível classifica-la a partir de grupos específicos da população, objetivo primordial do trabalho como um todo.

Självskadebeteende är en komplicerad företeelse som förekommer vanligast under tonårstiden. Tidigare litteratur har kunnat se en koppling mellan självskada och identifikation med vissa subgrupper såsom goth, punk och hårdrockare. Dessa personer självskadar i högre utsträckning än personer som anser sig själva tillhöra någon annan subgrupp. För att utöka kunskapen om denna länk mellan självskada och identifikation med alternativa subgrupper var studiens syfte att undersöka om identifiering med alternativa subgrupper hade samband med självskada utöver den väldokumenterade effekten av depression. Studien byggde på befintliga longitudinella data från en forskningsmiljö vid Örebro Universitet där 1478 högstadieelever följdes över ett års tid. Resultatet visade att det fanns tydliga effekter av identifikation med subgrupper tillsammans med och utöver depressiva symtom vad gäller prediktion av självskada. Kön visade sig vid kontroll av studiens övriga variabler inte påverka resultatet. Studien kom fram till att ungdomar som visar högre nivåer av både identifikation med subgrupper och depressiva symtom visar högre nivåer av självskada än någon av företeelserna separat. / Self-harming is a complicated phenomenon that is most common during adolescence. Previous literature has seen a connection between self-harm and specific subcultures such as goth, punk and hardrock that shows that members in these groups self-harm in greater extent than persons that consider themselves members of other subgroups. This study therefore aims to broaden the field of knowledge regarding this increasing problem behavior. In order to do that we examined if identifying with alternative subcultures could show a connection with self-harm, above and beyond that of the far well-documented predictor, depressive symptoms. The study was based on previous data collection that involved 1478 junior high school students that were measured over a time period of one year. The results showed that there were important effects of subculture identification not only above and beyond that of depression but also in interaction regarding influencing and predicting self-harm. Controlling for gender differences showed that it did not affect the outcome in self-harm. The study showed that adolescents that display higher levels of subculture identification and depressive symptoms show higher levels of self-harm then any of the phenomena separate.

Background: Self-harm is important considering the demand it places on health services and its strong association as a risk factor for suicide. Research regarding protective factors for self-harm is limited, protective factors can be personal or social resources that reduce the impact of negative consequences, in the face of stressors. Identifying protective factors is important, provided they can be enhanced and utilised to inform intervention. Aims: This thesis had two aims; to systematically review the literature investigating the relationship between social support and suicidality, and to use Interpretative Phenomenological Analysis to explore the factors that support desistance from self-harm. Methods: Quantitative studies, exploring the relationship between social support and suicidality were reviewed systematically. The empirical study employed Interpretative Phenomenological Analysis to investigate self-harm behaviour in context, identify potential protective factors and explore what participants have found to be helpful to desist from selfharm behaviour. Semi structured interviews were conducted with nine participants (18- 61years) recruited from the Adult Community Mental Health Team. Results: Findings of the systematic review indicate that there is an association between poor social support and increased suicidality in adulthood. In the empirical study four main themes emerged from the data: Self-harm provided Relief from Psychological Distress, Difficulties Communicating, Social support and Gradual desistance. Conclusions: Social support may be an important factor that protects against suicidality; however further research is required to investigate this association. Findings from the empirical study suggest that treatment providers must be sensitive to the context and function of self-harm behaviour for the individual, and be willing to work to reduce the self-harm behaviour, while being cognisant that self-harm may be protective for the individual and prevent more severe self-harm or even suicide.

Background: Mental illness is growing rapidly today, with a population that is getting worse within a younger age. Parts of mental illness is linked to what we callself-harm, or self-mutilation. This in order to alleviate his/her anxiety as a result of a compulsion or impulse to add injury to one’s body, motivated by a need to master mental health or to regain emotional balance. Purpose: The purpose of this study was to illustrate how patients with self-injury behavior experience the attitudes and treatment in their received care. Method: This study is a qualitative content analysis with an inductive approach of autobiographies written by persons with self-harm. Result: Positive treatment strengthens patient self-esteem, relieves inner suffering and anxiety, and provides a foundation for a trustworthy relationship between caregivers and patients, while negative treatment, stigmatization, preconceptions and ignorance of healthcare professionals contribute to an insecure care experience for this patient group. Conclusion: Nurses working with self-injurypatients should reflect on their treatment, occupational role and responsibility towards the patient, as this group often feels poorly treated in care. Clinical significance: The content of this study addresses the problemsof caring for patients with self-harm, which may help nurses and healthcare staff to contribute to better treatment and better care. / Bakgrund: Den psykiska ohälsan kraftigt ökar i dagens samhälle, med en befolkning som mår sämre i allt yngre åldrar. En del av den psykiska ohälsan är kopplad till det vi idag kallar Självskadebeteende. Detta i syfte att lindra sin ångest som en följd av ett tvång eller en impulsatt tillfoga sin kropp skada, motiverat av ett behov att bemästra psykisk ohälsa eller av att återvinna känslomässig balans. Syfte: Syftet var att belysa hur patienter med självskadebeteende upplever bemötandet inom vården. Metod: Denna studie är en kvalitativ innehållsanalys med induktiv ansats av självbiografier skrivna av personer med självskadebeteende. Resultat: Positivt bemötande stärker patienternas självkänsla, lindrar det inre lidandet och ångesten och gav en grund för en tillitsfull relation mellan vårdgivare och patient, där istället negativt bemötande, stigmatisering, förutfattade uppfattningar och okunskap hos vårdpersonalen bidrar till en otrygg vårdupplevelse för denna patientgrupp. Slutsats: Vårdpersonal som jobbar med självskadande patienter bör reflektera över sitt bemötande, sin yrkesroll och sitt ansvar gentemot patienten, då denna grupp ofta känner sig illa bemötta inom vården. Klinisk betydelse: Denna studie lyfter problematiken runt vårdandet av patienter med självskadebeteende, vilket kan hjälpa sjuksköterskor och vårdgivande personal vid vårdmöten.

ABSTRAKT Bakgrund: Självskadebeteende är ett svårdefinierat och svårt problem att handskas med eftersom det oftast sker i hemlighet med en stor känsla av skam och skuld. Mörkertalet är stort och det är en känslig och svårbehandlad grupp, och denna grupp av människor har svårt att söka hjälp. Det finns en tydlig korrelation mellan självskadebeteende och suicidförsök. För att försöka få dessa personer att söka hjälp och minska risken för suicid måste det uppdagas varför dessa personer tvekar till att söka hjälp.   Syfte: Syftet med denna litteraturöversikt är att beskriva varför personer med självskadebeteende tvekar till att söka hjälp.   Metod: Studien är en allmän litteraturöversikt av 8 vetenskapliga artiklar med kvalitativa data. Artiklarna har kvalitetsgranskats och analyserats genom kvalitativ innehållsanalys för att slutligen sammanställas. Databaser som användes var CINAHL, PubMed och PsycINFO.   Resultat: 5 kategorier identifierades: ”Vad är vitsen egentligen?”, “Vissa ser på en som att man vore ett monster”, “Jag vet inte vad jag ska göra eller vart jag ska vända mig”, “Jag skadade mig själv allvarligt med flit idag och nu skäms jag över det” och “Så länge det är under min kontroll är det lugnt”.   Konklusion: När personer med självskadebeteende söker hjälp och får ett negativt bemötande leder det till att deras rädsla att bli dömd bekräftas och känslorna av skuld och skam förstärks. Negativa erfarenheter av att söka vård leder till att hjälp inte söks i framtiden. För personerna som vill söka vård blir det inte lättare när vårdsystemet inte är tydligt med hur personen ska söka hjälp. / ABSTRACT History: Deliberate self-harm is a hard to define phenomena that is hard to deal with because it is often done in secret and with a great feeling of shame and guilt. These patients are hard to treat due to the sensitive nature of the subject and that is why there is a large number of unreported cases. There is a clear correlation between deliberate self-harm and suicide attempts. In order to facilitate help seeking in people who self-harm we need to find out why this group of people don’t seek help in the first place so that further suicide attempts are prevented.   Aim: The aim is to describe the hesitation to why people who self-harm does not seek help.   Method: This study is a qualitative literature review of 8 articles. The data was analyzed inspired by content analysis. The databases used were CINAHL, PubMed and PsycINFO.   Results: 5 categories were identified: “Really, what’s the point?”, “Some people look at you like you are some kind of monster”, “I don’t know what to do or where to turn”, “I hurt myself severely on purpose today and now I feel bad about it” and “As long as it’s under my control I’m fine”.   Conclusion: When people who self-harm seek professional help are met with a poor attitude by staff, their fear of being judged is confirmed and their sense of shame and guilt increases. A negative experience when seeking help may lead to a reluctance for future help-seeking. An unclear process on how to seek help is an obstacle for people trying to receive treatment.

The prevalence rates for adolescent suicide and self-harm are alarming, suggesting a continued need for research into effective treatment strategies for young people experiencing suicidal phenomena. This thesis explores the impact of two treatment approaches: Mindfulness and Broad Minded Affective Coping (BMAC; Tarrier, 2010). Paper One is a systematic review exploring the potential role of mindfulness in the treatment of adolescent suicidality and depression. There were two broad aims: to present an argument for the utility of mindfulness practice in alleviating suicidal phenomena and depression in young people, and to systematically review studies that examined the impact of mindfulness-based approaches with adolescent populations, specifically exploring outcomes relating to suicide, self-harm, and depression. Twenty-eight papers were identified; studies were critically evaluated and findings were integrated to provide an overall account of the potential efficacy of mindfulness-based approaches. Findings were promising, suggesting that these approaches could be helpful in the treatment of young people experiencing suicidal phenomena or depression. Areas for further exploration are considered and clinical implications discussed. Paper Two is an empirical paper investigating the effectiveness of a therapeutic tool of affect-regulation – the Broad Minded Affective Coping (BMAC) method. A case-series design was employed and participants were young people who had recently attempted suicide or self-harmed. The study explored the impact of BMAC practice on self-reported hope and happiness and on a range of outcomes associated with adolescent suicidality. Findings were promising; BMAC practice appeared to be associated with improvements in all areas of interest. Whilst encouraging, findings are considered in light of the limitations of case-series methodologies. Future investigations are recommended, and clinical implications outlined. Paper Three is a reflective paper exploring the process of conducting the aforementioned research and discussing some of the challenges involved. Reflections on the strengths and limitations of the research are integrated within the paper, alongside areas for further research. The theoretical context and clinical implications of the research are considered.

Bakgrund: Självskadebeteende grundar sig ofta i att en människa mår psykiskt dåligt och genom att skada sig själva vill de dämpa den ångest som detta medför. En stigmatisering i såväl samhället som inom vården finns och att möta dessa människor upplevs som skrämmande. Stigmatiseringen bidrar till att ämnet blir tabubelagt och det är svårt att söka den hjälp som behövs. Syfte: Att beskriva upplevelsen av att leva med självskadebeteende. Metod: Studien har genomförts med en kvalitativ innehållsanalys där bloggar har analyserats. Resultat: Analysen av datamaterialet har genererat i olika teman enligt följande: en ständig närvaro av ångest, att fysisk behandla sig själv för att hantera ångest, oavbruten planering av att skada sig själv, kastas mellan känslor – en ständig ambivalens, vårdare iakttar mig, men ser mig inte samt ett dömande förhållningssätt från omgivningen. Att leva med ett självskadebeteende innebar ständig ångest samt många olika tillvägagångssätt kring hur de kan skada sig själva för att hantera denna. Diskussion: Det är viktigt för sjuksköterskan att ha en god kunskap samt förståelse för hur det är att leva med ett självskadebeteende för att på bästa möjliga sätt kunna bemöta dessa människor med respekt. Slutsats: Bristande kunskap och förståelse för människor med självskadebeteende bidrar till att upplevelsen av densamma blir sämre. / Background: Self-harm is often found in the fact that a person is mentally ill and by harming themselves, they want to subdue the anxiety it causes. There is a stigmatization in both society and in healthcare and meeting these people may seem fearful. Stigmatization helps to make the subject taboo and it is difficult to seek the help that is needed. Aim: To describe the experience of living with a self-harm behavior. Method: The study has been conducted with a qualitative content analysis where blogs have been analyzed. Result: The analysis of the data has generated in various headings as follows: a constant presence of anxiety,  to physically treat oneself to deal with anxiety, uninterrupted planning to harm itself, thrown between emotions - a constant ambivalence, caregiver observes me but does not see me and a judicial way from the surroundings. Living with self-harm involves constant anxiety and many different approaches to how they can harm themselves to deal with this. Discussion: It is important for the nurse to have a good knowledge and understanding of how it is to live with self-harm in order to best approach these individuals with respect. Conclusion: Lack of knowledge and understanding for people with self-harm contributes to the poorer experience.