Risk taking (RT) and self-harm (SH) are clinically, conceptually, and empiricallyrelated, yet separate constructs, which occur most frequently during adolescence. The current study utilized retrospective reports of college students to determine reported ages of engagement in RT and SH behaviors. Reported ages were compared with predictions for ages of high frequency engagement in RT based on the Dual Systems Model of Adolescent Risk Taking (DSMART; Steinberg, 2010). The sample consisted of 228 college students, ranging in age from 18 to 48 years (mean 22.8), who completed a survey of commonly investigated RT (12 items) and SH (18 items) behaviors. A positive correlation between the RT and SH scales supported a relationship between RT and SH, as predicted. The mean ages of engagement reported for both RT and SH behaviors were significantly higher than the ages predicted by the DSMART. However, the mean ages of engagement varied significantly by behavior grouping (RT, SH), and by subgroups within each behavior group. The NSSI subgroup of SH and the Situational subgroup of RT were noted to have the lowest mean age of high frequency engagement at the subgroup and behavior item level. A relationship between RT and SH was supported and information regarding ages of engagement in RT relative to ages of engagement in SH in the sample provided a further basis for understanding the emergence of these behaviors. The findings are discussed with regard to the DSMART and the relationship between RT and SH behaviors

Background The definition of self-harm used in this project is repeated, impulsive behaviour causing tissue damage, yet not intended as a suicide attempt. Instead of wishing to die, the person who self-harms wishes to be relieved from anxiety. The thesis comprises four studies and the overall aim was to describe experiences of care among people who self-harm, professional caregivers, and close relatives (parents), and to explore interpretative repertoires that jointly construct the interaction between people who self-harm and their professional caregivers. Methods The participants were nine women who self-harmed (I), six nurses, three of each sex (II), five mothers and one stepfather (III), and six women who self-harmed in two psychiatric inpatient wards and their caregivers (IV). Data were collected through narrative interviews (I, II, III), participant observations (IV), and informal interviews (IV). The interviews lasted between 40 and 50 minutes (I), between 40 and 65 minutes (II), and between 30 and 85 minutes (III). The observations including informal interviews in study IV comprised 150 hours of descriptive observations and 40 hours of focused observations. The data were analysed using qualitative content analysis (I, II), phenomenological hermeneutics (III), and discursive psychology (IV). Results People who self-harmed experienced care as inferior, not satisfying their needs. The findings presented a paradox; on the one hand, the women realised that society considered self-harm an inappropriate way to alleviate mental suffering, and on the other hand, they experienced self-harm as the only way to survive and to foster hope in themselves (I). Caregivers felt powerless and burdened when unable to identify and satisfy the women’s needs. Feelings of fear, frustration, and abandonment created a significant burden for caregivers (II). Parents’ lived experience of the professional care and caregivers of their self-harming adult children could be described as a hostage drama. As in a hostage situation, parents felt held to emotional ransom by deficient care and sometimes hostile caregivers (III). The interpretative repertoires that jointly constructed the interaction between those who self-harmed and their professional caregivers, were for the caregivers a fostering and a supportive repertoire, and for the women who self-harmed a victim and an expert repertoire. The interactions between a fostering caregiver and a woman as expert or as victim, and between a supportive caregiver and a woman as victim, were complicated and promoted feelings of hopelessness among the participants. Interactions between a supportive caregiver and a woman as expert were more satisfying and raised hope among the participants (IV). Synthesis of findings Hope and hopelessness ran together as a thread of meaning throughout the studies. All participants experienced and expressed hope and hopelessness in various ways. The self-harming women hovered between hope and hopelessness, hoping for help and support, but led back to hopelessness by their experiences in care. The women used self-harm as a way to cope and to maintain hope in themselves. The parents initially had confidence in healthcare and hoped for help. However, their experiences of meeting deficient care often made them feel hopeless. Parents paid an emotional ransom when they accepted deficient care for their daughters. The caregivers felt frustrated, angry, and powerless, and their view of self-harm as an endless behaviour led to hopelessness. However, they struggled to see the women’s abilities, not only their difficulties, and described how they had to try to see self-harm in another way. Caregivers who were convinced that it was possible to stop self-harming and leave it behind were able to bring hope to themselves, to parents, and to the women who self-harmed. The present studies suggest that there is a difference between self-harm and suicide attempts or suicide. Other researchers echo these findings. Conclusions Paradoxically, self-harm usually seems to be a life sustaining act, a way of raising hope in oneself. The importance of caregivers who listen and try to understand people who self-harm, as well as their close family members, is evident. By asking open-ended questions and being non-judgemental, listening, and showing a genuine interest in the person’s lived experience; caregivers can inspire hope in people who self-harm. / Bakgrund Självskadebeteende definieras i denna avhandling som ett upprepat, impulsivt beteende där hudskada uppstår. Avsikten med handlingen är inte att begå självmord, stället har personen en önskan att lindra ångest. Avhandlingen består av fyra delstudier och det övergripande syftet var att beskriva erfarenheter av vård bland personer med självskadebeteende, professionella vårdare och närstående (föräldrar), samt att belysa tolkningsrepertoarer som konstruerar interaktionen mellan personer med självskadebeteende och deras professionella vårdare. Metod Deltagarna var nio kvinnor med självskadebeteende (I), sex sjuksköterskor, tre av vardera kön (II), fem mammor och en styvpappa (III) samt sex kvinnor med självskadebeteende som vårdades vid två psykiatriska slutenvårdsavdelningar och deras professionella vårdare (IV). Datainsamlingsmetoder var narrativa intervjuer (I, II, III), deltagande observationer samt informella intervjuer (IV). De narrativa intervjuerna varade mellan 40 och 50 minuter (I), mellan 40 och 65 minuter (II) samt mellan 30 och 85 minuter (III). Beskrivande deltagande observationer genomfördes, totalt 150 timmar, varav ca 40 timmar var fokuserade deltagande observationer. Data analyserades med hjälp av kvalitativ innehållsanalys (I, II), fenomenologisk hermeneutik (III) samt diskurspsykologi (IV). Resultat Personerna med självskadebeteende upplevde att vården var undermålig och att den inte tillfredställde deras behov. Resultaten visar en paradox, å ena sidan insåg kvinnorna att samhället i stort anser att självskadebeteende är ett oacceptabelt sätt att hantera psykiskt lidande, å andra sidan, upplevde kvinnorna att självskadandet var det som gjorde det möjligt att överleva och att inge sig själv hopp (I). Professionella vårdare kände sig maktlösa och tyngda när de inte kunde identifiera och tillfredsställa kvinnornas behov av vård. Vårdarnas rädsla, frustration och känsla av övergivenhet, vilka medförde en känsla av att vara belastad, framkom (II). Den levda erfarenheten av professionell vård och vårdare bland föräldrar till vuxna barn med självskadebeteende beskrevs som ett gisslandrama. Föräldrar till en dotter i en gisslansituation betalade en känslomässig lösensumma när de mötte en undermålig och ibland fientlig vård (III). De dominerande tolkningsrepertoarerna som tillsammans konstruerade interaktionen för vårdarna var en fostrande och en stödjande repertoar. För kvinnorna med självskadebeteende dominerade en offer och en expertrepertoar. Interaktionen mellan en fostrande vårdare och kvinna som expert eller offer, samt en stödjande vårdare och en kvinna som offer, var mer komplicerad och ingav hopplöshet bland deltagarna. Interaktionen mellan en stödjande vårdare och en kvinna som expert var mer tillfredsställande och främjade hopp bland deltagarna. Syntes av resultat Hopp och hopplöshet visade sig vara ”en röd tråd” genom delstudierna. Alla deltagare upplevde och uttryckte hopp och hopplöshet på olika sätt. Kvinnorna svävade mellan känslor av hopp och hopplöshet, med önskningar om hjälp och stöd men deras erfarenheter av vård ingav hopplöshet. Kvinnorna använde självskada som en hanteringsstrategi och som ett sätt att inge sig själv hopp. Föräldrarna hade initialt ett förtroende för vården och hade förhoppningar om hjälp, men deras erfarenheter av att möta en undermålig vård ingav istället en känsla av hopplöshet. Föräldrarna betalade en känslomässig lösensumma när de accepterade en dålig vård för sin dotter. Vårdarna kände sig frustrerade, arga och maktlösa och deras syn på självskadebeteende som något ändlöst ingav hopplöshet. Vårdarna kämpade för att se kvinnornas förmågor, inte bara deras svårigheter och försökte förstå självskadebeteende. Vårdare som var övertygade om att det var möjligt att sluta skada sig och lämna det bakom sig lyckades inge sig själv, föräldrarna och kvinnorna med självskadebeteende hopp. Resultaten från föreliggande studier tyder på en skillnad mellan självskadebeteende och självmordsförsök eller självmord, vilket även stöds av andra forskare. Slutsatser Paradoxalt nog verkar självskadebeteende vara ett livsuppehållande beteende, ett sätt att inge sig själv hopp. Betydelsen av vårdare som lyssnar och försöker förstå personen som skadar sig och närstående är tydlig. Genom att ställa öppna frågor och tala på ett icke dömande sätt, samt genom att lyssna och visa ett genuint intresse för personens upplevelser, kan vårdare förmedla hopp.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-06-21T12:06:44Z No. of bitstreams: 1 lilianaguiarvieira.pdf: 829755 bytes, checksum: bafd8acee6f1b0f73d3e0f36cd430974 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-07-13T15:27:20Z (GMT) No. of bitstreams: 1 lilianaguiarvieira.pdf: 829755 bytes, checksum: bafd8acee6f1b0f73d3e0f36cd430974 (MD5) / Made available in DSpace on 2016-07-13T15:27:20Z (GMT). No. of bitstreams: 1 lilianaguiarvieira.pdf: 829755 bytes, checksum: bafd8acee6f1b0f73d3e0f36cd430974 (MD5) Previous issue date: 2012-03-28 / A relação existente entre capital social e a saúde tem sido objeto de estudo há longa data. A participação cívica encontra-se presente em legislações de saúde, nos movimentos pela prevenção e promoção da saúde e nas conferências e conselhos de saúde. Este estudo busca contribuir com a discussão da existência de associação entre saúde e capital social. Foram verificadas associações entre taxa de mortalidade por causas externas – agressão e lesões autoprovocada – e participação ativa na vida associativa dos indivíduos, manifestações de interesse na organização da sociedade civil e atividade dos conselhos gestores municipais, em municípios com mais de 100.000 habitantes. Aplicou-se o método de regressão múltipla assimétrica no modelo skew-normal. Utilizaram-se como variáveis de controle: Coeficiente de GINI, renda per capita dos municípios, IFDM e o PIB. Os resultados mostram existência de associação entre as taxas de mortalidade e variáveis que captam aspectos do capital social. Mortalidade por agressão e mortalidade por lesões autoprovocadas apresentaram perfis diferentes de associação com variáveis relacionadas ao capital social. / The relationship between social capital and health has been studied for a long time. Civic participation is present in the laws of health, health promotion movements and other councils and conferences about health. This study intends to contribute to the discussion of the existence of an association between health and social capital. Associations were found between mortality from external causes - aggression and self-harm injuries - and active participation in associational life of citizens, expressions of interest in civil society organization and activity of the municipal councils in cities with more than 100,000 habitants. Method was applied in multiple regression assymmetric skew-normal model. Thus, some control variables were used: Gini coefficient, per capita income of the cities, municipal development Firjan index (IFDM) and the Gross National Product (PIB). The results show an association between mortality rates and variables that capture aspects of social capital. Mortality from aggression and self-harm mortality showed different patterns of association with variables related to social capital.

I denna studie har cismäns och hbtqi-personers, särskilt transpersoners, perspektiv varit huvudfokus i undersökandet av teman i mediala skildringar av deras erfarenheter kring att ha sex mot ersättning. Anledningen till detta specifika fokus grundas i en brist på forskning kring dessa personers erfarenheter samt att det i undersökningar framkommit att dessa personer är vanligt förekommande bland folk som har sex mot ersättning. Målet med studien är att försöka fylla kunskapsluckan och belysa ämnet. Berättelserna är inhämtade från olika medier samt från organisationer för hbtqi-personer som har erfarenhet av sex mot ersättning och är därmed i form av sekundärdata. En tematisk analys har genomförts där temana Unga säljer våldsamt sex till äldre män, Startskottet är ett övergrepp eller längtan efter kärlek och närhet, Sex mot ersättning som självskada, “Man får ju en väldigt skruvad syn på sex” och Det finns inget rum att prata om det alls har identifierats, vilka diskuteras utifrån socialkonstruktionism, intersektionalitet samt den sparsamma tidigare forskningen kring ämnet. Sammanfattningsvis visar resultatet att maktstrukturer och tolkningsföreträde är viktigt för förståelsen av dessa specifika erfarenheter samt att det nuvarande myndighetsstödet är bristfälligt. / The perspective of cismen and lgbtiq-people, in particular trans people, has been the main focus in this study when investigating the themes in media depictions of their experiences of having sex for compensation. The reason for this particular focus is the lack of research regarding these people’s experiences and that surveys show that they are common within the population of people who have had sex for compensation. The aim is to fill in the existing gaps of knowledge as well as to shine a light on this topic. The stories have been collected from different media outlets as well as organizations for lgbtiq-people who have had sex for compensation and is therefore in the form of secondary data. A thematic analysis has been conducted, where the themes Young people sell violent sex to older men, Abuse or longing for love and closeness are the starting points, Sex for compensation as self-harm, “You get a very twisted view on sex” and There’s no room to talk about it at all have been identified, which are discussed in relation to social constructionism, intersectionality and the sparse previous research regarding this topic. In conclusion, the results show that power structures and interpretative prerogative are important in understanding these particular experiences and that the current support from authorities is deficient.

Självskadebeteende är ett växande folkhälsoproblem hos barn-och ungdomar som orsakar lidande hos gruppen. När ett barn eller en ungdom kontaktar vården för stöd remitteras personen till barn-och ungdomspsykiatrin (BUP). Patientgruppen kan genomgå ett lidande i väntan på behandling och interventioner. Självskadebeteende i ung ålder ökar risken för suicid flera år efter vilket innebär att det behövs stöd, bedömning och tidiga insatser för att förebygga detta. Sjuksköterskor som möter patientgruppen har ett stort ansvar och kompetens för att minska riskbeteenden och främja friskfaktorer. Studier visar betydelsen av att minska lidandet hos patientgrupper där sjuksköterskans förutsättningar för detta tidigare inte belysts. Studien belyser vilka förutsättningar sjuksköterskan har att minska lidandet i mötet med barn- och ungdomar med självskadebeteende. Syftet var att belysa sjuksköterskors inom barn och ungdomspsykiatrins upplevda möjligheter att minska lidandet genom att stödja barn och ungdomar med ett självskadebeteende. En intervjustudie med semistrukturerade frågor. Nio sjuksköterskor deltog i studien. En kvalitativ innehållsanalys valdes för att analysera intervjuerna. Tre huvudkategorier framträder i resultatet, “Genom tillit och förtroende skapas ett helhetsperspektiv “, “Den upplevda vikten av kunskap” och “Upplevelsen av utmaningar och begränsningar” som utmynnande i åtta subkategorier. Sjuksköterskor som möter patientgruppen visar resultatet är ovärderliga i sin yrkesroll för att minska lidandet genom stödsamtal, helhetsbedömningar och kunskapsspridning. Brist av resurser och tidspress hindrar sjuksköterskorna till att minska lidandet. I resultatdiskussionen framkommer vikten av tid till stödsamtal för att kunna lindra lidande samt vikten av att involvera familjen i vården. Att arbeta efter livsvärldsperspektivet och personcentrerat ökar möjligheten att minska lidandet. / Self-harming behavior in children and young people is a growing public health issue, often leading to significant suffering. When seeking support, these individuals are referred to child and youth psychiatry (BUP), where delays in treatment can exacerbate their distress. Early intervention is crucial as self-harming at a young age increases the risk of future suicide. Nurses play a pivotal role in reducing risk behaviors and promoting protective factors for this patient group. This study explores nurses' perceptions of their ability to support children and adolescents with self-harming behavior within child and adolescent psychiatry. Using semi-structured interviews with nine nurses, a qualitative content analysis revealed three main categories: "Through trust and confidence a holistic perspective is created," "The perceived importance of knowledge," and "The experience of challenges and limitations," with eight subcategories emerging from these themes. The findings highlight the essential role of nurses in mitigating suffering through supportive conversations, comprehensive assessments, and knowledge sharing. However, resource shortages and time constraints significantly hinder their effectiveness. The discussion emphasizes the need for adequate time for supportive conversations and involving the family in care to alleviate suffering. Adopting a lifeworld perspective and person-centered approach can enhance the potential for reducing suffering in this vulnerable group.

本研究旨在探索自我傷害行為的動機、相關現象與情緒調節功能，並以此為基礎釐清該行為的情緒內涵，包括正向情緒強度特質、負向情緒強度特質、平靜滿足、經驗迴避程度及情緒調節能力。此外，本研究以因素分析探索自傷動機的分類，並以此分類結果為基礎，探討不同自傷動機所引發的情緒種類、情緒強度是否有所不同，在自傷行為的進行方式、次數上是否有顯著差異，並瞭解其無法適當應用的情緒調節能力為何。研究採用問卷調查的方式，研究對象為839位私立高中職生，包括日間部與夜間部，調查所得資料以描述統計分析、卡方檢定、相關分析、獨立樣本t檢定、相依樣本t檢定、因素分析、邏輯迴歸分析和階層迴歸分析進行處理。 本研究主要結果如下：首先支持自傷行為具有負向情緒調節的功能，而經驗迴避對於自傷行為的影響有限。其次，將自傷動機進行因素分析的結果發現可以將其分為四類：人際影響、負向感受的因應、避免失控和負向自我評價。在區分是否有自傷行為部分，情緒調節困難的不接納與無助能夠有效解釋自傷行為的有無；在影響自傷行為的頻率部分，自傷動機的強度與情緒調節困難的衝動失控能夠有效解釋自傷頻率的多寡。此外，本研究發現不同的自傷方式與不同的動機、所處的自傷前情緒有關，且不同的自我傷害動機在情緒強度特質、情緒調節困難、負向情緒和自傷方式上會呈現出不同的樣貌。 / The purpose of this study was to explore the motivations, the phenomenon, and the function of deliberate self-harm behaviors(DSH), and based on these, to clarify emotional contents behind DSH, including positive affect intensity, negative affect intensity, serenity, experiential avoidance and the emotional regulation ability. Besides, the study investigated the classification of the motivations of DSH by exploratory factor analysis, and accordingly discussed whether the affect categories and the affect intensity resulted from the motivations of DSH were different, and whether the motivations of DSH resulted in significantly different using of methods and frequencies, moreover, the emotional dysregulation. The study was based on questionnaires, and the participants were 839 students from a private senior high school , including vocational schools. Data obtained were analyzed by descriptive statistics, correlation analysis, t-test, factor analysis (FA), logistic regression, and hierarchical regression analysis. The main results were as follows: First, the results supported that DSH has regulative function on negative affect, and experiential avoidance influenced DSH limitedly. Second, according to factor analysis, the motivations of DSH were classified into four categories: interpersonal influence, negative affect modulation, control, and negative self-evaluation. Moreover, nonacceptance of the emotion dysregulation could successfully distinguish students with DSH from students with no history of DSH in the past 1 year. Both intensity of motivations and impulse of the emotion dysregulation could reliably predict DSH’s frequency. Finally, different methods of DSH correlated to different motivations and different emotions before DSH, and there were various representations of affect intensity, emotion dysregulation, and methods depends on different motivations.

Clients diagnosed with Borderline Personality Disorder (BPD) interact with healthcare professionals in compelling ways. By virtue of the symptoms that define BPD, it is likely that the client will challenge the therapist with regards to their theoretical approach or therapeutic style. In addition, clients with BPD are likely to project their need for a therapeutic interaction that is both genuine, empathic and at the same time, flexible. In light of this, it is not uncommon for healthcare practitioners to consider clients with BPD as “difficult” in some way or the other. This study explores how clinical psychologists in Gauteng conceptualise and manage a “difficult” client presenting with Borderline Personality Disorder. Further, coping strategies of the clinician will also be explored. The qualitative study, couched in a social constructionist paradigm, involved interviewing seven clinical psychologists practicing in Gauteng, South Africa. The transcripts of the semi-structured interviews were thematically analysed. The findings of the current study indicated that the difficulties experienced are reflective of the general criteria of the disorder. The picture of the difficult client is painted by personal experience, as well as stereotypes gained from interactions with colleagues and other healthcare professionals. It was further found that management of these patients were viewed and implemented based on the nature of the disorder. In addition, management by the clinician often included supervision and leisure activities. / Psychology / M.A. (Clinical Psychology)