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Self-harming behaviour is prevalent in modern society and occurs across genders from an early age (Horrocks, 2003; Wilhelm 2003). The thesis examines one component notably, self-injury. Self-injury remains prevalent in a high percentage of people accessing health services. A recent survey in an NHS Trust estimated cutting in people who accessed their services as being 50% of their total self-harming population (Horrocks et al 2003). To understand this phenomenon the researcher investigated the language utilised by a group of women to describe and interpret what self-injurious behaviour meant and their need to self-injure. These women (Experts by Experience) had utilised mental health services. The others were a group of nurses (Experts) with various experiences of self-injurious women. Self-injury has attracted considerable academic and popular attention and is contentious, with differing interpretations and language utilised for description and definition. The language may have different significance for men and women in both those who injure and those working to support them. In general the number of women who self-injure was higher and was part of the rationale for examining the behaviour of women alone. The thesis explores some contextual and suggested causative factors thought to initiate the behaviour, including childhood sexual trauma. Data is obtained from interviews (including electronic, face to face and telephone) with both groups and additional examination of published literature and testimonies of women who self-injure. Such testimony (including grey literature, Jones 2004) is an integral part of the study and provides "triangulation" of data source analysis (48 "Bibbits" were analysed). The study is framed in a grounded feminist framework as interpreted by Kirby & McKenna (1989), whose methodological approach is utilised. Data analysis evolved a series of models which served to ground the study. From these models the conclusion is drawn that simplistic, behaviourally driven clinical solutions are not always feasible. Numerous complexities surround the behaviour, which this study ultimately termed "Converging Complexities". Both groups agreed on the significance but interpretation differed between groups. In order that these complexities are more fully understood, recommendations are made that greater use of survivor literature, articulating the depth of feelings in selfinjurious women, is used to prepare nurses. In addition, greater emphasis might be placed on the value of feminist and embodiment theory in training curricula. The study proposes a "model of hope" to provide an insight into the understanding of self-injury between the groups.

Epidemiological studies have reported significantly higher rates of self harm in South Asian women than South Asian men or White British women, particularly within the 16-24 age group (Cooper et al., 2006). Furthermore, findings of qualitative studies indicate that South Asian women do not feel able to access mainstream support services (Chew-Graham, Bashir, Chantler, Burman, & Batsleer, 2002). As a result researchers have emphasised the importance of developing services which are appropriate to South Asian women’s needs and that achieving this will require understanding of self harm from the women’s own frame of reference (Husain, Waheed, & Husain, 2006). The present study aimed to explore the experiences and meanings of South Asian women who self harm; and their experiences and perceptions of support services. Semi-structured interviews were conducted with six women of South Asian ethnicity who have experience of self harm, five of which were analysed using Interpretative Phenomenological Analysis. Individual and group level analyses were conducted and three superordinate themes of control, identity and communication emerged, although the interrelations between them were also important in understanding the women’s experiences and meanings of self harm. The meanings of self harm offered by the women in this study are similar to those described in other studies with South Asian women (Bhardwaj, 2001; Chantler, Burman, Batsleer, & Bashir, 2001; Marshall & Yazdani, 1999) and white western women (Babiker & Arnold, 1997); however, the participants’ ambivalence regarding their self harm was more apparent. Qualitative methodology allowed exploration of the complexities and ambiguities in the women’s experiences and meanings, including how they both endorsed and rejected concepts such as ‘culture clash’ and self harm as ’attention seeking’. Participants simultaneously described both positive and negative experiences and perceptions of support services, including valuing a confidential forum within which to talk and feel understood. Themes which emerged included service responses inadvertently exacerbating distress; fear of judgment and the impact of ethnicity. These findings are discussed in relation to the wider research and the extent to which the women’s accounts speak to psychological models of self harm is also considered. Strengths and limitations of the study, clinical recommendations and further research possibilities are outlined.

Introduction Self-harm is a substantial problem in the UK with significant human and economic costs. It is one of the most common reasons for acute admission to hospital in the UK and is an important risk factor for suicide. Psychological theory and empirical studies indicate that the characteristics of self-harm may differ in people of different ages, and that these characteristics may influence the care that people receive when they attend hospital after selfharm. Method The study data were collected as part of a UK multi-centre self-harm monitoring project. The data cover 11,243 consecutive attendances at hospital emergency departments in Leeds made by 6292 individuals between 1 October 2004 and 30 September 2007. The data were analysed across the age range using comparison of odds ratios, linear chi squared tests for trend and survival analysis. Results Characteristics of self-harm and hospital management differ for people of different ages. Severity of self-harm increases with increasing age, but service provision is not closely linked to severity. The youngest and oldest age groups receive the best service and the working age adults, who conduct medically serious self-harm and are at high risk of repeating self-harm, receive the worst service. The oldest age group appear to be substantially different from the younger groups in terms of their history. Discussion The differences in the characteristics of self-harm across the age range are compatible with psychological theory relating to the reasons people may conduct self-harm at different ages. Adult mental health services could learn from the high standards of care provided to the youngest and oldest people who self-harm. Further research to explore self-harm in different age groups is recommended.

Evidence has demonstrated that anger is a risk factor for aggression and violence, and that paranoia can operate as a motivator for violent offending. In spite of this, there has been no research that has examined the emotional experiences of anger and its relationship to paranoid ideation in violent mentally-disordered offender (MOO) populations. This is in the face of evidence that has suggested limited long-term efficacy of anger management and psychosis interventions with MDOs. Experimental paradigms have been developed to measure paranoia with non-clinical populations, and recently the Prisoner's Dilemma Game (PDG) has been validated as a measure of non-clinical paranoia. The current study examined the relationships between anger and paranoia in a sample of 66 male and female MOOs, and aimed to investigate the utility of the PDG as an assessment of paranoia with a forensic population. Participants completed the PDG and self-report measures that examined trait anger, anger expression, trait paranoia, socially desirable responding, anxiety and depression. Results indicated that trait anger and anger expression were associated with paranoia, and that these relationships were not due to possible confounding relationships with social desirability, anxiety or depression. The findings suggested a trend towards gender differences in levels of anger and paranoia. The relationships between anger and paranoia, however, did not differ between males and females. The results indicated that further research is needed to validate the PDG as a behavioural indicator of paranoia with MDOs. The findings were discussed in relation to previous literature, and limitations of the study were highlighted. The clinical implications for assessment, formulation and intervention were considered.

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