Thesis (M.S.W.)--Smith College School for Social Work, Northampton, Mass., 2007 / Thesis submitted in partial fulfillment for the degree of Master of Social Work. Includes bibliographical references (leaves 63-68).

The aim of this research was to describe the borderline individual’s lived experience of inhibiting self-mutilation and thus capacity for healthy functioning. A question which would elicit a description of the experience o f this phenomena was formulated. Three self-mutilators were interviewed and the two psychologically richest narratives were chosen for the research. Based on phenomenological methodology the two protocols were analysed in detail. From the results it becomes clear that borderline individuals are ambivalent when attempting to inhibit self-mutilation. Although they have a need to be self-sufficient and through a process of trial and error find the method of inhibiting that best suits them, it appears difficult for such individuals to trust that they have this ability and thr hnsr resources to find such a method. Borderline personality structure may be viewed along a continuum. The technique chosen by the individual is likely to fit with where they are developmental^ in relation to this continuum. Hence, while each individual may or may not make use of transitional objects within their techniques, they do have a need to draw on ‘soothers’. Although the ‘soothers’ may vary with regard to shape and form, they do appear to share similar qualities and to become imbued with like meanings by the individuals. The ‘soothers’ create a safe and holding space which is empathic, attuning, non-judgmental and non-directive in its interaction with the borderline individual. ‘Soothers’ need to allow the individual a sense of mastery and control over their otherwise chaotic environment. Repeated use of ‘soothers’ allows the borderline individual to begin drawing on good introjects as opposed to negative introjects which serves to increase confidence, sense o f self and the ability to trust in their own inner resources. This pin points an area of healthy functioning in the individual with borderline structure which until presently has been overlooked in the literature on the functioning of those with borderline structure

While 800,000 people die by suicide every year worldwide, it is estimated that self-harm occurs 10 to 20 times more frequently. However, in Hong Kong there has been no comprehensive epidemiological information relating to self-harm produced since 2004. Prevention measures must be guided by local knowledge, and the findings of previous studies mainly conducted in the West may not be generalizable to Hong Kong. This study aims to investigate the epidemiological features of self-harm in order to understand its pattern and characteristics. Four topics were analyzed: 1) incidence rates and patients’ demographic profile; 2) non-fatal repetition; 3) suicide following self-harm; and 4) temporal variations. Since there exists no citywide surveillance and monitoring system for self-harm patients in Hong Kong, self-harm data are not collected in a timely or systematic manner. Emergency attendance and inpatient admissions data of public hospitals managed by the Hospital Authority were therefore used to trace relevant medical records. It should be noted that, as hospital administrative data are not collected for research purpose, there have been some concerns about the feasibility of using the data for a study of self-harm. Thus this study also examined the features of the best available hospital data, finding some evidence that these records offer a representative cohort of self-harming patients for research purpose. Between 2002 and 2011, it was found that the average annual incidence rate of self-harm in Hong Kong was 116.0 per 100,000 people. This estimate is a lot lower than those in the West, but is at the upper end of findings in Asian countries. The risk of non-fatal repetition was 6.9% within the year following the index episode of self-harm. Using a survival model specifically for recurrent events data, 8.9 cases of repeated self-harm were expected per 100 patients. The corresponding risk of suicide was much lower at 0.6%. A higher risk of repeated self-harm was observed during the first three months, while the high-risk period of suicide lasted for five months. A diminishing seasonality in self-harm was found, from a bi-seasonal pattern in 2002-2006 to a one-cyclic pattern in 2007-2011, with a peak from May to July and anadir in December. A strong holiday variation was detected around Lunar New Year, but only among males. The temporal variation in Hong Kong due to holidays revealed a different pattern from the West. The findings provide the epidemiological pattern of self-harm in Hong Kong, which can assist clinical assessment and suicide prevention strategy, and also offer directions for future research. The latter include the extraordinary increase in self-poisoning among males in 2003 and 2007; the cost burden on the healthcare and social system; the association between immediate risk of repetition and hospital stay; frequent repeaters of self-harm; and explanations of reported temporal patterns. The results also suggest the importance of implementing a surveillance system to better collect information on self-harming patients, not only for research and evaluation study but also to facilitate management and service provision. / published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

This study explored whether female college students who endorse a history of self-mutilation and those who do not can be reliably differentiated across the following constructs derived from object relations theory: representations of parental care and overprotection, separation-individuation conflicts, emotional body investment, affect regulation, and perceived stress. While these variables have been implicated in the selfmutilation literature, there have been few attempts to empirically assess them. Moreover, there has been very little research investigating self-mutilation in non-clinical, college age youths, despite the reported risk and prevalence of this behavior within the college population. The operational definition of self-mutilation utilized in this study was borrowed from Favazza (1996) and refers to deliberate, non-suicidal infliction of harm to the body. Self-mutilation was assessed using the Deliberate Self-Harm Inventory (DSHI; Gratz, 2001), from which a group of 85 self-mutilators and a group of 176 non-mutilators were identified. A mixed methods approach was utilized and included the collection of quantitative data via a secure, online questionnaire, as well as a qualitative interview component with a small number of self-mutilators designed to offer a more complete, phenomenological understanding of this experience. Logistic regression analyses indicated the following variables were significant predictors of self-mutilation: Mother Care, Father Overprotection, Separation Anxiety, Body Care, and Body Protection. Self-mutilators were more likely to experience their fathers as encouraging of autonomy and to experience separation anxiety compared to non-mutilators. Self-mutilators were also less likely to perceive maternal care as warm and affectionate and less likely to care for and protect their bodies compared to nonmutilators. Qualitative interviews uncovered salient themes related to self-mutilation in this sample. The overall results suggest that object relations may be a useful perspective from which to conceptualize self-mutilation and offer important implications for future research and clinical practice. / text

Thesis (M.S.)--West Virginia University, 2008. / Title from document title page. Document formatted into pages; contains vi, 59 p. Vita. Includes abstract. Includes bibliographical references (p. 29-32).

Thesis PlanB (M.S.)--University of Wisconsin--Stout, 2008. / Includes bibliographical references.

Thirty-two juvenile delinquent males were tested for Kinesthetic Figural Aftereffects using the method developed by Petrie in an effort to determine if self-mutilation is more prevalent among kinesthetic reducers than augmenters. The results were in the predicted direction, but failed to reach significance. Verbal measures administered proved unrelated to both KFAE scores and self-mutilation category.

This dissertation research constitutes a mixed methods investigation of the phenomenon of nonsuicidal self-injury (NSSI) among transgender and gender nonconforming (TGNC) people. An integrative review of the current literature about NSSI among sexual and gender minority populations established that NSSI is reported at higher rates by sexual and gender minorities than by cisgender (nontransgender) and heterosexual populations. Additionally, TGNC people appeared to report higher rates of NSSI than cisgender sexual minorities. Among TGNC people, transmasculine spectrum people (i.e., gender identity is male, man, transgender man, transmasculine, genderqueer, nonbinary, etc., with female sex assigned at birth) reported higher rates of NSSI compared to transfeminine spectrum people (i.e., gender identity is female, woman, transgender woman, transfeminine, genderqueer, nonbinary, etc., with male sex assigned at birth). Guided by Meyer’s (2003) minority stress model and Nock’s (2009) model of NSSI, qualitative interviews were conducted with eighteen transmasculine individuals to understand what contributes to the higher rates of NSSI in this population. The qualitative data supported aspects of Nock’s model as well as minority stress processes, and additionally revealed that NSSI may be related to transgender identity development processes. Aspects of Nock’s model that were supported included risk factors for NSSI (adverse childhood experiences), intrapersonal and interpersonal vulnerability factors, and identification with the behavior. Minority stress processes related to stigma associated with transgender identity included the impact of nonconformity in appearance and behavior, nonconformity in identity with nonbinary identified participants reporting additional stress, concealment of identity, and expectations of rejection. Transgender identity development stages of pre-coming out (confusion prior to understanding one’s gender identity), coming out, and exploration (finding a community of similar peers) were also related to NSSI. This latter finding highlighted that, in addition to being a response to stigma and minority stress, NSSI may occur in the context of normal transgender identity development. Finally, a quantitative investigation was conducted to examine correlates of past-year NSSI among a diverse community-based sample of TGNC people. In the total sample (N = 332), 53.3% (n = 177) of participants reported having engaged in NSSI in their lifetime. Lifetime history of NSSI was more common among transmasculine spectrum compared to transfeminine spectrum participants (60.5% vs. 39.5%, p < 0.001). Past 12-month NSSI was reported by 22.3% (n = 74) of the sample and was not significantly different between transmasculine and transfeminine spectrum participants. Younger age and higher levels of felt stigma were associated with higher rates of NSSI, while transgender identity acceptance and congruence were protective factors. Together, the findings of this mixed method investigation provided new insights into the onset and maintenance of NSSI among TGNC people, informing the development of interventions to address the high rates of NSSI among gender minority populations. Implications for theory, clinical practice, provider education and training, health policy, and future research are discussed.

Purpose: Egypt has the highest prevalence of chronic Hepatitis C virus (HCV) infections and also a high prevalence of female genital mutilation (FGM). The high prevalence chronic hepatitis C has been attributed to HCV transmission by contaminated injections for the control of schistosomiasis. HCV infection has not been well studied in the context of female genital mutilation (FGM). We sought to identify associations between FGM and HCV using the Egypt Demographic and Health Survey (EDHS), 2008. Methods: FGM was chosen as the main independent variable of interest. Other independent variables such as age, education, marital status, residence, beliefs associated with FGM, history of blood transfusion, surgery, sharing needles, and history of schistosomiasis were included in the analysis. Throughout the analysis, HCV infection was used as the main dependent variable. Results: Univariate analysis of FGM and HCV showed a statistically significant association with a Prevalence Odds Ratio of 4.82 (2.91 -7.96), after adjusting for age and schistosomiasis injection, the association between FGM and HCV remained statistically significant with an odds of 2.98 (1.76 – 5.05)Among the category for FGM performer and association with HCV infection, the OR was 4.28 (2.31 – 7.91) when the FGM was performed by a ghagaria, 3.68 (2.76 - 4.90) when the FGM was performed by daya, and 3.30 (1.81 -5.88) when the FGM was performed by a barber. Among other independent variables, a lack of education, rural residence, and having religious precepts for FGM had statistically increased odds of association with HCV infection. Conclusion: There is a statistically significant association between FGM and HCV infection. There are increased odds of HCV when the FGM is performed by providers other than doctors. Participants from a rural residence and who those who did not have any education were at increased odds of HCV. Subjects who believed in religious precepts for FGM and also who answered that FGM can continue had increased odds of association with HCV infections.

Purpose and Questions: The purpose with this thesis is to explore why female genital mutilation (FGM) persist in Ethiopia, and secondly to explore reverberations felt in a wider context from a political and ethical perspective. The aim of this paper is not to argue that traditional female genital mutilation ought to be legalized, but to highlight the double standards of moral involved. Following questions were used as guidance to fulfil the purpose: how is the situation for women and what is the status of FGM in Ethiopia?; are there legal framework mechanisms in place?; what are the attitudes on the biggest challenges in the struggle against FGM and what are the way’s forward?; and what readings can be made with regards to the ‘phenomenon’ of genital alterations in a wider context from a political and ethical perspective? Method: This thesis is a case study of the phenomenon genital mutilation. It has elements of a field study with comparative elements, in terms of the ‘phenomenon’ of genital alterations. The material consists of data from fieldwork conducted in Ethiopia as well as data from literature review. Results:  The paper presents an alternative point of view on previously not so well understood relations on the subject matter. Ethiopia is a poor and highly traditional country, where women lack behind in most areas. The legal provisions in the Criminal Code against FGM are not strong enough, or in place. The Criminal Code only restricts the practice and doesn’t explicitly outlaw it. The country is also democratically crippled, and NGOs has been constrained (indirectly) in their work on FGM.  Ethnicity and culture, rather than religion, seem to be the most decisive factors for the practice in Ethiopia. However, it seems as though the veil of silence has been partially lifted. There seem to be awareness in some segments of the population, however much more work is needed towards the total elimination of the practice. Awareness on the harm as well as implementation and adherence to the law, and thus change takes time. Western cultural norms however seem to prevail over other cultural norms, and various forms of genital alterations undertaken due to individual non-medical reasons might create skewed attitudes and have a negative impact on the struggle against FGM, from a wider perspective.