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Med utgångspunkt att självskadebeteende är ett internaliserat problem är syftet med studien att i en ungdomspopulation undersöka om självskadebeteende även är länkat till externaliserade problem. Vi undersöker även om självskadebeteende hänger samman med att i olika miljöer utsättas och utsätta andra för negativa beteenden. Studien använder redan insamlade data i forskningsprojekt kallat - “Sju Skolor”: Center for Developmental Research (CDR). Data samlades in från 1478 högstadieelever. I studien fann vi samband mellan självskadebeteende (NSSI) och utåtagerande problem (kriminalitet, drickande, etc.). Vi fann också att ungdomar med självskadebeteende utmärks av att de i sina vardagsmiljöer både är utsatta för negativa beteenden från andra och utsätter andra för negativa beteenden. Detta är en viktig upptäckt när det kommer till att behandla och förebygga självskadebeteende (NSSI) hos unga.

Non-suicidal self-injury (NSSI) has been regarded as a dysfunctional coping strategy for managing intensely difficult feelings and is a growing area of concern in clinical and non-clinical populations alike. Individuals who engage in NSSI often report significant interpersonal difficulties, with studies showing that they have impaired social interactions. Attending to the emotional expressions of others is important for appropriate social functioning, and subtly mimicking the expressions of others is an unconscious behaviour that encourages empathy and interpersonal bonding. Differences in emotion recognition and reflection can impact social behaviour, yet little research has assessed how individuals with a history of NSSI (HNSSI) process facial expressions of emotion. In this thesis, the results of three studies designed to investigate potential differences in emotion recognition and emotion mimicry in individuals with a history of NSSI compared to controls are reported. Results from Study 1 revealed that when presented with colourful, dynamic morphing stimuli showing emotional expressions, HNSSI participants were able to correctly categorize negative expressions like anger, disgust, sadness, and the ambiguous emotion of surprise at a lower stimulus intensity compared to controls; They also correctly categorized fear with greater accuracy, though at the same intensity as controls. However, in Study 2, when static, greyscale images were obscured with varying levels of fractal noise, HNSSI individuals did not show superior signal-proportion thresholds. These results may suggest that higher-order elements of visual and cognitive processing are evoked by more realistic social stimuli. In the third study, HNSSI participants were found to produce significantly less electrical activity in the corrugator muscle in response to viewing angry stimuli, and significantly less of an expected relaxation in muscle activity in response to viewing happy stimuli. Complementing these results, it was found that endorsing social influence as a motivator for engaging in NSSI was associated with less mimicry, whereas endorsing emotion regulation as a motivator was associated with greater incongruent muscle response when viewing happy faces. These observed differences in facial mimicry between HNSSI and controls may be related to some of the observed relationship difficulties experienced by this group. Results from this research may help us to better understand NSSI behaviour, as well as help to inform and further develop therapies intended to address it.

I Sverige och globalt har det de senaste decennierna rapporterats en ökning av icke suicidalt självskadebeteende. Icke suicidalt självskadebeteende har definierats som skada en person medvetet tillfogar sin kropp. Forskning inom området har visat på att personer med icke suicidalt självskadebeteende känt sig stigmatiserade och upplevt dåligt bemötande inom vården. Syftet i denna studie var att beskriva hur det är att leva med icke suicidalt självskadebeteende (NSSI), genom att studera bloggar. En kvalitativ innehållsanalys på sex bloggar gjordes. En induktiv ansats användes för att fånga olika perspektiv angående hur det är att leva med NSSI. Analysen av innehållet resulterade i två kategorier som genomgående kunde återfinnas i alla studerade bloggar. En evig kamp med subkategorierna Att leva med ett beroende, Att sluta skada sig, Att känna sig utanför och Att dömas av vården, Att finna hopp och mening med subkategorierna Att känna stöd från andra och Att ha framtidstro. Personer med NSSI upplever ofta stigmatisering från samhället, vilket skapar lidande. Genom att, som sjuksköterska, möta dessa personer där de befinner sig i sitt lidande kan en trygg och respektfull relation skapas med vårdsökande person. / The recent decades, the number of Non-suicidal Self-injury (NSSI), has increased in Sweden and globally. NSSI has been defined as a conscious self-inflicted physical injury. Research within this field has shown that individuals with NSSI have been stigmatised and has received poor treatment by the healthcare. The purpose with this study is to describe what it is like to live with Non-Suicidal Self-Injury (NSSI) through the study of blogs. Qualitative content analysis of six blogs has been done, and an inductive approach was chosen to capture different perspectives of what it is like living with NSSI. The analysis of the content resulted in two categories that could consistently be found in all the studied blogs. An eternal struggle with the subcategories To live with addiction, To end self-harming, To feel left out, and To be judged by the care system, To find hope and meaning with the subcategories, To feel support from others and To have hope for the future. Individuals with NSSI often experience stigmatisation from the society, which causes further suffering. As a nurse, by meeting these care seekers at where they are in their suffering could help to create a safe and respectful relationship.

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.

Deliberate self-harm (DSH) is a major health concern, especially for high-risk populations such as incarcerated youth. DSH refers to socially unacceptable, deliberate behaviour that causes harm to the body regardless of intent to die. There is limited research concerning prevalence rates as well as risk and protective factors for high-risk, adolescent groups. Participants were recruited from a correctional facility for youth aged 12-18. Male (n = 36) and female (n = 51) incarcerated adolescents (N = 87; mean age = 15.9) completed a survey that measured social-demographic characteristics, current depressed mood, lifetime alcohol and drug use, perceptions of social support (availability and satisfaction), approach-avoidance coping, problem-solving confidence, and DSH. The prevalence rates (81% lifetime, 74% annual, and 51% while incarcerated) for this mainly Aboriginal and Métis population were much higher than previous offender, community, and hospital findings. Youth reported much higher rates of DSH on a checklist than in response to a general question previously used in such research, suggesting that previously reported prevalence rates are likely grossly underestimated. Hypotheses regarding risk and protective factors were only partially supported. Depressed mood and drug use were positively, directly related to annual DSH frequency. Depressed mood proved to be a significant risk factor as well for incarcerated DSH. Overall, protective factors did not predict DSH well for this group of offenders. Only approach coping was inversely related to DSH frequency. Participants in this study reported very low levels of protective factors, which likely affected the outcome of statistical analyses. In general, youth reported high rates of risk factors and low rates of protective factors. Rates of DSH warranting medical attention increased with duration and frequency of such behaviour, as did actually receiving medical attention. Although 74% of offenders indicated that medical attention had been warranted at least once, only 50% actually received medical attention. Offenders were equally likely to receive medical attention whether they had engaged in DSH once or repetitively. It is likely that offenders prefer to keep their behaviour private, which affects how often they seek medical attention, even if they believe it is warranted. Recommendations are advanced for detecting and responding to DSH in incarcerated youth.

Deliberate self-harm (DSH) is a major health concern, especially for high-risk populations such as incarcerated youth. DSH refers to socially unacceptable, deliberate behaviour that causes harm to the body regardless of intent to die. There is limited research concerning prevalence rates as well as risk and protective factors for high-risk, adolescent groups. Participants were recruited from a correctional facility for youth aged 12-18. Male (n = 36) and female (n = 51) incarcerated adolescents (N = 87; mean age = 15.9) completed a survey that measured social-demographic characteristics, current depressed mood, lifetime alcohol and drug use, perceptions of social support (availability and satisfaction), approach-avoidance coping, problem-solving confidence, and DSH. The prevalence rates (81% lifetime, 74% annual, and 51% while incarcerated) for this mainly Aboriginal and Métis population were much higher than previous offender, community, and hospital findings. Youth reported much higher rates of DSH on a checklist than in response to a general question previously used in such research, suggesting that previously reported prevalence rates are likely grossly underestimated. Hypotheses regarding risk and protective factors were only partially supported. Depressed mood and drug use were positively, directly related to annual DSH frequency. Depressed mood proved to be a significant risk factor as well for incarcerated DSH. Overall, protective factors did not predict DSH well for this group of offenders. Only approach coping was inversely related to DSH frequency. Participants in this study reported very low levels of protective factors, which likely affected the outcome of statistical analyses. In general, youth reported high rates of risk factors and low rates of protective factors. Rates of DSH warranting medical attention increased with duration and frequency of such behaviour, as did actually receiving medical attention. Although 74% of offenders indicated that medical attention had been warranted at least once, only 50% actually received medical attention. Offenders were equally likely to receive medical attention whether they had engaged in DSH once or repetitively. It is likely that offenders prefer to keep their behaviour private, which affects how often they seek medical attention, even if they believe it is warranted. Recommendations are advanced for detecting and responding to DSH in incarcerated youth.

Indiana University-Purdue University Indianapolis (IUPUI) / While deliberate self-harm (DSH) in adolescents and adults has been established as a reliable predictor of future suicidal behavior and attempts, whether the same is true for younger children has rarely been studied. Two separate articles will address issues regarding intentional self-injury in young children. The first identified describes the demographic profile of young children who engage in NSSI and evaluated whether predictors of adolescent NSSI are also associated with NSSI in children. The second manuscript analyzed NSSI behaviors to see if they can be correctly predicted from knowledge of a child's history of maltreatment to identify which trauma variables are central in prediction of NSSI status. A Chi-square and logistic regression were run on data from 16,271 records of children ages 5-9 years who received services from the IDMHA in 2018. NSSI was significantly (p < .000) associated with trauma history (x2 = 75.54, df = 1), anxiety (x2 = 107.59, df = 1), depression (x2 = 217.011, df = 1), suicide risk (x2= 993, df = 1), and impulsivity (x2 = 122.49, df = 1. Presence of a caregiver mental health problem (x2 =38.29, df = 1), age (x2 = 14.18, df = 4), being male (x2 = 11.59, df = 1), and being Caucasian (x2 = 23.29, df = 6) at p < .05. Regression results indicated the overall model of seven predictors (sexual abuse [OR 1.14], physical abuse [OR 1.26], emotional abuse [OR1.3], neglect [OR .895], medical trauma [OR 1.34], exposure to natural disaster [OR 1.81] and victim of a crime [1.14] was statistically reliable in distinguishing between children who self-injure and those who do not. [-2 Log Likelihood = 6228.78, x2(6) = 105.416, p < .000]. NSSI does occur in preadolescent children and while there is some indication that the risk factors and co-variates are like those of adolescents, there are some differences which need further study. Training clinicians to inquire about self-injury during assessment of younger children is a simple step. The variables of age and sex throughout development as well as identifying protective as well as risk factors with children should be studied.

University students with increased rates of reported perfectionism, anxiety, and depression, are vulnerable to non-suicidal self-injury (NSSI). However, not all students with psychological distress engage in NSSI, suggesting protective factors may help to mitigate this risk. The present study examined the relation between perfectionism and NSSI, via the mediating effects of anxiety and depression, and the moderating role of self-compassion. Participants were 338 university students (67% female; 87% White) who completed several self-report measures. Students with greater perfectionism reported higher levels of anxiety and depressive symptoms and, in turn, more NSSI engagement. Self-compassion and several self-compassionate domains attenuated connections between perfectionism and psychopathology and between depression and NSSI; conversely, non-self-compassionate domains strengthened associations between perfectionism and psychopathology. Addressing NSSI risk factors (e.g., perfectionism and psychopathology) and fostering self-compassion may reduce the risk of heightened anxiety and depression among perfectionists, consequently reducing their likelihood of NSSI engagement.

Syftet med denna kunskapsöversikt var att belysa olika aspekter av det kunskapsläge som finns idag sett till icke-suicidalt självskadebeteende bland unga kvinnor. Uppsatsens frågeställning var: Hur konstrueras och beskrivs ämnet icke-suicidalt självskadebeteende hos unga kvinnor i valda delar av forskningslitteraturen? Uppsatsen är en selektiv kunskapsöversikt som består av 11 primärdokument och resultaten analyserades med hjälp av en socialkonstruktionistisk teoribildning. Resultaten visade att kvinnor är överrepresenterade vad gäller icke-suicidalt självskadebeteende med fokus på att skära/rispa sig, men att det kan bero på vad forskaren väljer för inkluderings- och exkluderingskriterier i sin studie. Primärdokumenten vittnar om olika orsaker till varför unga kvinnor avsiktligen skadar sig själva, såväl inre som yttre faktorer är avgörande och samspelar med varandra. De unga kvinnorna upplevde att skärandehandlingen var ett effektivt sätt att hantera negativa känslor och att känna emotionell lättnad. Det fanns en stark korrelation mellan självskadehandlingar och dysfuntionella familjeförhållanden. Att självskada genom att skära samt rispa sig blev ett sätt att kanalisera svåra känslor men även att kommunicera med omgivningen då de unga kvinnorna inte lärt sig att på ett mer välgörande sätt uttrycka svåra känslor. De unga kvinnorna internaliserar omgivningens förväntningar – att vara ”den självskadande” – och skapar utifrån dessa en identitet. / The purpose of this systematic review was to highlight different aspects of the state of knowledge available today in terms of non-suicidal self-injury among young women. The question at issue was: How does the research literature – selected parts of it – construct and discuss the topic of non-suicidal self-harm in young women? The paper is a selective knowledge survey consisting of 11 primary document and the results were analyzed using a social constructionist theory. The results showed that women are overrepresented in terms of non-suicidal self-injury with a focus on cutting/scratch, but it may depend on what the researcher selects for inclusion and exclusion criteria in their study. Primary documents show various reasons why young women deliberately harm themselves, both internal and external factors are crucial and interact with each other. The young women felt that the cutting action was an effective way to deal with negative emotions and to feel emotional relief. There was a strong correlation between self-harm acts and dysfunctional family relationships. The young women learned to self-harm as a way to channel hard feelings but also to communicate with the environment because they had not learned to communicate difficult emotions in a more beneficial way. The young women internalize the expectations of - to be "the self-harming young woman” - and creates an identity from these expectations.