Thèse de doctorat présenté en vue de l'obtention du doctorat en psychologie - recherche intervention, option psychologie clinique (Ph.D). / L’automutilation est un problème de santé publique majeur, considéré comme l’un des plus pernicieux et inquiétants auxquels font face les cliniciens et intervenants. Ce type de conduites possède des taux de prévalence et de cooccurrence élevés et est susceptible d’engendrer des conséquences physiques et psychologiques délétères. Par conséquent, au cours de la dernière décennie, l’automutilation a suscité l’intérêt de nombreux chercheurs qui ont tenté de mieux comprendre les facteurs susceptibles de favoriser le recourt à ce type de conduite. À ce sujet, le trait autocritique de la personnalité, de même que les capacités de mentalisation sont des variables reconnues dans la compréhension de l’automutilation. Ces deux variables sont prometteuses parce qu’elles ont le potentiel de renseigner sur les mécanismes sous-tendant l’attaque au corps et d’offrir des leviers thérapeutiques. La présente thèse vise donc à approfondir l’exploration du rôle de l’autocritique et de la mentalisation dans l’automutilation en examinant des pistes de recherche qui n’ont pas encore été empruntées. L’échantillon à l’étude est composé d’étudiants universitaires, chez qui les taux de prévalence de l’automutilation sont particulièrement élevés. Afin de tenir compte de la complexité sous-jacente à l’automutilation, différents angles d’exploration sont abordés dans deux études. La première étude cible le caractère dichotomique de l’automutilation, c’est-à-dire la présence ou l’absence de comportements. L’objectif est d’examiner l’effet combiné de l’autocritique et de la mentalisation sur le risque de s’être automutilé par le passé. Bien que les deux variables aient été associées à l’automutilation, leur interaction n’a jamais encore été explorée. Pour cette étude, 420 étudiants inscrits dans un programme universitaire de premier cycle ont répondu à des questions sur la présence ou l’absence de comportements d’automutilation, ce dans la dernière année et au cours de leur vie. Ils ont aussi répondu au Depressive Experiences Questionnaire, qui évalue la continuité entre les formes normales et pathologiques des composantes autocritique et dépendante de la personnalité, au Reflective Functioning Questionnaire, qui évalue l’importance de deux lacunes de la mentalisation, soit l’hypomentalisation (c.-à-d. une pensée concrète qui se caractérise par la difficulté de former des modèles mentaux complexes relatifs au soi ou aux autres) et l’hypermentalisation (c.-à-d. la formation excessive de représentations mentales de ses actions ou de celles des autres fondées sur des preuves ou indices inexacts), et au Childhood Trauma Questionnaire, visant à évaluer la maltraitance à l’enfance. Les analyses de modération ont permis d’identifier des effets significatifs d’interaction entre l’autocritique et l’importance de deux lacunes de la mentalisation (c.-à-d. hypo- et hypermentalisation) dans le risque de s’être automutilé dans la dernière année. Aucun effet d’interaction n’a été identifié pour la période ciblant l’automutilation au cours de la vie. Les interactions sont demeurées statistiquement significatives en contrôlant pour les effets du sexe, du trait dépendant de la personnalité, et des expériences traumatiques vécues à l’enfance. En mettant en évidence un effet de modération par la mentalisation, ces résultats contribuent à clarifier les conditions dans lesquelles l’autocritique et l’automutilation sont associées. La deuxième étude cerne quant à elle le caractère multidimensionnel de l’automutilation en s’intéressant à ses différentes caractéristiques. Celles-ci sont de plus en plus étudiées en tant que corrélats de la sévérité de l’automutilation puisqu’elles refléteraient des variations dans la sévérité de la morbidité associée à ce type de conduite. La nature de cette étude étant exploratoire, l’objectif est de documenter un ensemble de corrélats potentiels de la sévérité de l’automutilation (fréquence, nombre de méthodes, récence, type de soins requis) en examinant leurs associations avec l’autocritique et la mentalisation, toutes deux identifiées comme des facteurs de vulnérabilité transdiagnostiques associés à la sévérité de la perturbation du fonctionnement et de la détresse psychologique. L’échantillon comprend deux cent quatre étudiants de premier cycle, soit les participants de la première étude ayant un historique d’automutilation. Ceux-ci ont répondu aux mêmes questionnaires pour l’automutilation, l’autocritique et les lacunes de la mentalisation, en plus du Brief Symptom Inventory (échelles de dépression et d’anxiété). Les données ont été soumises à des tests t et à des analyses de variance. Les résultats ont permis d’identifier des associations positives entre les caractéristiques de l’automutilation, d’une part, et les niveaux d’autocritique, l’importance des lacunes de la mentalisation et certains indices cliniques (anxiété, dépression, pensées suicidaires), d’autre part. Ceci renforce la proposition selon laquelle les caractéristiques de l’automutilation peuvent être utilisées comme des indicateurs de la sévérité de la perturbation du fonctionnement et de la détresse psychologiques chez les individus qui s’automutilent. Ces données préliminaires ouvrent aussi la voie à l’exploration de modèles plus complexes du rôle de l’autocritique et de la mentalisation dans les variations au sein des caractéristiques de l’automutilation. De façon générale, les résultats de la présente thèse indiquent que l’automutilation présente des niveaux de sévérité, et que l’autocritique puis des déficits de la mentalisation sont associés à la présence et à la qualité (niveaux de sévérité) de l’automutilation. Ces résultats suggèrent que des interventions visant à améliorer le rapport que l’individu entretient avec lui-même, de même que sa capacité à attribuer une qualité mentale à ses expériences personnelles et interpersonnelles pourraient être pertinentes en contexte de prévention et d’intervention entourant les conduites d’automutilation. / Nonsuicidal self-injury (NSSI) is a significant public health issue. It is considered as one of the most concerning and pernicious behavior faced by health professionals. NSSI has high prevalence and cooccurrence rates and can lead to deleterious physical and psychological consequences. This phenomenon therefore has elicited a great deal of empirical and theoretical research in the last decade, as substantial efforts have been directed toward a better understanding of the factors underlying it. Among such factors are self-criticism and mentalizing abilities whose potential to clarify the mechanisms underlying NSSI and to provide therapeutic leverage make them promising variables. The goal of the present thesis is to investigate in more detail the role of self-criticism and mentalizing in NSSI by exploring new research avenues. The study sample consists of university students, a population in which NSSI is alarmingly common. In order to better apprehend the complexity of NSSI, different exploration angles are addressed in two studies. The first study targets the dichotomic nature of NSSI, that is, the presence or absence of the behavior. The objective is to examine the combined effect of self-criticism and mentalizing in the risk of having engaged in NSSI in the past. Although self-criticism and mentalizing have both been associated with NSSI, their interplay in predicting NSSI has never been explored. For this study, four hundred and twenty Canadians undergraduates answered online questions regarding the presence or absence of NSSI, over either the previous year or their lifetime. They also completed the Depressive Experiences Questionnaire, which assesses the continuity between normal and pathological forms of self-criticism and dependency, the Reflective Functioning Questionnaire, which evaluates the degree of two mentalizing deficits, namely hypomentalizing (i.e., concrete thinking characterized by the difficulty to form nuanced and complex models of the mind relating to the self and others) and hypermentalizing (i.e., excessive mentalizing characterized by the tendency to generate excessively detailed models of the mind of the self and others without accurate evidence to support these models), and the Childhood Trauma Questionnaire, which assesses experiences of childhood maltreatment. The moderation analyses showed significant interaction effects between self-criticism and the two mentalizing deficits (i.e. hypo- and hypermentalizing) in the risk of having engaged in NSSI in the previous year. No moderation effects were found for the lifetime period. The results remained statistically significant after adjusting for sex, dependency and childhood traumas. By identifying an interaction between self-criticism and impairments in mentalizing (i.e. hypo- and hypermentalizing) in the occurrence of NSSI, this study contributes to the clarification of the conditions in which self-criticism may be related to NSSI. The second study focuses on the different characteristics of NSSI and therefore targets the multidimensional nature of this behavior. NSSI features are increasingly studied as proxies for NSSI severity, as they relate to variations in the severity of the morbidity associated with this type of behavior. This study is exploratory. Its objective is to cluster and document a set of potential NSSI severity proxies (frequency, number of methods, recency, type of care needed) by examining their associations with self-criticism and mentalizing, which are both identified as transdiagnostic vulnerability factors associated with the severity of psychological distress and functional impairment. For this study, only the students who were recruited in the first study and who had a history of NSSI were selected (N = 204 participants). They completed the same online questionnaires for NSSI, self-criticism and mentalizing, in addition to the Brief Symptom Inventory (depression and anxiety scales). T tests and analyses of variance were conducted. The results show positive associations between NSSI features and self-criticism levels, degrees of mentalizing deficits and clinical indicators (anxiety, depression, suicidal thoughts). Those results support the proposition that NSSI characteristics could be used as psychological distress and functional impairment severity indicators in individuals engaging in self-injury. They also open the door to the exploration of more sophisticated models of the role of self-criticism and mentalizing in NSSI characteristics variations. Overall, the results of the present thesis indicate that NSSI presents various severity levels, and that self-criticism and mentalizing deficits are associated with the presence as well as the quality (i.e. severity levels) of NSSI. Those results suggest that interventions aiming at improving an individual’s relationship with himself, as well as his capacity to give a mental quality to his personal and interpersonal experiences could be relevant in NSSI prevention and intervention.

This study centered on adolescent self-mutilation as well as possible forms of support and prevention. The information was gathered by assessing the needs of the adolescent girls who self-mutilate by means of semi-structured interviews. In these interviews the adolescent girls expressed their experiences of self-mutilation and their emotional needs. The aim of the study was to explore and describe the needs of adolescent girls who self-mutilate in order to develop guidelines of support so that parents may feel less helpless and overwhelmed. The findings of the study indicated that there are various reasons why an adolescent would engage in selfmutilation, that it serves a function in the adolescents’ lives and surfaces at times of emotional crisis. This study found further that a lack of problem-solving skills, coping abilities and social skills could play a role in whether an adolescent chooses to self-mutilate. / Social Work / M. Diac. (Play therapy)

Autobiographies and documentaries usually aim to elicit a discussion about social issues by shocking and horrifying readers and viewers, often through graphic imagery. This study's ambition is to examine how literary documentary borrows from the gothic tradition to depict real societal issues. My aim is to show how the gothic style transcends the borders of the genre and that literary documentary about self-harm tends to work through the same thematic and narrative structures as the literary gothic. With a focus on contemporary depictions of self-harm and mental illness in young women and girls in Sweden, this analysis explore how the function of sexuality, gender and self-harm in gothic horror can be applied on these texts. At the same time this study explores how selfharming women tend to use gothic imagery to portray the horrors of their own reality that is saturated with extreme and negative emotions. For comparison, two famous depictions of girls going through puberty from the literary horror genre; Carrie and The Exorcist, are examined to further anchor the connection between femininity, blood and puberty in the gothic theoretical field.

Submitted by SBI Biblioteca Digital (sbi.bibliotecadigital@puc-campinas.edu.br) on 2017-04-07T14:08:33Z No. of bitstreams: 1 GUILHERME WYKROTA TOSTES.pdf: 1193399 bytes, checksum: b3ef0dec85a943ae0c917ab3cb8e07cc (MD5) / Made available in DSpace on 2017-04-07T14:08:33Z (GMT). No. of bitstreams: 1 GUILHERME WYKROTA TOSTES.pdf: 1193399 bytes, checksum: b3ef0dec85a943ae0c917ab3cb8e07cc (MD5) Previous issue date: 2017-02-07 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / This research aims to psychoanalytically investigate the experience of people who selfinjure themselves. It is justified by the comprehension that the symptom that expresses emotional suffering it is catching attention among mental health professionals and gaining a certain social visibility. This essay is structured as qualitative research and it is organized around the use of the psychoanalytical method and the investigation of a set of posts which, in the foreground, is signed by people who identify themselves as adepts of self-injurious acts and, in the background, there are also comments made by other Internet users linked to the main post. Successive readings of the material, in a floating attention state, allowed the interpretive production of two affective-emotional fields: "Lack of affection" and "Crime and Punishment". The overall frame indicates that those who have shown the conduct studied here live in an imaginative / imaginary hostile world, marked by the experience of persecutory guilty due to the lack of affection, care and consideration, pointing out that fundamental requirements in the constitution of the personality are not being satisfactorily contemplated. / Esta pesquisa objetiva investigar psicanaliticamente a experi?ncia vivida de pessoas que se autolesionam. Justifica-se na medida em que diz respeito ao sintoma que expressa sofrimento emocional que enseja preocupa??o entre profissionais da sa?de mental e que tem ganhado certa visibilidade social. Articula-se como pesquisa qualitativa mediante uso do m?todo psicanal?tico, pelo estudo, em primeiro plano, de um conjunto de postagens assinadas por pessoas que se identificam como praticantes de atos autolesivos e, em segundo plano, por outros internautas que se pronunciam sobre esse problema a partir de outras perspectivas. Leituras e releituras do material, em estado de aten??o flutuante, permitiram a produ??o interpretativa de dois campos de sentido afetivo-emocional: ?Desprovidas de afeto? e ?Crime e Castigo?. O quadro geral indica que aqueles que apresentam a conduta aqui estudada habitam imaginariamente um mundo hostil, marcado pela experi?ncia de culpa persecut?ria pela priva??o de afeto, cuidado e considera??o, apontando que exig?ncias fundamentais na constitui??o da pessoalidade n?o est?o sendo satisfatoriamente contempladas.

Introduction Child sexual abuse is a common problem. Psychological and behavioural problems in children and adults who have experienced child sexual abuse have been associated with the abuse. Little research has been conducted which has been long-term, prospective, involved substantiated sexual abuse, included a control group, took into account mediating factors, utilised multiple data sources, relied on standardised measures and had a high follow-up rate. Aim The aims of this study were to compare a cohort of sexually abused young people with a group of nonabused peers and to establish predictors of psychological and behavioural outcome. Method This study was a follow-up which was long-term, prospective, involved a sample of children with substantiated sexual abuse, included a control group, took into account mediating factors, utilised multiple data sources, relied on standardised measures and had a high follow-up rate. Eighty-four sexually abused young people were followed up five years after presenting to Children�s Hospitals� Child Protection Units for sexual abuse and were compared to a group of 84 nonabused young people of similar age and sex. The two groups were compared on the basis of demographic variables, family functioning, mother�s mental health and life events; the outcome measures of depression, self-esteem, anxiety, behaviour, criminal activity, alcohol and other drug use, eating problems, running away, suicide attempts, self-injury, hopefulness, despair and attributional style; and potential mediating factors such as further notifications to the Department of Community Services, receipt of psychological treatment, legal action against offenders and victims compensation. Potential predictors of outcome were (1) demographic variables, (2) sexual abuse characteristcs, (3) intake data and (4) five year follow-up variables. Main findings Follow-up rates were 81percent (n equals 68) for cases and 89percent (n equals 75) for controls. Five years after presenting for the sexual abuse, the sexually abused young people were performing more poorly than their nonabused peers on various measures of psychological state and behaviour. Although the abused children had experienced more negative life events (p<.001), were from lower socio-economic groups (p<.0001), had more changes in parent figures (p<.001) and had mothers who were more psychologically distressed (p equals .03), multiple regression analysis showed that after allowing for these and other demographic and family factors, there were still significant differences between the groups after the 5 years. The abused children displayed more disturbed behavior (p equals .002), had lower self-esteem (p<.001), were more depressed or unhappy (p<.001) and were more anxious (p equals .03) than controls. Sexually abused children had significantly higher levels of bingeing (p equals .02), self-injury (p equals.009) and suicide attempts (p equals .03). Significant predictors of psychological and behavioural outcome were significantly related to family and parent functioning variables. Abuse status was not a significant predictor when offered to each of the predictive models. Significant predictors of outcome included the following intake variables: family functioning, mother�s mental health, whether parents were employed or not, behaviour scores, prior notifications for neglect, history of parental discord and whether there were caregiver changes or not prior to intake. The classification of the index sexual abuse event as indecent assault and whether there were notifications for sexual abuse prior to the index event also significantly predicted outcome. Five year follow-up variables which were significant predictors of outcome were the young person�s age, number of negative life events, attributional style, self-esteem, depression, number of parent changes, anxiety, despair, whether there were notifications for abuse/neglect after intake and having a parent with a history of drug/alcohol problems. Conclusions Difficulties associated with child sexual abuse continue for some years after the abuse event. Child sexual abuse needs to be considered as a possible antecedent of behaviour and psychological difficulties in young people. Treatment and monitoring should continue for some years after the abuse. Treatment may need to be directed more towards young people�s psychological states rather than focusing specifically on the sexual abuse. Family and parent functioning may need to be addressed early in order to prevent some of the behavioural and psychological difficulties associated with the long-term outcome of child sexual abuse.

本研究結合Clark與Watson（1991）的三角模式（Tripartite Model）以及Brown、Chorpita和Barlow（1998）提出的階層性概念，結構正向情感、負向情感、焦慮、憂鬱、無望感、自傷、自殺的關係，建立自傷與自殺的階層預測模式，說明自傷與自殺的同異處。研究對象為487位大學生，325位女性與162位男性，採取自陳式問卷的方式施測，包含自我傷害行為量表、自殺危險程度量表、貝克無望感量表、正負向情感量表、症狀檢核表-90-修正版（摘錄測量焦慮與憂鬱的題目）、相關背景變項的測量，並以描述性統計、相關性考驗、階層迴歸分析、結構方程模式等統計方式對資料進行處理。主要的研究結果為：（1）負向情感能預測與解釋焦慮和憂鬱，且能透過焦慮預測自傷與自殺，唯焦慮對自傷的解釋力較高；負向情感亦能透過憂鬱預測自殺，但無法透過憂鬱預測自傷。（2）正向情感能預測與解釋憂鬱，且能透過憂鬱預測自殺。（3）加入無望感分析後，發現憂鬱能透過無望感預測自殺，憂鬱也能直接預測自殺，顯示無望感為憂鬱與自殺的部分中介變項。最後，結果發現有15.81%的自傷比例、24.64%的自殺意念比例、8.01%的自殺企圖比例。 / This study combined Clark & Watson’s (1991) tripartite model with Brown, Chorpita, and Barlow’s (1998) hierarchical model to structure the relationship of positive affect (PA), negative affect (NA), anxiety, depression, hopelessness, non-suicidal self-injury (NSSI), and suicide. This study attempted to establish hierarchical predictor model of NSSI and suicide, and explain the relationship of NSSI and suicide. The participants were 487 university students, 325 females and 162 males, who were participating in a study of test of deliberate self-harm inventory, suicide risk inventory, Beck hopelessness scale, positive and negative affect schedule, symptom checklist-90-R, and background variables. The data were examined by descriptive statistics, correlation, hierarchical analysis, and structural equation modeling. The main results were : (1) NA could predict anxiety and depression ; anxiety could not only mediate the relationship of NSSI and NA, but also mediate the relationship of NA and suicide ; anxiety accounted for more of the variance in NSSI than in suicide ; depression could mediate the relationship of NA and suicide, but could not mediate the relationship of NSSI and NA. (2) PA could predict depression, and depression could mediate the relationship of PA and suicide. (3) the role of hopelessness was partial mediator of depression and suicide. Finally, the result found 15.81% NSSI, 24.64% suicidal ideation, and 8.01% suicidal attempt.

Introduction Child sexual abuse is a common problem. Psychological and behavioural problems in children and adults who have experienced child sexual abuse have been associated with the abuse. Little research has been conducted which has been long-term, prospective, involved substantiated sexual abuse, included a control group, took into account mediating factors, utilised multiple data sources, relied on standardised measures and had a high follow-up rate. Aim The aims of this study were to compare a cohort of sexually abused young people with a group of nonabused peers and to establish predictors of psychological and behavioural outcome. Method This study was a follow-up which was long-term, prospective, involved a sample of children with substantiated sexual abuse, included a control group, took into account mediating factors, utilised multiple data sources, relied on standardised measures and had a high follow-up rate. Eighty-four sexually abused young people were followed up five years after presenting to Children�s Hospitals� Child Protection Units for sexual abuse and were compared to a group of 84 nonabused young people of similar age and sex. The two groups were compared on the basis of demographic variables, family functioning, mother�s mental health and life events; the outcome measures of depression, self-esteem, anxiety, behaviour, criminal activity, alcohol and other drug use, eating problems, running away, suicide attempts, self-injury, hopefulness, despair and attributional style; and potential mediating factors such as further notifications to the Department of Community Services, receipt of psychological treatment, legal action against offenders and victims compensation. Potential predictors of outcome were (1) demographic variables, (2) sexual abuse characteristcs, (3) intake data and (4) five year follow-up variables. Main findings Follow-up rates were 81percent (n equals 68) for cases and 89percent (n equals 75) for controls. Five years after presenting for the sexual abuse, the sexually abused young people were performing more poorly than their nonabused peers on various measures of psychological state and behaviour. Although the abused children had experienced more negative life events (p<.001), were from lower socio-economic groups (p<.0001), had more changes in parent figures (p<.001) and had mothers who were more psychologically distressed (p equals .03), multiple regression analysis showed that after allowing for these and other demographic and family factors, there were still significant differences between the groups after the 5 years. The abused children displayed more disturbed behavior (p equals .002), had lower self-esteem (p<.001), were more depressed or unhappy (p<.001) and were more anxious (p equals .03) than controls. Sexually abused children had significantly higher levels of bingeing (p equals .02), self-injury (p equals.009) and suicide attempts (p equals .03). Significant predictors of psychological and behavioural outcome were significantly related to family and parent functioning variables. Abuse status was not a significant predictor when offered to each of the predictive models. Significant predictors of outcome included the following intake variables: family functioning, mother�s mental health, whether parents were employed or not, behaviour scores, prior notifications for neglect, history of parental discord and whether there were caregiver changes or not prior to intake. The classification of the index sexual abuse event as indecent assault and whether there were notifications for sexual abuse prior to the index event also significantly predicted outcome. Five year follow-up variables which were significant predictors of outcome were the young person�s age, number of negative life events, attributional style, self-esteem, depression, number of parent changes, anxiety, despair, whether there were notifications for abuse/neglect after intake and having a parent with a history of drug/alcohol problems. Conclusions Difficulties associated with child sexual abuse continue for some years after the abuse event. Child sexual abuse needs to be considered as a possible antecedent of behaviour and psychological difficulties in young people. Treatment and monitoring should continue for some years after the abuse. Treatment may need to be directed more towards young people�s psychological states rather than focusing specifically on the sexual abuse. Family and parent functioning may need to be addressed early in order to prevent some of the behavioural and psychological difficulties associated with the long-term outcome of child sexual abuse.

This study centered on adolescent self-mutilation as well as possible forms of support and prevention. The information was gathered by assessing the needs of the adolescent girls who self-mutilate by means of semi-structured interviews. In these interviews the adolescent girls expressed their experiences of self-mutilation and their emotional needs. The aim of the study was to explore and describe the needs of adolescent girls who self-mutilate in order to develop guidelines of support so that parents may feel less helpless and overwhelmed. The findings of the study indicated that there are various reasons why an adolescent would engage in selfmutilation, that it serves a function in the adolescents’ lives and surfaces at times of emotional crisis. This study found further that a lack of problem-solving skills, coping abilities and social skills could play a role in whether an adolescent chooses to self-mutilate. / Social Work / M. Diac. (Play therapy)

This thesis investigated the experience of taking part in a psychosocial assessment following an episode of self-harm from the service user perspective. Psychosocial assessments are a key aspect of self-harm management in secondary care, designed to identify needs and risk and determine further care. This study utilised interpretative phenomenological analysis to privilege the voices of service users and produce in-depth, contextualised understandings of the experience of assessment and its impact on future help-seeking and engagement with services. Data collection consisted of semi-structured interviews with thirteen participants soon after their hospital attendance; follow-up semi-structured interviews were also completed with seven participants three months later, to explore patient-derived outcomes from assessment and hospital attendance. The lived experiences of participants were characterised by two main features: experiences of life as a struggle and of the self as “less than”. As a result of these struggles and experiences of powerlessness and devaluation, participants mostly saw self-harm and suicide as a natural progression in their narratives. Expressions of suicidal intent reflected a struggle between a desperate desire for change and hopelessness in the face of current circumstances. The key message gained from participants’ accounts of assessment was that the interaction with staff had the power to reinforce or challenge hopelessness and negative self-evaluations. In addition, the way an assessment was conducted had influence beyond the hospital: as an experience which created or reinforced expectations for future instances of help-seeking; as a deterrent or an encouragement to seek help; and as the first step along the path to change. Unfortunately, participants’ experiences of aftercare were dominated by a sense of stagnation due to the failure of services to follow through with promises of aftercare, which affected their attitudes towards future help-seeking and towards themselves. This thesis is the first study to utilise an in-depth idiographic methodology to explore and contextualise the service user experience of psychosocial assessment following self-harm within the wider circumstances of their lives. It demonstrates how patient-staff interactions within the hospital and after discharge can affect future help-seeking through reinforcing or challenging the hopelessness and self-negativity of patients.

L’objectif de cette thèse est de jeter un éclairage sur ce qui influence une personne, ayant peur d’être abandonnée, à s’automutiler. Les modèles psychologiques des relations d’objet et de l’attachement ont montré empiriquement que la peur de l’abandon, via les concepts de l’anxiété d’attachement et de la dépendance, est associée à l’automutilation. Cependant, la nature de cette relation n’a jamais été approfondie. Après avoir défini et mis en contexte la notion d’automutilation, une explication théorique est proposée à l’aide des approches des relations d’objet, de l’attachement et de l’évitement expérientiel des fonctions de l’automutilation, afin de mieux comprendre ce qui influencerait une personne dépendante à s’automutiler. La présente thèse suggère que les individus dépendants et ayant peur d’être abandonnés s’automutileraient afin de gérer leurs émotions négatives liées à la perception d’un abandon, d’une séparation ou d’un rejet. Cette influence de l’automutilation se ferait, théoriquement, à travers des fonctions de régulation intrapersonnelle et interpersonnelle, telles que la régulation affective, l’autopunition et l’influence interpersonnelle, mais également par une fonction d’évitement de l’autonomie. Ces fonctions permettraient de préserver les représentations internes d’une relation de dépendance et ainsi réduire les sentiments subjectifs de l’abandon. Pour appuyer empiriquement ces propositions, 58 participants consultant en clinique externe de psychologie ont, entre autres, complété le Questionnaire des expériences dépressives (DEQ), l’Inventaire d’énoncés sur l’automutilation (ISAS) et l’Entrevue diagnostique révisée pour les troubles limites de la personnalité (DIB-R). Les résultats montrent qu’une dépendance, de type anaclitique, et la fréquence de l’automutilation sont associées et que leur relation peut s’expliquer par les effets médiateurs des difficultés sur les plans affectifs et interpersonnels. En outre, la dépendance anaclitique apparaît être liée spécifiquement à différentes fonctions de l’automutilation, soit symboliser la détresse interne, l’antidissociation, l’influence interpersonnelle ainsi que l’évitement de l’autonomie. Ces résultats suggèrent que la dépendance anaclitique favorise l’expérience de difficultés affectives et interpersonnelles qui augmentent la fréquence de l’automutilation. En outre, ils suggèrent que l’automutilation, associée à ce type de dépendance, servirait à réguler des états affectifs internes, influencer l’environnement interpersonnel et éviter l’autonomie. Quant à elles, la régulation affective et l’autopunition sont présentes chez une majorité des personnes qui s’automutilent, sans égard à leur niveau de dépendance. Ainsi, si ces fonctions sont bien liées théoriquement à la dépendance derrière l’automutilation de certains individus, les analyses rappellent qu’elles contribuent également à l’automutilation chez des personnes n’ayant pas de crainte particulière de l’abandon. / The objective of this thesis is to shed light on what may lead a dependent person who fears abandonment to engage in self-injury. Psychological models of object relations and attachment have shown that self-injury is empirically associated with fear of abandonment via dependency and attachment anxiety. However, the nature of this relationship has yet to be thoroughly explained. Having defined and contextualised self-injury, a theoretical explanation is proposed through object relations, attachment and experiential avoidance functions of self-injury, all with the goal of better understanding what can influence a dependent individual to self-injure. This thesis suggests that individuals who are dependent and afraid of being abandoned might use self-injury to regulate negative emotions associated with their perception of abandonment, separation or rejection. Theoretically, this influence of self-injury could occur through intrapersonal and interpersonal functions, such as affect regulation, self-punishment and interpersonal influence, as well as autonomy avoidance. These functions might serve to protect internal representations of dependence and thus, reduce subjective feelings of abandonment. To test these theoretical proposals, 58 outpatient participants completed, among other measures, the Depressive Experiences Questionnaire (DEQ), the Inventory of Statements About Self-Injury (ISAS) and the Revised Diagnostic Interview for Borderlines (DIB-R). Results showed a relationship between anaclitic neediness and self-injury frequency, which was explained by mediator effects of both affective and interpersonal problems. Furthermore, this type of dependency was found to be specifically associated with marking distress, anti-dissociation, interpersonal influence and autonomy avoidance functions of self-injury. These findings suggest that anaclitic neediness favours the experience of affective and interpersonal difficulties, which in turn increase the frequency of self-injury. Results also suggested that self-injury associated with this type of dependency might serve to regulate internal affective states, to influence the interpersonal environment and to avoid autonomy. Affect regulation and self-punishment functions were endorsed by the majority of individuals who self-injured, regardless of their level of dependence. While these two functions are associated in theory to dependency issues that underpin self-injury for some individuals, analyses indicated that these functions also contribute to self-injury behaviour in people who do not fear abandonment specifically.