Publication - Research and analysis
Self-harm strategy development: qualitative evidence
Supporting development of a self-harm strategy for Scotland, what does the qualitative evidence tell us?
Appendix 3: Themes and concepts: Translation tables
| Concept | Studies | Illustrative Quotes | |
|---|---|---|---|
| Not just teenage white girls | (Baker et al., 2013; Bermeo Coronel, 2021; Biddle et al., 2018; Dargan et al., 2016; Donskoy and Stevens, 2013; Jacob et al., 2017; John et al., 2022; Klineberg et al., 2013; Lavis and Winter, 2020; Lockwood et al., 2020; Long, 2018; Marzano et al., 2016, p. 201; Turrell, 2019; Wadman et al., 2018)(Sharmin Aktar, 2022; Baker et al., 2013; Ballantyne, 2020; Boyce, 2021; Chandler, 2019; Chandler and Simopoulou, 2021; Inckle, 2014; Klineberg et al., 2013; Marzano et al., 2016, 2012; Marzetti et al., 2022; Mason et al., 2022; McDermott et al., 2015; Polling et al., 2021; Richardson et al., 2021; Sambath, 2016; M Isabela Troya et al., 2019; M. Isabela Troya et al., 2019; Turrell, 2019; Williams et al., 2021) | McDermott et al. (2015) | I am bi-sexual. I’m always getting made fun of, and I hate it! I’ve thought about suicide…a lot…I self-harm. My life is horrible. |
| Year X is stressful and self-harm is my coping mechanism…I’m tired of everyone thinking I am depressed over being a lesbian…I love being a lesbian. | |||
| …because of low self-esteem and a messed up world. not because of my preference for girls. | |||
| It’s not being gay…it’s being tormented and belittled. | |||
| I think it’s true that LGBT youth are at higher risk for self-harm, mostly because of bullying and social rejection they go through, rather than because of ‘confusion’. | |||
| Troya et al. (2019) | I felt embarrassed because of me age, I didn’t wanna ask for help. I’m thinking it’s girls that do it, 16, 17-year-olds you know and they’re self-harming and here is me, at 67, you know, I should know better’. | ||
| It’s still something not taken seriously, like it will go away or grow out of it. When the truth is, you don’t grow out of it if you don’t receive the help. | |||
| Ballantyne (2020) | I would look at girls and I’d be like- I want to be like that, that’s what I would like. I’d do anything to be like just like that, like so normal and em and I remember I’d like I’d take a knife and I’d press really hard like really like going harder and harder and just to feel the pain and I think it would numb me in a way. | ||
| Boyce (2021) | It’s never been easy being a male who has had an eating disorder or been a cutter, most programmes are for young women. | ||
| I very recently had an assessment with IAPT who wanted to refer me to a self-harm support group, but it’s not available to those over the age of 25, which is upsetting. Many resources online seem to be aimed at those under 25 too, so they don’t always feel as applicable or helpful to me because they focus on issues typically faced by teens. | |||
| Often people seem to associate self-harm with teenagers only, and label it as ‘just a phase’ or something to do with a subculture e.g. Emos. I think there is therefore very little understanding or compassion generally in society for people who are older that self-harm. | |||
| I think if an adult is seen with healed scars it’s acceptable, as if they had got past a bad time or phase. But to be an adult self-harmer is a different matter. | |||
| Now that I’m older I’m supposed to know that it’s not an okay coping mechanism. | |||
| People expect that you ‘grow out of it’ and that you’re very highly strung, but it will level out as you grow up. When you don’t fit that, people get frustrated and believe you are childish or juvenile. | |||
| It doesn’t stop when you get to 18, but that is how it’s portrayed. People have said to me “Haven’t you grown out of that by now?”. I wish people were better informed. I sometimes feel embarrassed because I am 33, which just makes it all worse. I hate that. | |||
| Generally, when discussing self-harm, the conversation focuses on teenage girls. As a male, it is much more stigmatised, and less accepted. Adults who self-harm, generally I find are stigmatised even more, almost as though as an adult you should have more control of your emotions. | |||
| Chandler and Simopoulou (2021) | It’s easier to hide self-harm if you’re a rugby player and you come out all bruised and battered, there’s something like you can’t hide that, whereas maybe women don’t have the same exposure to the physical sports that they could get that release from…I don’t know, maybe that’s how men have found certain ways of self-harming and women have found other ways of self-harming. | ||
| Williams et al. (2021) | If I was already in a bad place you know something just as small as one pronoun would just sort of send me into a spiral…Yeah I’d say especially like dealing with like gender dysphoria, you know, it feels you know kind of natural to take those feelings out on your body when it feels like it shouldn’t even be yours. | ||
| Hurt myself in my biceps or where I’m muscular. And when I was younger, so I would hurt, I would disproportionately get hurt in my testicles a lot. Erm like I tried to, I tried to castrate myself sort of. | |||
| I think it was a lot of me feeling like I deserved it [self-harm]. Erm and that it was again a form of punishment for me because I genuinely thought that what I was feeling was sinful and that I needed to get it out of me. | |||
| I had probably at least half, 150 people being “oh [name] dirty lesbian” coming into my classrooms. I had people throwing balls of yarn covered in piss, piss, urine, didn’t ever hit me. | |||
| Everyone would be like “ew she’s going to be looking at us” like “aw I bet she fancies us kind of thing,” like I felt better being away from everyone else which it didn’t feel great that I had to kind of go somewhere else from other people […] I think definitely the discrimination I got when I was younger from other girls, that definitely impacted it [self-harm and suicidal thoughts’ because it added to that low mood and just not feeling accepted. | |||
| Brown et al. (2022) | In our religion we’re not meant to be like in a relationship before marriage and stuff…so I’ve always, erm, known…I probably deserve to be struggling, as a punishment | ||
| Something is very wrong with me. | (Sharmin Aktar, 2022; Baker et al., 2013; Ballantyne, 2020; Bermeo Coronel, 2021; Brown et al., 2022; Camm-Crosbie et al., 2019; Chamberlen, 2016; Chandler, 2019; Dargan et al., 2016; Donskoy and Stevens, 2013; Edmondson et al., 2018; Givissi, 2016; Inckle, 2014; Mason et al., 2022; McDermott et al., 2015; Morris et al., 2015; O’Brien et al., 2021; Rouski et al., 2021; Sambath, 2016; Steggals et al., 2020; Wadman et al., 2017; Walker et al., 2021; Williams et al., 2021) | Anderson and Clarke (2019) | I think I try too hard for perfection, and ironically […] sabotage it by squeezing away. |
| O’Brien et al. (2021) | I feel like it’s all my fault. I feel like I’m the problem. | ||
| Marzetti et al. (2022) | Some of the things they said on a regular basis was like, ‘you are the ugliest person in the world, like no-one will ever love you’, and things like that. Like once I feel like that because a think you hear all the time you believe in it. It’s like, although after I finished secondary school, although I didn’t hear from them again for a long time, it was like they left but I kind of created this bully that was inside me and like even after losing my contact with them I realised I had the same pressure on me, myself now, like ‘why are you like this? You are so ugly. You’re never enough!’ and things like that. | ||
| Mason et al. (2022) | I just don’t think very much of me at times, at those time I feel like scum. | ||
| Sometimes I look in the mirror when I’m in a really low point and I think ‘what is this thing looking back at me?’ I almost feel sick to the point, because it’s just, that’s my low state of mind at that point, when I’m feeling really low. | |||
| Weak. Disgusting…I never feel clean…what happened to me shouldn’t happen to anybody. And it just makes me feel worthless, shit, I shouldn’t be here. | |||
| Information and influence | (Baker et al., 2013; Bermeo Coronel, 2021; Biddle et al., 2018; Dargan et al., 2016; Donskoy and Stevens, 2013; Jacob et al., 2017; Klineberg et al., 2013; Lavis and Winter, 2020; Lockwood et al., 2020; Long, 2018; Marzano et al., 2016; Turrell, 2019) | Jacob et al. (2017) | I was in complete secrecy about my self-harm, but then I’d go home and I had all these people on the computer who I could talk to, who would support me. |
| I would just look at tips; how to hide it you know how to make it, make it hurt more and things like that, and yeah just kind of, I don’t know, I don’t know. I did go on there for a positive reason in the beginning, but after that I was just looking at negatives so like pro self-harm sites and that was it then. | |||
| Biddle et al. (2018) | Biddle et al. (2018) It was around the time that Mick Jagger’s girlfriend took her own life and I remember reading she was six foot and managed to hang herself on [names ligature point]…so I went online and I was reading about it…and I went down and I tried to do it [using same ligature point]. | ||
| Wikipedia told me the answer…they told you what was poisonous about them, how many you needed to kill yourself, how much in grams. | |||
| When my head’s been bad, I’ve wanted to be dead and not helped, so I’m more likely to Google what can kill me quickest than how I can get help. | |||
| I was really interested in the way that others were talking about it and it would be like a nice little comfort blanket…it was literally just like not feeling so alone. | |||
| I Googled ‘how to hang yourself’…it was an in depth report on how Saddam Hussein had been hanged and the knot had to go [states location] to break your neck. | |||
| Lockwood et al. (2020) | I think it’s very much what will help me immediately – oh, I’ve self-harmed before, I’ll do that again. | ||
| Lavis and Winter (2020) | I think there’s a misconception that people will, like, get into self-harm because they see these pictures [online] and I really don’t think that’s true. | ||
| Coronel (2021) | I think it also had a lot to do with the time, you know, emo was becoming like a big thing you know like, Senses Fail and, you know, half of their songs are about, their most popular songs Bloody Romance, like, literally is about cutting yourself, Hawthorn Heights, and you know, every other line was about cutting my wrists or whatever. Taking Back Sunday, like, it was right when that whole scene was going to explode. So, I think it was again partially that, you know, you just, it was more in the spotlight, and when I listened to those songs, it was exactly how I felt, how they were dealing with those feelings, so I thought why the hell not. | ||
| John et al. (2022) | It seemed like the press were trying to find a link between all of them and I think obviously some of them were linked but [M] had nothing to do with any of the others. So that was upsetting for people reading it because it was like they were just saying how they were killing-, killing themselves because their friend had done it or their family had done it and that wasn’t the case, for [M] it wasn’t anyway cause I knew him, I spoke to him that day. | ||
| Self-harm and the State | (Baker et al., 2013; Chamberlen, 2016; Donskoy and Stevens, 2013; Griffiths et al., 2019; Inckle, 2014; Johnson et al., 2017; Mackenzie et al., 2018; Marzano et al., 2016, 2012; Polling et al., 2021; Quinlivan et al., 2021; Rouski et al., 2021; Wadman et al., 2017; Walker et al., 2021; Whalen, 2016) | Marzano et al. (2012) | In here they don’t see it as serious. They think you might be playing with them; you are playing tricks on their mind or something…to draw attention; to make them do something. They don’t see what is in your mind, or what you think. |
| They hate you for it. But, you know, I mean, it’s part of prison life in a way. You know, you get, you get persecuted all the way through…some of the staff, they are supposed to be trained nurses, bless them. Yeah? And they obviously don’t understand, well, they hate you for it. | |||
| It is the worst possible care that they could give, they do not give a toss… They just don’t wanna do anything, they’re better than me, that’s it…You’re supposed to get NHS care, you don’t even get that. | |||
| They need to have a lot more help for the mental health. A lot more help. And a lot more screws in here with a lot more understanding. And the GPs need to listen a bit more and not tar everybody with the same brush as being a junkie. Because it’s all right sending me to yoga, but yoga ain’t worth a wank…it does not relax you at all. For someone like me – don’t get me wrong I’ve done it twice and it did relax me for that hour – and as soon as I walked back on the wing and got spoken to like a piece of dirt, do you know what I mean? My back went up again. And then it starts off again. | |||
| Donskoy and Stevens (2013) | I think also it was two fingers to the system because I was supposed to be on 15 minute observations […] I managed to do that whilst sat on my bed, with, in full view of the door, just dismantle a razor blade, and nobody actually noticed me doing it, so I supposed I was partly trying to show a weakness in the system, that I could take control, and if I wanted to harm myself I could do. | ||
| Chamberlen (2016) | I would spend hours in my cell alone, I had to think, I wanted to and at the same time I resented having to think, so that’s how the self-cutting started, you know, trying to avoid the thinking. It meant accepting what happened, what harm I caused and how I had to pay for it, it meant re-evaluating my life. I couldn’t sleep or eat because of all the thinking, I barely left my cell, and I really just couldn’t bring myself to get out of bed most days. I was really that low…and there’s nobody who can really help you, it’s just a painful time you have to be with yourself, your worst enemy. | ||
| When I first went in, I was completely gobsmacked […] it took a while to sink in really. The first prison I was sent to was proper HMP, old, stuffy, everything was metal. Metal bars, metal doors, keys jangling all night, keeping you up all night… And they put you in this block for people who just got in, and that was quite upsetting…It was like listening to a different story every night with the crying and the cutting […] and the next morning, some girls wouldn’t even try to hide [the scars], the younger ones would kind of show off, you know it was like their survival mark. | |||
| And in the main wing, nearly everyone I met had self-harm marks all over their bodies; they had slashes on their arms, scratches, deep wounds. That was very disturbing to see, especially when you first walk in, because you think, ‘god, is it going to be that bad? Is it so bad that we all have to do this to ourselves?’ | |||
| Marzano et al. 2016 | Because it’s disgusting the way they treat people on the mental health side of things. It’s a joke, it really is a joke. No wonder there is so much suicide and self-harming in these places – not just this place, in all of them. Do you know what I mean? You can’t believe the way that they treat you. | ||
| I try to explain, I do tell them, but it’s still they don’t wanna know. Until you do something […] what do I have to do? Right, I’ll cut myself. They might listen to me then. | |||
| Johnson et al. (2017) | If you were sixteen years old and you were in care, you had all your stuff in your room taken out how would you like it? | ||
| If you’re in your room with nuthin in it, could make you feel like depressed and could probably make hundreds of thoughts go through yer heed if you’re angry or sad or whatever | |||
| Polling et al. (2021) | I went to school with some really nice middle-class girls. And a few of them took overdoses and their parents then sent them to the south of France to rehab, and stuff like that. Whereas we’d get none of that. We’d get our children taken away from us, would have to go through social services craziness, we’d probably have to go and do some parenting courses, we’d have to go to court, we’d probably lose our flats. There is so much more for us to lose if we were to kill ourselves. | ||
| Rouski et al. (2021) | Well once I got to know the staff a bit and built relationships with them, I felt like I could tell them. I still wouldn’t tell them before I do it, but if I done it and it was quite bad then I could tell them. | ||
| Concept | Studies | Illustrative Quotes | |
|---|---|---|---|
| Compulsion and control | (Sharmin Aktar, 2022; Anderson and Clarke, 2019; Bermeo Coronel, 2021; Brown et al., 2022; Chandler, 2019, 2014, p. 201; Donskoy and Stevens, 2013; Mackenzie et al., 2018; Marzano et al., 2016, 2012; Miller et al., 2021; Morris et al., 2015; Owens et al., 2016; Rouski et al., 2021; Sambath, 2016; Steggals et al., 2020; Sutherland et al., 2014; M. Isabela Troya et al., 2019; Wadman et al., 2017; Woodley et al., 2021) | Chandler (2014) | If I’m no’ in control of a situation, or if I’m no’ in control of what’s happenin’…that’s when I self-harm […] It’s like…if, if somebody says something or, or [pause] or…you know something’s going on and I’m like ‘oh god I cannae stop this’ or…em sometimes I start to panic aboot things, and the only way I can not stop panicking about it and think rationally about it is…cut myself [pause] it’s just like, I dunno it makes me just stop I suppose and then, it's like right ok, deal wi it. So I think it’s like getting control or gaining control. |
| Sutherland et al. (2014) | Self-harming, for me, was a compulsion. | ||
| Wadman et al. (2017) | …it [self-harm] is like an addiction, life for example if a drug user takes drugs and they get a good feel from it, they’ll do it again and again. | ||
| Wadman et al. (2018) | I just didn’t have no control in my life. And everyone was making choices for me and that was my only way of controlling anything. That was my choice to do or not, and that was the only thing I could control, everything else was controlled by people. | ||
| Anderson and Clarke (2019) | It seems like I have to get all this disgusting stuff off my face | ||
| Boyce (2021) | It has always been a coping mechanism, it allows a release of bottled up emotions, a feeling of control when all else feels uncontrollable. | ||
| Miller et al. (2021) | I have a craving, it’s like it will not stop until like, I hurt myself. | ||
| They [urges] just take over; you feel that you have no control left…It’s physical and mental, you feel that you have no control…progressively over the years it has got worse and completely out of control. | |||
| Woodley et al. (2021) | I found I had less control using the razor blades because the cuts would hurt less and you could cut deeper. | ||
| I don’t do it a deep as I’d like to sometimes because I think, no, because that’s going on your medical record…if you are going to do it, do it sensibly. | |||
| The work of staying alive | (Anderson and Clarke, 2019; Baker et al., 2013; Ballantyne, 2020; Biddle et al., 2018, p. 201; Chandler, 2019; Donskoy and Stevens, 2013; Edmondson et al., 2018; Givissi, 2016; Guest et al., 2021; John et al., 2022; Klineberg et al., 2013; Long, 2018; Mackenzie et al., 2018; Marzano et al., 2016; Marzetti et al., 2022; Mason et al., 2022; McAndrew and Warne, 2014; McDermott et al., 2015; Miller et al., 2021; O’Brien et al., 2021; Polling et al., 2021; Quinlivan et al., 2022, 2021; Richardson et al., 2021; Sutherland et al., 2014; M Isabela Troya et al., 2019; Ruth Wadman et al., 2018; R. Wadman et al., 2018, p. 201; Wadman et al., 2017; Walker et al., 2021) | Baker et al. (2013) | I was just doing what made me feel better. |
| I think if someone did not really know about self-harm and they were upset they might just change to suicide. | |||
| Donskoy and Stevens (2013) | I was quizzing in my head whether it was suicide or was it a cry for help. It’s just like you know I’ve got all the respect for people who commit suicide, sort of fair enough, fair enough. You know. Get out of it basically, you know […] I dunno, whether or not for me it was a cry for help or whether it was actually like I really wanted to do it. I still don’t know, to be honest. | ||
| Marzano et al. (2016) | It’s the way I cope. It’s the way I adapted to cope, anyway [to] the situations that I’ve been in my life since I was a kid. | ||
| Chandler (2019) | I just think, wouldn’t it be fucking great, just walk in front of that bus, right now, just as the bus is coming along, and then I’ve got no worries anymore like that, or anything like, you know. I think about things like that all the time. I would just drink all the time, because I had nothing…basically it wasn’t just ‘cause I had nothing else to do, it’s just I was lonely. Loneliness. And I would drink bad. And on other days…some days I would take too many tablets. I’ve been hit by a through cars just wanted to end it. | ||
| Miller et al. (2021) | I think it’s a way of taking care of yourself, because I feel in a way like self-harm stops you thinking about suicide as well. | ||
| O’Brien et al. (2021) | Everything just piled up, and it was just like, “I’m done’. Can’t do this anymore”. | ||
| I think that most of the people I know would be better off not knowing me. I feel like their life would just be much easier… | |||
| I didn’t have the little things to live for. It was all falling apart, family life and school life. There wasn’t any good. I couldn’t see the light at the end of the tunnel. It just seemed like darkness. I couldn’t imagine myself being anywhere else. | |||
| Walker et al. (2021) | When I ligature, I expect to die. When I cut myself it feels good. | ||
| Hanging – wanted to die and expected to die. Cutting- wanted to let frustrations out and expected a release. | |||
| Mason et al. (2022) | Step One; Self-harm’s not helping. Step two; That feeling of total…even though you’re with somebody you love more than anything, it can be the loneliest place in the fucking world when you’re sat there. And if I get there, that means I’m on to Step three [suicide attempt]. | ||
| Drama vs. mundanity | (S. Aktar, 2022; Ballantyne, 2020; Boyce, 2021; Donskoy and Stevens, 2013; Edmondson et al., 2018; Givissi, 2016; Guest et al., 2021; Inckle, 2014; Lockwood et al., 2020; Mason et al., 2022; Miller et al., 2021; Rayner and Warne, 2016; Richardson et al., 2021; Steggals et al., 2020; M. Isabela Troya et al., 2019; Turrell, 2019; Walker et al., 2021; Williams et al., 2021; Woodley et al., 2021) | Marzano et al. (2016) | When things get too much you know; that’s how I release. It released things on the inside of me. How I feel. |
| I cut personally to have a bleed, to get rid of what I consider to be my blood pressure. I’ve been to the doctor’s in the past and asked him to withdraw blood with a syringe and needle. | |||
| Wadman et al. (2017) | I think it was a good release…[to] take my head out of that heightened, tense state and down to something that was a little bit more level and calm | ||
| Wadman et al. (2018) | I was really, really angry and then I cut myself, and then all of a sudden I just wasn’t angry any more. | ||
| It’s just become habitual now. Like if I have something, something bothers me; my first instinct is always hurting myself. | |||
| Lockwood et al. (2020) | A lot of things I went through o impulse…even with the bleach, that was completely – I wasn’t even thinking about it two minutes before that. I was washing up. | ||
| Whenever [the impulsive to self-harm] happens to people, they don’t know what they’re doing…maybe we need to see the warning signs first. Because once it gets to the urge, maybe it’s too late. | |||
| It’s sort of like an inbuilt thing now. It’s like…I’m feeling like that, so then, I’ll do this [self-harm]. It’s like Maths – you add ‘this’ and then ‘that’ and it’s equal to self-harm. | |||
| Miller et al. (2021) | Self-harm is always sitting in your mind and if I am watching the telly or something, I’ll be thinking about it and it will be like, ‘Oh I need to see the self-harm, I didn’t self-harm earlier, I have to self-harm later. | ||
| Pleasure and pain | (S. Aktar, 2022; Anderson and Clarke, 2019; Bermeo Coronel, 2021; Chandler, 2013; Donskoy and Stevens, 2013; Givissi, 2016; Inckle, 2014, p. 201; Klineberg et al., 2013; Miller et al., 2021; Sambath, 2016; M Isabela Troya et al., 2019; Turrell, 2019; Walker et al., 2021) | Donskoy and Stevens (2013) | I don’t think it’s the hurt that appeals to me, I think it’s – I just wish somebody would know how I was feeling. It was great. |
| It was great. It was a sense of – I suppose it must be like for a drug addict for its first fix. You know, phyorr! You know, your serotonins and everything straight up the roof, great! | |||
| Chandler (2013) | It just varies but, I think like, sometimes you don’t, you don’t feel as much pain as you’d think you do […] all these chemicals in your brain get released […] so that it acts like a pain killer […] so you don’t actually feel the pain that you think you would. | ||
| A lot of people don’t talk about that, about how good it [self-injury] feels. And, also that, erm, people that haven’t experienced how that feels, and think that, people that self-harm are masochists or something. But, mostly you don’t actually feel the pain. And, I know a lot of people have gone on about, it’s endorphins and stuff. And I guess it is, I don’t know […] but, em, it feels good…but a lot of people don’t really want to talk about that. | |||
| Mostly when I self-harmed I didn’t really feel the pain, as, other people would feel the pain […] so I think when I went into school with that short sleeved t-shirt that time, it was more, kinda, macho swaggering kinda thing […] which sounds really daft, but, it, it made me feel, em, less of the victim actually. | |||
| Wadman et al. (2017) | I got a good feel from it [self-harm] that one time; and when I felt bad again I did it again [pause] and it just continued. | ||
| Anderson and Clarke (2019) | …I get a little rush out of [picking] | ||
| Miller et al. (2021) | I just love watching the blood drip from it, it makes me feel good. It takes my focus away from another kind of pain, like the pain inside, like the way I feel. So, it overtakes that so I kind of forget about the other sort of pain. | ||
| I am doing it to feel pain to remind myself that I can still feel pain, because at the moment I feel nothing I feel numb and it’s my only way that I am reminding myself that I am still here, that I am still alive…by seeing the blood. | |||
| Concept | Studies | Illustrative Quotes | |
|---|---|---|---|
| Scars, stigma and shame | (S. Aktar, 2022; Anderson and Clarke, 2019; Baker et al., 2013; Boyce, 2021; Brown et al., 2022; Camm-Crosbie et al., 2019; Chamberlen, 2016; Chandler, 2014, p. 201; Donskoy and Stevens, 2013; Givissi, 2016; Hunter et al., 2013; Inckle, 2014; Klineberg et al., 2013; Long, 2018; Mason et al., 2022; McAndrew and Warne, 2014; McDermott et al., 2015; Owens et al., 2016; Polling et al., 2021; Quinlivan et al., 2022; Sambath, 2016; Sass et al., 2022; Sutherland et al., 2014; Turrell, 2019; R. Wadman et al., 2018; Walker et al., 2021) | Chandler (2014) | The scars are there, for ever now, so [pause] I think that’s kinda a bad thing though because it,…see if it’s something that faded over time, you might sorta go, oh well, it all faded so, that’s it I’ll no bother. But I’ve got these scars now, they’re there now, the damage is done, I just cut on top eh scars now, just, covered…totally utterly covered [pause] so it’s like, phew [pause] what’s the point, of stopping. |
| I just have this, sortie warped body image, and I don’t know if that’s, again, I don’t know if that’s part ae the…the self-harm, d’you know, I don’t know if that’s why [pause] like I hate this body so I’ll just [pause] abuse it [laughs] […] I mean I cannae, can’t look in the mirror, cannae look at myself [long pause] just, disgusting. | |||
| It is about adornment and celebration […] And in a way my scars are as well, actually, ‘cos I do think they’re really beautiful, and they’re like a part of my, my experience, my history. And I very much believe about, em, your experience – written on the body and the body telling a story. | |||
| Sutherland et al. (2014) | I am now a university student, and my scars are now visible. I made the decision not to spend another hot day in extreme discomfort, not to let my fashion sense be dictated by anything other than desire and not to obsess over every action with the anxiety of being exposed. The transition was easy. I was meeting new people and if I didn’t mention my scars, neither would they. On the flip side, if I did choose to mention self-harm to close friends, they then weren’t shocked. I can have intimate relationships without the fear that I am being deceptive – something that held me back before. | ||
| Becoming visible around old friends was a little harder. I hadn’t work short clothes around them for many years, and none of them knew the extent of my mental health problems. The first time I wore a t-shirt, one friend remarked, “Oh my God, what happened to your arms?”. I told her they were just old scars, and she was satisfied. There is now an unspoken understanding that I have a problem with self-harm, and I feel infinitely more comfortable socialising with these people. | |||
| Chamberlen (2016) | It really used to affect me; I would be all about hiding them, now I’m getting over it a little, because you can tell they are old scars, you can tell I don’t do it so much any more. But when they were redder, more prominent, when they were fresh, I was very conscious. I wouldn’t wear short-sleeved tops, even in hot weather, I would keep my arms and legs covered, even my neck I had to have covered up. But some of these marks will never go away so I have to deal with it […] I used to think people would look at me and think I’m a freak, like tell I wasn’t normal. Nobody else other than the girls in prison looked like this, so I knew it was something wrong. | ||
| Givissi (2016) | There may be times where I might deliberately want to show someone my scars because I really want to connect with them and I can’t work out how to do it. Umm particularly if I’m... if I am really low umm and ... because I’ve become very withdrawn and... and I lock myself away and stuff, and if I do it, if I cut umm I might sort of accidentally on purpose, accidentally let someone see it so they can see that something’s not right. | ||
| I think each scar is special to me because each scar saved my life, you know | |||
| They don’t define who... who I am but it’s like the marks of your... or a storm that my inner self was having with itself. I know... and not because I deserved it either | |||
| Wadman et al. (2018) | I just think that I felt horrible for doing it because, well, I promised people, my boyfriend, that I wouldn’t do it [self-harm] anymore and then I did it. I was kind of the ‘breaking the promise’ thing as well. | ||
| Anderson and Clarke (2019) | I indulge in a destructive and shameful habit of incessantly picking at my face and upper back, chest, forearms, scalp and hands. Ick! I’m grossing myself out! | ||
| The worst part for me is the shame and self-hatred. Knowing intellectually that I am harming myself and not being able to stop. Consumed with thoughts about how weak I am, how pathetic, and people must think I’m really sick. | |||
| I’m scared that the dermotillomania is a symptom of fundamental symptom of fundamental deficits within me which are unlovable. | |||
| Boyce (2021) | I think it can often seem like I am less capable or mentally stable if I tell people, for example in a professional setting. | ||
| Work colleagues they’d be horrified, not trust me, as they’d see me as having something deeply wrong with me. It would be a terrible move in terms of my career, as I would probably be fired as they’d want rid of me so they’d find a way, if not I’d never be considered for any sort of promotion ever again. | |||
| Judgements lead to worsening self-worth, self-confidence and guilt. I already have a lot of demons, I don’t need people’s opinions and view to make it worse. | |||
| Aktar (2022) | In the Islamic religion you’re not supposed to inflict any harm on your body it’s like a sort of promise that you make with God. Your body’s like a promise and you have to return it in a proper state | ||
| She started talking about religion and how she was like don’t you know its haram to self-harm urm how’s God gonna feel, like something about being punished I can’t remember | |||
| Brown et al. (2022) | If you feel ashamed what can you do?...it’s not really [an emotion] that people teach you how to deal with, it’s like, you can go online and say, like, how do you deal with anxiety, there are a hundred videos that will come up, erm, you try and say I feel ashamed of myself, what will come up is, you should love yourself, it’s like, that’s not very helpful. | ||
| [she said] everyone’s embarrassed by you…you need to cover up [the scars] on your arms | |||
| Normally, if you’ve done something wrong, you feel ashamed, you say “I’m really sorry”, and the person goes “I forgive you”…but if it’s something you’re doing to yourself…there’s nowhere for it to go. | |||
| Put a jacket on, you’re triggering people. | |||
| Navigating the world | (S. Aktar, 2022; Anderson and Clarke, 2019; Ballantyne, 2020; Chandler, 2019, 2014; Guest et al., 2021; Klineberg et al., 2013; Sambath, 2016; Steggals et al., 2020; Sutherland et al., 2014; Turrell, 2019; Ruth Wadman et al., 2018; Wadman et al., 2017) | Wadman et al. (2018) | My mum was like ‘well why are you doing it?’ She got dead angry with me, she wouldn’t give me eye contact or talk to me. The next day… we had this huge argument and I was crying and she was shouting at me and she was like ‘is it something that you and your friends do?’ And I was just ‘no’. |
| I think they’re more frustrated at the fact that I don’t go to them and talk to them first, and then I end up in hospital again. If my mum and dad found out again then it’d just be a whole lot of drama again and I just, I think I’d rather not deal with the drama. | |||
| She just broke down into tears. She wasn’t angry or anything, she broke into tears and she just gave me a massive huge and told me that we’d get it sorted and everything. | |||
| Anderson and Clarke (2019) | Who would hire a teacher that looks like this…always picking at themselves. | ||
| My children have seen my bloodied face and back. There are days I want to call ‘Child protective services’ on myself. | |||
| I’ve just had my first child, and I want to be free of this – don’t want to pass it on to her. | |||
| If it weren’t for my very supportive husband […] I would starve to death because I will not and cannot go to the grocery store. | |||
| I’ve cancelled meetings with friends, missed work, let people down and one of my biggest regrets and shames was missing a friend’s funeral. | |||
| I have spent thousands on makeup and skincare. Worn long sleeves, jeans and boots in the middle of summer. Worn more makeup than a circus performer. Been hours late for engagements because I was picking then had to jump through all the hoops to cover it up. I have even not gone out when my apartment building had a real fire alarm because I was picking and didn’t have enough time to slap on enough makeup and cover up my marks. | |||
| Boyce (2021) | One thing that has been difficult, as I get older, is sharing within relationships and friendships and then losing the relationship or friendship. | ||
| Higgins (2020) | He [manager] didn’t say the word ‘self-harm’ but he said, about being a danger, he said do you feel like you’re safe to be at work and I said what do you mean, and he ignored me and said do you think you’re dangerous to be at work. That’s how he put it, he meant, he said both: like to me or people I were looking after... that made me not tell anyone else for ages | ||
| Brown et al. (2022) | It’s not fair on them, erm, and they don’t know what they’re looking at, and it’s not fair to introduce them to it, ‘cos they’re suggestible…I’ve got to be really careful…I can’t put myself in a position where I could be that influence on a child | ||
| I (don’t) need to stop | (Baker et al., 2013; Boyce, 2021; Donskoy and Stevens, 2013; Guest et al., 2021; Lockwood et al., 2020; Long, 2018; McAndrew and Warne, 2014; Morris et al., 2015; Owens et al., 2020, 2016; Rouski et al., 2021; Sass et al., 2022; Sutherland et al., 2014; Wadman et al., 2017; Woodley et al., 2021) | Sutherland et al. (2014) | I found out that I really enjoyed writing stories and poetry and started to do that when I felt like hurting myself. The harming didn’t stop straight away but I started to do it less and less and found other things to do to take my mind off it. |
| Wadman et al. (2017) | Now I don’t really see myself stopping completely. Probably, cutting down a lot, but at the moment, as it stands, I probably won’t stop completely. | ||
| I don’t think I will ever be able to say like categorically that I’ve like now stopped…I think it’s just…like it’s nice to have the option. | |||
| I’d have nowhere to turn to…I wouldn’t have that [self-harm]. It’s just easy to self-harm and I wouldn’t have that. | |||
| Long, 2018 | I really resented attempts to get me to stop cutting because I felt like they were taking away the one thing that was a release. | ||
| I don’t think I ever really wanted anybody to take it away from me…and none of the counsellors ever did really, they just accepted it, that it was part of me and was what I do to keep living too so nobody really tried to take it from me. | |||
| Rouski et al. (2021) | I want to stop but I don’t. | ||
| I’d love to stop. But I can’t. | |||
| Woodley et al. (2021) | It’s the quickest, easiest way out and there’s nothing second. Nothing is going to be more effective than self-harm really, and it isn’t. Unfortunately. | ||
| I’ve worked my way through the coping skills list. I think I’ve literally tried everything. | |||
| Finding help that doesn’t hurt | (Bailey et al., 2019; Baker et al., 2013; Biddle et al., 2018; Boyce, 2021; Boyce et al., 2018; Brown et al., 2022; Camm-Crosbie et al., 2019; Cully et al., 2022; Guest et al., 2021, p. 202; Harris, 2019; Hunter et al., 2013; Johnson et al., 2017; Klineberg et al., 2013; Lavis and Winter, 2020; Long, 2018; Long et al., 2016; Marzano et al., 2012; McAndrew and Warne, 2014; Miller et al., 2021; Mughal et al., 2021; Owens et al., 2020, 2016; Polling et al., 2021; Quinlivan et al., 2022, 2021; Rayner and Warne, 2016; Rouski et al., 2021; Sambath, 2016; Sass et al., 2022; Sutherland et al., 2014; M. Isabela Troya et al., 2019, p. 20; Turrell, 2019; R. Wadman et al., 2018; Wadman et al., 2020, p. 202, 2017; Walker et al., 2021; Whalen, 2016) | Wadman et al. (2020) | [CAMHS] just giving me the same solutions over and over again, it didn’t feel like there was anything new. It was just ‘have you tried this, have you tried that’ and I’d just be like ‘no, it doesn’t work’, and she’d just be like ‘well try it again’. |
| I used to go to CAMHS but I always thought they treated you like a little kid. Year, like obviously I’m 16, and they always like show you a piece of paper saying ‘look at this blob, what do you feel today?’ I’m, like, that’s summat what you would do with younger people. | |||
| Obviously, I guess the best outcome would be that people stop self-harming | |||
| It could be that you’re doing it less often but it’s more severe, and is that really an improvement?... Like, if it’s less frequent and less severe, then that’s an improvement. | |||
| The only time you’d go to hospital is if it was really severe. So you’re not actually measuring when they’re self-harming, you’re only measuring things like when you had an accident and it got too deep. | |||
| Camm-Crosbie et al. (2019) | I tried to kill myself and I was really f***ed up and needed counselling. The NHS waiting list was nine months. You can’t wait nine months when you’re suicidal…I only got through that period by abusing drugs. | ||
| Troya et al. (2019) | He [GP] just kept looking at his watch. | ||
| Lavis and Winter (2020) | Rather than saying, like ‘if you ask for help, the help is out there’, that’s not entirely true so instead, we should say, ‘if you ask for help, the help may be difficult to get’ but that’s not a reflection on how much you need it, it’s a reflection of high tight the services are at the moment, and how resources are being diverted to other areas, it’s not your fault and it’s not something that you should have to tackle on your own. | ||
| Owens et al. (2020) | Some nurses…just look at you with utter disgust like you’re some monster. | ||
| I was treated from start to finish as if I was pathetic and not worthy of treatment. | |||
| They refused to treat me!!...basically ‘cos it’s self-harm…I feel like giving up. What’s the point if no-one even wants to try and help. | |||
| I can understand their frustration at having to stitch someone up knowing that there is a possibility of them returning the next day with a new injury or after re-opening the stitches…They are only human and have bad days just like anyone else. | |||
| You feel so low after self-harming and being treated with contempt or anger or people working on eggshells just makes it worse. If people would simply treat us in a business-like manner, with a touch of sympathy perhaps, it would help. I know it’s frustrating treating a self-harmer, but taking the frustration out on us tends to push us further from the idea of getting support. | |||
| I will not go up there anymore, mainly because I feel like such a time waster, and I hate all the questions they ask you…I just want to get back home, hide under the duvet and die of shame…I’ve ended up with numerous infections however from not getting wounds treated. | |||
| When you’re that low, you think you deserve bad treatment and are not able to complain. | |||
| Wadman et al. (2020) | They give you leaflets about 105 ways to stop harming and things, but it’s like I’ve tried the laggy [rubber] band, I’ve tried drawing on myself. I’ve tried the ice. And it’s like, these things don’t work. | ||
| I think the one where you draw on yourself with red pen, I think that’s completely ridiculous…they were saying some people who self-harm do it because they like to see the blood…but also they need the pain as well, so that one was quite pointless. | |||
| Quinlivan et al. (2021) | In any situation, what works well is when I feel listened to and like I had some input and agreement into the decision and follow and most importantly that I understood the situation and why it was happening. | ||
| I was given a very quick psychiatric assessment in A&E. I was appreciative of being given some attention at the time as it was the first time I’d spoken about my mental health and self-harm/suicidal ideation…Ideally it would be beneficial to be given some time and space to explore issues rather than feeling that they want you processed and out of the department as soon as possible. | |||
| The last two occasions I have had an assessment with a psychiatric-liaison practitioner, they have been really positive. I was made to feel as a human and felt as though how I was feeling was validated…They temporarily restored my faith in the MH system. | |||
| What didn’t work well was being told I would be okay, the nature of a checklist-like set of questions to evaluate someone’s mental health, left no room for me to really talk about how I was actually feeling. | |||
| What doesn’t help is being told I am doing it for attention, and that they know better than me what is helpful so they won’t change the plan. The most unhelpful things are to be told that I didn’t really mean to kill myself because I’m not dead and that it is up to me if I kill myself. | |||
| When I have presented with a diagnosis of emotionally unstable personality disorder, triage was still quick but staff have been cold and lacking in empathy and compassion. Assessments were treat, almost with boredom, and I’ve been discharged despite being a current risk of suicide or further self-harm. | |||
| Quinlivan et al. (2022) | You have to be deemed medically fit first before the in-house psych team will even speak to you. You are usually having to wait and additional four hours after you have been treated for the harm. I poison myself, so sometimes I could have been in already for 24hrs, and this means often not sleeping, so I am very cranky, and sometimes I can just tell them to fuck off and just [allow me to be] back on my way. | ||
| I was in withdrawal for a tramadol addiction and the mental health nurse told me I should be a pharmacist because I knew a lot about tramadol. I got up and left. | |||
| I was refused treatment for self-harm and to see a psych by an ED doctor because ‘you’re just going to do it again anyway’ so I left the ED department in distress (only a day out of being discharged from an acute ward very suddenly) and with a wound on my leg that was muscle-deep and eventually required internal suturing. | |||
| Mental health professionals wrote on my file that I should not receive mental health assessments or treatment from the emergency department, | |||
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