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Social Representations about the Functions of Deliberate Self-Harm from Adults and Adolescents: A Qualitative Study

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This study aimed to describe the social representations about the functions of deliberate self-harm and to compare these representations from adolescents with and without a history of deliberate self-harm and adults without a history of these behaviours. We conducted a qualitative study involving the thematic analysis of forty-one semi-structured interviews. The participants consisted of 11 adolescents with a history of deliberate self-harm, 15 adolescents without a history of deliberate self-harm and 15 adults also without a history of behaviours. The interviewees mentioned eight functions of deliberate self-harm consistent with the existing literature, namely interpersonal functions (Communication Attempt, Interpersonal Boundaries, Interpersonal Influence, and Peer Bonding) and intrapersonal functions (Affect Regulation, Anti-Dissociation, Escape Mechanism, and Self-Punishment). Also, two new functions not described in the literature were mentioned (Introspective Mechanism and Replacement of Suffering). Regarding the differences between the three groups, several disparities emerged. Overall, results revealed that the group of adults referenced more interpersonal functions, while both groups of adolescents emphasized intrapersonal functions. This study provides insight regarding the social representations about the functions of deliberate self-harm, also focusing on the differences between adolescents with and without a history of these behaviours and adults without a history of deliberate self-harm.
Trends in Psychology / Temas em Psicologia DOI: 10.9788/TP2019.4-05
ISSN 2358-1883 (online edition)
Article
Trends Psychol., Ribeirão Preto, vol. 27, nº 4, p. 879-894 - December/2019
–––––––––––––––––––––––––––––––––––––––––––
* Mailing address: Instituto Universitário de Ciências Psicológicas, Sociais e da Vida (ISPA), Rua Jardim do
Tabaco, 34, 1149-041 Lisboa, Portugal. Phone: +351 919169191. E-mail: psi.eva@hotmail.com, mpereira@
ispa.pt and d.sampaio@netcabo.pt.
Social Representations about the Functions
of Deliberate Self-Harm from Adults and Adolescents:
A Qualitative Study
Eva Duarte*, 1
Orcid.org/0000-0001-6617-3252
Maria Gouveia-Pereira1
Orcid.org/0000-0001-7814-466X
Daniel Sampaio2
Orcid.org/0000-0001-8049-7536
–––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––
1Instituto Universitário de Ciências Psicológicas, Sociais e da Vida, Lisboa, Portugal
2Universidade de Lisboa, Lisboa, Portugal
Abstract
This study aimed to describe the social representations about the functions of deliberate self-harm and to
compare these representations from adolescents with and without a history of deliberate self-harm and
adults without a history of these behaviours. We conducted a qualitative study involving the thematic
analysis of forty-one semi-structured interviews. The participants consisted of 11 adolescents with a
history of deliberate self-harm, 15 adolescents without a history of deliberate self-harm and 15 adults
also without a history of behaviours. The interviewees mentioned eight functions of deliberate self-
harm consistent with the existing literature, namely interpersonal functions (Communication Attempt,
Interpersonal Boundaries, Interpersonal Infl uence, and Peer Bonding) and intrapersonal functions
(Aff ect Regulation, Anti-Dissociation, Escape Mechanism, and Self-Punishment). Also, two new
functions not described in the literature were mentioned (Introspective Mechanism and Replacement
of Suff ering). Regarding the diff erences between the three groups, several disparities emerged. Overall,
results revealed that the group of adults referenced more interpersonal functions, while both
groups of adolescents emphasized intrapersonal functions. This study provides insight regarding
the social representations about the functions of deliberate self-harm, also focusing on the diff erences
between adolescents with and without a history of these behaviours and adults without a history
of deliberate self-harm.
Keywords: Deliberate self-harm, social representations, functions, interviews, qualitative
study.
Duarte, E., Gouveia-Pereira, M., Sampaio, D.
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Representações Sobre as Funções dos Comportamentos
Auto-Lesivos de Adolescentes e Adultos:
Um Estudo Qualitativo
Resumo
Este estudo teve como objetivo descrever as representações sociais sobre as funções dos comportamentos
auto-lesivos e comparar as representações de adolescentes com e sem uma história de comportamentos
auto-lesivos e de adultos sem uma história destes comportamentos. Foi realizado um estudo qualitativo
que envolveu a análise de conteúdo de 41 entrevistas semi-directivas. Os participantes consistiram
em 11 adolescentes com uma história de comportamentos auto-lesivos, e 15 adolescentes e 15 adultos
sem uma história destes comportamentos. Os participantes referiram oito funções dos comportamentos
auto-lesivos consistentes com a literatura existente, nomeadamente funções interpessoais (Infl uência
Interpessoal, Ligação com os Pares, Limites Interpessoais, e Tentativa de Comunicação) e funções
intrapessoais (Auto-Punição, Auto-Regulação do Afecto, Anti-Dissociação, e Mecanismo de Fuga).
Duas novas funções não descritas na literatura foram também mencionadas (Mecanismo Introspectivo
e Substituição do Sofrimento). No que se refere às diferenças entre os três grupos, no geral, o grupo
de adultos referenciou mais funções interpessoais, enquanto os grupos de adolescentes destacaram as
funções intrapessoais. Este estudo contribui para a compreensão das representações sociais sobre as
funções dos comportamentos auto-lesivos, focando igualmente as diferenças entre adolescentes com e
sem uma história destes comportamentos e adultos sem uma história de comportamentos auto-lesivos.
Palavras-chave: Comportamentos auto-lesivos, representações sociais, funções, entrevistas, estudo
qualitativo.
Representaciones Sociales Sobre las Funciones
de Comportamientos Autolesivos de Adultos y Adolescentes:
Un Estudio Cualitativo
Resumen
Este estudio tuvo como objetivo describir las representaciones sociales sobre las funciones de
comportamientos autolesivos y comparar las representaciones de adolescentes con y sin antecedentes de
comportamientos autolesivos y adultos sin antecedentes de estos comportamientos. Realizamos un estudio
cualitativo que incluía el análisis de contenido de 41 entrevistas semiestructuradas. Los participantes
fueron 11 adolescentes con antecedentes de comportamientos autolesivos, y 15 adolescentes y 15
adultos sin antecedentes de estos comportamientos. Los entrevistados mencionaron ocho funciones de
autolesión deliberada coherentes con la literatura existente, a saber, funciones interpersonales (Infl uencia
Interpersonal, Intento de Comunicación, Límites Interpersonales, y Vinculación entre Pares) y funciones
intrapersonales (Anti-Disociación, Autocastigo, Mecanismo de Escape, y Regulación del Afecto).
Además, se mencionaron dos funciones nuevas no descritas en la literatura (Mecanismo Introspectivo y
Reemplazo de Sufrimiento). Respecto a las diferencias entre los tres grupos, en general, los resultados
revelaron que el grupo de adultos hizo referencia a más funciones interpersonales, mientras que ambos
grupos de adolescentes destacaron las funciones intrapersonales. Este estudio proporciona información
sobre las representaciones sociales acerca de las funciones de los comportamientos autolesivos, y
también se enfoca en las diferencias entre adolescentes con y sin antecedentes de estos comportamientos
y adultos sin antecedentes de comportamientos autolesivos.
Palabras clave: Comportamientos auto-lesivos, representaciones sociales, funciones, entrevistas,
estudio cualitativo,
Social Representations about the Functions of Deliberate Self-Harm from Adults
and Adolescents: A Qualitative Study.
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Trends Psychol., Ribeirão Preto, vol. 27, nº 4, p. 879-894 - December/2019
Deliberate self-harm is considered a
public health problem (Hawton, Saunders, &
O’Connor, 2012), aff ecting mainly adolescents
and young adults. In Portugal, where this study
was conducted, it is estimated that its prevalence
among adolescents oscillates between 7.3% and
30% (Carvalho, Motta, Sousa, & Cabral, 2017;
Gouveia-Pereira, Gomes, Santos, Frazão, &
Sampaio, 2016; Guerreiro, Sampaio, Figueira,
& Madge, 2017). This prevalence is similar to
those found in other countries (Brunner et al.,
2013; Calvete, Orue, Aizpuru, & Brotherton,
2015; Muehlenkamp, Claes, Havertape, &
Plener, 2012).
There have been some conceptual problems
surrounding the defi nition of deliberate self-
harm. In the present study, we follow the
defi nition stipulated in the Child and Adolescent
Self-Harm in Europe (CASE) Study (Madge et
al., 2008) and in the National Plan for Suicide
Prevention in Portugal ([Plano Nacional de
Prevenção do Suicídio], Carvalho et al., 2013).
Hence, deliberate self-harm encompasses several
self-aggressive behaviours regardless of suicidal
intent and includes self-cutting, self-burning,
self-hitting, jumping from high places, ingesting
medication and other dangerous substances,
amongst other behaviours.
Apart from the attention this phenomenon
has been receiving from the scientifi c fi eld, there
is also growing visibility of deliberate self-harm
in the general media (Biddle et al., 2016; Haim,
Arendt, & Scherr, 2017; Mok, Jorm, & Pirkis,
2015; Swannell et al., 2010; Whitlock, Powers,
& Eckenrode, 2006; Whitlock, Purington,
& Gershkovich, 2009), and particularly in
social media (Canady, 2017; Dyson et al.,
2016; Krysinska et al., 2017; Marchant et
al., 2017; Memon, Sharma, Mohite, & Jain,
2018; Moreno, Ton, Selkie, & Evans, 2016;
Niwa & Mandrusiak, 2012; Reddy, Rokito, &
Whitlock, 2016; Zdanow & Wright, 2012). The
normalization of these behaviours in the media
may help those who engage in deliberate self-
harm feel less isolated, but it may also increase
interest in trying or adopting this practice as a
way of coping with stress or distress (Reddy et
al., 2016).
Social representations are a modality
of knowledge that produces and determines
behaviours since they defi ne the nature of
the stimuli that surround us and the answers
we give them (Moscovici, 1961). Also, these
representations can be understood as dynamic
sets that aim at the production of social
behaviours and interactions, and not only as
the mere reproduction of these behaviours and
interactions as reactions to external stimuli
(Rodriguez-Zoya & Rodriguez-Zoya, 2015;
Sampaio et al., 2000). Therefore, the growing
visibility of deliberate self-harm can confront
the general public with the existence of this
phenomenon and subsequently build and modify
their social representations about it, regardless
of not having personal contacts with deliberate
self-harm. In addition, the high prevalence
rates of deliberate self-harm may imply that
more individuals are aware of this behaviour
(for example parents, teachers or peers)
and, as a consequence, build diff erent social
representations about this phenomenon.
Research has shown that deliberate self-
harm can have several functions (e.g. Bentley,
Nock, & Barlow, 2014; Nock, 2009). Klonsky
and Glenn (2009) systematized the most common
functions in the Inventory of Statements about
Self-Injury, an instrument which includes a scale
that evaluates 13 types of functions of deliberate
self-harm that aggregate in two dimensions.
These dimensions include interpersonal
functions (Autonomy, Interpersonal Boundaries,
Interpersonal Infl uence, Peer Bonding,
Revenge, Self-Care, Sensation Seeking,
and Toughness) and intrapersonal functions
(Aff ect Regulation, Anti-Dissociation,
Anti-Suicide, Marking Distress, and Self-
Punishment). Understanding the functions of
these behaviours is crucial for supportive and
eff ective responses to individuals’ disclosures
of self-harm (Muehlenkamp, Brausch, Quigley,
& Whitlock, 2013). Furthermore, knowing how
this phenomenon is viewed by others may have
important implications for clinical intervention
and prevention programs (Arbuthnott & Lewis,
2015; Baetens et al., 2015; Bresin, Sand, &
Gordon, 2013; Miner, Love, & Paik, 2016).
Duarte, E., Gouveia-Pereira, M., Sampaio, D.
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Hence, analysing the representations about the
functions of deliberate self-harm of subjects
with and without these behaviours is relevant.
Most of the existing studies focus on the
description of the attitudes and experiences
of diff erent types of populations, namely
adolescents who self-harm (Batejan, Swenson,
Jarvi, & Muehlenkamp, 2015; Klineberg, Kelly,
Stansfeld, & Bhui, 2013; Rissanen, Kylmä, &
Laukkanen, 2008), parents of adolescents who
self-harm (Ferrey et al., 2016; Kelada, Whitlock,
Hasking, & Melvin, 2016; McDonald, O’Brien,
& Jackson, 2007; Oldershaw, Richards, Simic, &
Schmidt, 2008; Rissanen, Kylmä, & Laukkanen,
2009), peers (Berger, Hasking & Martin,
2013, 2017; Bresin et al., 2013), healthcare
professionals (Karman, Kool, Poslawsky, &
Van Meijel, 2015; McHale & Felton, 2010;
Rai, Shepherd, & O’Boyle, 2019; Rees,
Rapport, Thomas, John, & Snooks, 2014; Vine,
Shawwhan-Akl, Maude, Jones, & Kimpton,
2017), counsellors (De Stefano, Atkins, Noble,
& Heath, 2012; Fox, 2011; Long & Jenkins,
2010), or teachers (Berger, Hasking, & Reupert,
2014; Heath, Toste, & Beettam, 2007; Heath,
Toste, Sornberger, & Wagner, 2011).
However, there is still a general lack
of knowledge concerning the social repre-
sentations about the functions of deliberate
self-harm, since a considerable part of research
focused only on the attitudes towards self-
harm. Moreover, there is limited information
regarding the perspectives of individuals
that did not have direct contact with these
behaviours (professionally or personally). In
addition, there are few studies that compared
the social representations of diverse samples
and their possible divergences, including the
social representations about the functions of
these behaviours. Therefore, one of the goals of
the present research is to understand and explore
the social representations about the functions of
deliberate self-harm from adolescents with and
without a history of deliberate self-harm and
adults without a history of these behaviours.
There are two studies which compared the
views about the functions of deliberate self-harm
from college students with and without a history
of these behaviours (Batejan et al., 2015; Bresin
et al., 2013). The study developed by Batejan and
colleagues (2015) concluded that the participants
without a history of self-harm appeared to
emphasize some interpersonal functions slightly
more than participants with a history of self-
harm. On the other hand, the study conducted
by Bresin et al. (2013) found little diff erentiation
among functions between groups. There is also
a recent study (Duarte, Gouveia-Pereira, Gomes,
& Sampaio, 2019) that compared the social
representations about the functions of deliberate
self-harm from adolescents and their parents
in families of adolescents with and without a
history of deliberate self-harm. Results showed
that parents emphasized interpersonal functions
and devalued intrapersonal functions when
compared to both groups of adolescents and that
these diff erences were heightened in the families
of adolescents with a history of deliberate self-
harm.
Specifi cally in Portugal, as far as we know
there are no qualitative studies that explored
the representations about the functions of
deliberate self-harm. Thus, our study aimed to
qualitatively describe the social representations
about the functions of deliberate self-harm
from adolescents with and without a history of
deliberate self-harm and adults without a history
of these behaviours, and to compare the social
representations of these three groups. We did not
involve adults with a history of deliberate self-
harm in the present investigation since it is part of
a wider research project that focuses on the study
of the social representations about deliberate
self-harm from groups that have been described
as being more important for intervention and
prevention in this context, namely peers (e.g.
Berger et al., 2013, 2017; Hasking, Rees, Martin,
& Quigley, 2015) and family (e.g. Arbuthnott &
Lewis, 2015; Miner et al., 2016), and also since
these behaviours are considerably less frequent
in adults (Klonsky, 2011).
Social Representations about the Functions of Deliberate Self-Harm from Adults
and Adolescents: A Qualitative Study.
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Method
Participants
In total, our sample comprised 41 parti-
cipants, which were organized into three
distinct groups: 11 adolescents with a history
of deliberate self-harm, 15 adolescents without
a history of deliberate self-harm, and 15 adults
also without a history of these behaviours.
The interviewees lived in the centre region
of Portugal. The socio-demographic data that
was obtained is summarized in Table 1. Focusing
on the group of adolescents who had a history
of deliberate self-harm, most of the participants
were female, with an age of onset ranging from
12 to 16 years old (mean=13.5, SD=1.4), and the
most common method was cutting (Table 2).
Table 1
Sample Characteristics (N=41)
Adolescents With
Deliberate Self-Harm
(n=11)
Adolescents Without
Deliberate Self-Harm
(n=15)
Adults Without
Deliberate Self-Harm
(n=15)
Gender
Female 8 8 7
Male 3 7 8
Age
Range 14-20 14-18 33-65
Mean 17.7 15.9 45.7
Current School
Grade
9th grade 2 5 N/A
10th grade 2 2 N/A
11th grade 3 2 N/A
12th grade 4 6 N/A
Number of
Siblings
0 4 5 1
1 4 6 7
2 2 4 5
>2 1 0 2
Marital Status
Single N/A N/A 3
Married N/A N/A 10
Divorced N/A N/A 2
Interpersonal
Contacts with
Deliberate
Self-Harm
Yes 11 6 7
No 0 9 8
Note. N/A – Not applicable.
Duarte, E., Gouveia-Pereira, M., Sampaio, D.
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Table 2
Age of Onset, Gender and Methods Used for Deliberate Self-Harm (N=11)
Age of Onset Gender Methods
12 Female Cutting
12 Female Cutting
12 Female Cutting, Drinking and Ingesting Medication
12 Female Biting and Banging or Hitting Self
13 Female Cutting
13 Female Cutting and Burning
14 Female Cutting
14 Male Cutting
15 Female Cutting
15 Male Cutting
16 Male Cutting and Burning
Instruments
The instruments used in the present study
comprised a set of brief socio-demographic
questions (made after the interview) and a semi-
structured interview script. The interview script
was designed to obtain information regarding
the social representations about the functions
of deliberate self-harm. The main goal was
to allow participants to talk freely about their
experiences, thoughts and opinions, but there
was also the concern to elicit information
about this topic. Therefore, the script included
open-ended questions and possible follow-up
questions (Dörnyei, 2007) which were framed
according to information from the literature
(Klonsky, 2007; Nock, 2009). Providing some
examples, the interview script included questions
such as “Please share what you think about these
behaviours...”, “What do you think that might
get young people to self-harm...” and “What
reasons exist for young people to engage
in deliberate self-harm? Please share your
thoughts...”.
Procedure
The participants were recruited through
contacts with one school and personal contacts
who then snowballed into other connections.
The potential participants were contacted by
telephone or email and informed about the
goals of the investigation. Those who agreed to
participate were then given more detail about the
study and a meeting was arranged to perform the
interview according to their availability.
The interviews were conducted between
September 2015 and August 2016 and had
an average duration of 30 minutes. After the
interviews, the participants were asked if they
had any doubts about the study. The audio from
the interviews was recorded with permission
and later transcribed. The 41 transcripts which
constituted the data were then imported into
QSR International NVivo8 software for further
analysis.
Ethical Procedures
This study was part of a wider research
project that aimed to study social representations
Social Representations about the Functions of Deliberate Self-Harm from Adults
and Adolescents: A Qualitative Study.
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Trends Psychol., Ribeirão Preto, vol. 27, nº 4, p. 879-894 - December/2019
about deliberate self-harm. This project was
approved by the General Education Directorate
of the Ministry of Education and Science
from Portugal regarding the participation of
adolescents.
Prior to the interview, each participant was
guaranteed anonymity and asked to sign a written
consent form. The participants could withdraw
at any time. Regarding adolescents, their parents
were responsible for signing the consent form
after being informed about the study. All the
parents had previous knowledge of their children
deliberate self-harm.
Data Analysis
In accordance with the aims of this study,
content analysis was used in an inductive
approach, since it is considered an appropriate
analysis in qualitative descriptive studies
(Sandelowski, 2000; Vaismoradi, Jones,
Turunen, & Snelgrove, 2016; Vaismoradi,
Turunen, & Bondas, 2013). In a rst moment,
the transcripts were comprehensively read to
understand what the participants told regarding
the functions of deliberate self-harm and what
were the emerging categories. Afterwards, all
the statements about this subject were coded and
sorted into categories based on how diff erent
codes were related and linked (Hsieh & Shannon,
2005).
Results
Several functions emerged from the content
analysis of the 41 interviews. In total, participants
made references to 10 diff erent functions that we
organized into interpersonal and intrapersonal
functions. The interpersonal functions include
Communication Attempt (to communicate
with others), Interpersonal Boundaries (to
establish a distinction between self and others),
Interpersonal Infl uence (to manipulate others
or seek help) and Peer Bonding (to establish
a connection with peers). The intrapersonal
functions include Aff ect Regulation (to alleviate
negative aff ect or to create positive aff ect),
Anti-Dissociation (to cease the experience of
dissociation), Escape Mechanism (to escape from
or to ignore problems), Introspective Mechanism
(to concentrate on thoughts), Replacement of
Suff ering (to replace emotional distress with
physical pain), and Self-Punishment (to express
anger towards oneself). With the exception of
Introspective Mechanism and Replacement of
Suff ering, all the functions that emerged from
content analysis have been previously described
in the literature (e.g. Conterio & Lader, 1998;
Klonsky, 2007, 2011; Klonsky & Glenn, 2009;
Nock, 2009). Table 3 presents some excerpts
from the interviews.
In total, 237 references to the functions of
deliberate self-harm emerged from the content
analysis: 94 (39.7%) referring to interpersonal
functions and 143 (60.3%) to intrapersonal
functions. In Table 3 we detail the number of
participants that mentioned the functions in each
group, the number of references that each group
made to the functions, and the totals for each
function.
Focusing on the interpersonal dimension,
our results showed that the participants’
social representations comprised four distinct
interpersonal functions and that there were
diff erences between the three groups. The
most prominent function was Interpersonal
Infl uence, with a total of 71 references made
by 23 participants, followed by Interpersonal
Boundaries (10 references), Communication
Attempt (nine references) and Peer Bonding
(four references). In terms of diff erences between
groups, adults made references to all the four
interpersonal functions, especially Interpersonal
Infl uence (34 references from 11 participants).
The group of adolescents without a history of
deliberate self-harm cited two interpersonal
functions, Communication Attempt and
Interpersonal Infl uence, and particularly
emphasized this last one with 26 references
made by eight participants. However, the group
of adolescents with a history of deliberate self-
harm only mentioned Interpersonal Infl uence,
with 11 references made by four participants.
Regarding the intrapersonal dimension,
results revealed social representations that
referred to six intrapersonal functions and
further diff erences between the three groups
Duarte, E., Gouveia-Pereira, M., Sampaio, D.
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Table 3
Functions that Emerged from Content Analysis and Excerpts from the Interviews
Interpersonal Functions
Communication
Attempt
It is like they are trying to communicate something to the world (adolescent without DSH)
They are saying something through self-harm, something that they can not say otherwise
(adult without DSH)
Interpersonal
Boundaries
They want to diff erentiate themselves from schoolmates” (adult without DSH)
Self-harm implies an enormous tendency for self-affi rmation (adult without DSH)
Interpersonal
Infl uence
When we do it, we are desperately asking for help (adolescent with DSH)
It is a way to make their family and friends understand they are not alright and that they
need to do something” (adolescent without DSH)
It seems like a call, a scream, a call for attention, like, look at me!’” (adult without DSH)
Peer Bonding They want to belong to some kind of adolescent thing” (adult without DSH)
It is a form to get integrated with other adolescents” (adult without DSH)
Intrapersonal Functions
Aff ect Regulation
Not all people do it because it hurts, because of the emotional part, I think of it as the release
of their negative energies” (adolescent with DSH)
It is the way out, it is the way to release their bad feelings” (adolescent without DSH)
They feel such great pain that they want to relieve it through cutting” (adult without DSH)
Anti-Dissociation
Because they want to feel something” (adolescent with DSH)
Maybe they have to feel themselves and that’s the only way” (adolescent without DSH)
They need to feel alive” (adult without DSH)
Escape
Mechanism
It is the only way to run away from something, from all the problems” (adolescent with DSH)
They are trying to run away from bad things” (adolescent without DSH)
They self-harm because there is something wrong and they need to escape from it(adult
without DSH)
Introspective
Mechanism
I mutilate myself in an introspective way because it helps me to think and connect many
ideas when I do it” (adolescent with DSH)
Maybe they do it to imagine other things, to put your head in other worlds, in your own
thoughts” (adolescent without DSH)
Replacement
of Suff ering
I am substituting the soul’s pain by the body pain” (adolescent with DSH)
They are creating a physical pain to forget a psychological pain” (adolescent without DSH)
Self-Punishment They mutilate as punishment” (adolescent without DSH)
Instead of taking revenge on others, they blame themselves” (adult without DSH)
Note. DSH = Deliberate Self-Harm.
were found. The function with more references
was Aff ect Regulation (78 references made by 22
participants), followed by Anti-Dissociation (25
references), Self-Punishment (14 references),
Replacement of Suff ering (12 references),
Escape Mechanism (seven references), and
Introspective Mechanism (seven references).
Focusing on the diff erences between groups,
adolescents without a history of deliberate self-
harm mentioned all the intrapersonal functions,
emphasizing Aff ect Regulation (19 references),
similarly to adolescents with a history of
deliberate self-harm, which mentioned ve out
of the six functions. The group of adults cited
four intrapersonal functions. However, if we
observe the number of references made by each
group, adolescents with a history of deliberate
self-harm made a total of 75 references to the
Social Representations about the Functions of Deliberate Self-Harm from Adults
and Adolescents: A Qualitative Study.
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Table 4
Number of Participants who mentioned the Function and Frequency of References
Adolescents
With DSH
(n=11)
Adolescents Without
DSH
(n=15)
Adults
Without DSH
(n=15)
Total
(N=41)
Part. Ref. Part. Ref. Part. Ref. Part. Ref.
Interpersonal Functions 94
Communication Attempt - - 2 3 3 6 5 9
Interpersonal Boundaries - - - - 3 10 3 10
Interpersonal Infl uence 4 11 8 26 11 34 23 71
Peer Bonding - - - - 3 4 3 4
Intrapersonal Functions 143
Aff ect Regulation 11 49 7 19 4 10 22 78
Anti-Dissociation 3 8 4 10 4 7 11 25
Escape Mechanism 1 2 2 2 2 3 5 7
Introspective Mechanism 2 6 1 1 -- 3 7
Replacement of Suff ering 3 10 1 2 -- 4 12
Self-Punishment - - 2 2 3 12 5 14
Total of References - 86 -65 -86 -237
Note. Part. - Number of participants that mentioned the functions; Ref. - Number of times each function was mentioned by the
participants.
intrapersonal dimension, while adolescents
without a history of these behaviours made 36
references and adults made 32 references.
Globally, these results indicate that there
are some diff erences concerning the social
representations from the three groups, especially
in the interpersonal dimension. Results will be
further discussed taking into account the contents
of the interviews.
Discussion
The present study focused on the
understanding and comparison of the social
representations about the functions of deliberate
self-harm from adolescents with and without
a history of deliberate self-harm and adults
without a history of these behaviours.
Previous to content analysis, the socio-
demographic data allowed us to gain some
insight into the participants’ interpersonal
contacts with individuals who have self-
harmed. It is important to underline that all of
the adolescents with a history of deliberate self-
harm stated that they knew or were close friends
with other individuals who self-harmed, while
only six adolescents and seven adults without a
history of deliberate self-harm had interpersonal
contacts with a history of these behaviours. Some
studies have found that those who self-harm
know more peers who also self-harm than those
who do not have a history of deliberate self-harm
Duarte, E., Gouveia-Pereira, M., Sampaio, D.
888
Trends Psychol., Ribeirão Preto, vol. 27, nº 4, p. 879-894 - December/2019
(Claes, Houben, Vandereycken, Bijttebier, &
Muehlenkamp, 2010), including friends (Nock
& Prinstein, 2005; Yates, Carlson, & Egelang,
2008). Hence, we consider that this data may be
associated with the infl uence that peers have in
the onset of these behaviours (Jarvi, Jackson,
Swenson, & Crawford, 2013). In terms of the
interpersonal contacts of adolescents without a
history of deliberate self-harm, our ndings are
also consistent with previous research (Bresin
et al., 2013). Nonetheless, this result shows that
more than half of the adolescents and adults
without a history of deliberate self-harm build
their representations based on other “sources”
besides personal contacts with experiences of
these behaviours, such as information presented
in the media.
Overall, the participants cited 10 diff erent
functions, although there were diff erences between
the three groups. The interpersonal functions
included Communication Attempt, Interpersonal
Boundaries, Interpersonal Infl uence and Peer
Bonding, while the intrapersonal functions
included Aff ect Regulation, Anti-Dissociation,
Escape Mechanism, Introspective Mechanism,
Replacement of Suff ering and Self-Punishment.
Comparing these functions with the organization
proposed by Klonsky and Glenn (2009), only six
of the thirteen functions proposed by the authors
were cited by the participants. Regarding the
interpersonal dimension, the participants did
not mention Autonomy, Revenge, Self-Care,
Sensation Seeking and Toughness. Focusing on
the intrapersonal dimension, Anti-Suicide and
Marking Distress were also not mentioned. These
results may indicate that there is still a general
lack of scientifi c knowledge about the functions
of deliberate self-harm. Nonetheless, two
functions not mentioned in this systematization
emerged from content analysis (Communication
Attempt and Escape Mechanism), as well as
two new functions which were not found in
the literature (Introspective Mechanism and
Replacement of Suff ering).
Focusing on these four functions, Com-
munication Attempt has been mentioned by
some authors (e.g. Conterio & Lader, 1998;
Favazza, 1987) but it was not present in Klonsky
and Glenn’s categorization (2009). Regarding
Escape Mechanism, although it can be considered
a form of Aff ect Regulation because it involves
the reducing of negative states (Klonsky,
2007), the interviewees’ verbalizations of
this function implied the specifi c escape from
problems. Therefore, we opted by considering
Escape Mechanism as an independent function.
Likewise, the function Replacement of Suff ering
has some similarities with Marking Distress
because both of them are based on the physical
expression of negative emotions. However, we
decided to diff erentiate these functions, since
Replacement of Suff ering consists of a specifi c
mechanism where emotional distress is replaced
by physical pain. At last, we did not fi nd any
references in the literature to the function
Introspective Mechanism nor to the contents
associated with it.
Regarding the disparities between the
three groups of participants, there are some
diff erences that should be noted. Overall, the
group of adults referenced more interpersonal
functions, while both groups of adolescents gave
more relevance to intrapersonal functions. These
results are similar to those previously found
(Batejan et al., 2015; Duarte et al., 2019), where
participants without a history of deliberate self-
harm considered interpersonal functions for
engaging in these behaviours as more relevant
than participants with a history of deliberate
self-harm did.
In the present study, adults were the only
group that mentioned the interpersonal functions
Interpersonal Boundaries and Peer Bonding,
and greatly emphasized Interpersonal Infl uence.
Moreover, the interviewees’ discourses about
Interpersonal Infl uence, were oriented towards
two distinct approaches. Adolescents with a
history of deliberate self-harm described this
function as a help-seeking behaviour, while
adults tended to view this function as a negative
call for attention from the adolescent. On the
other hand, adolescents without a history of
deliberate self-harm verbalized both types of
perspectives concerning this function. These
Social Representations about the Functions of Deliberate Self-Harm from Adults
and Adolescents: A Qualitative Study.
889
Trends Psychol., Ribeirão Preto, vol. 27, nº 4, p. 879-894 - December/2019
ndings may suggest that, as Law, Rostill-
Brookes, and Goodman (2009) found in their
study, there is still the stigma and social belief
that these behaviours have a manipulatory
nature. Hence, we hypothesize that this stereo-
typical perspective has infl uenced adults’ social
representations.
Subsequently, when comparing these results
with the perspectives of parents of adolescents
with deliberate self-harm some similarities
emerge, such as the description of deliberate
self-harm as a “time-limited phase”, infl uenced
by peers, and sometimes seen as a “fashion”
(Oldershaw et al., 2008). In this study, authors
also found that all parents felt that they could not
fully understand or empathise with self-harm,
which most adults also stated in our interviews.
These similarities between the representations
of adults without interpersonal contacts with
deliberate self-harm and parents of adolescents
who self-harmed may imply that these social
representations are build regardless of having
contact with these behaviours.
Nonetheless, the fact that the group of ado-
lescents without a history of deliberate self-harm
also emphasized Interpersonal Infl uence as a
help-seeking function and cited all the functions
that adolescents with a history of deliberate
self-harm mentioned, might indicate that age
proximity can play a role in the understanding
of these behaviours. Therefore, peers seemed
to be more aware of the functions of deliber-
ate self-harm, which is not in accordance with
previous research that concluded that peers were
largely unclear about why people engage in
these behaviours (Bresin et al., 2013). However,
this discrepancy can be related to the methods
used in the studies, since we followed a qual-
itative approach that allowed participants to
talk freely, while the mentioned study was
based on the reading of fi ctional vignettes. Fur-
thermore, we hypothesize that since six adoles-
cents without a history of deliberate self-harm
reported knowing other adolescents with these
behaviours, their social representations might
have been infl uenced by the sharing of experi-
ences from their peers, hence the references to
intrapersonal functions.
On the other hand, the focus of adolescents
with a history of deliberate self-harm on
intrapersonal functions is also important and
consistent with previous research (e.g. Duarte et
al., 2019; Klonsky, 2007). In our results, it is clear
that this group of participants emphasized this
type of functions, specially A ect Regulation.
We might conclude that these adolescents’
social representations about deliberate self-
harm – and, of course, their own experiences
are based on the idea that self-harm is a lonely
and autonomous way of coping with negative
emotional states (Aff ect Regulation), avoiding
dissociative states (Anti-Dissociation), escaping
and withdrawing from negative emotions
(Escape Mechanism) and isolating themselves
in their thoughts (Introspective Mechanism).
When we take into consideration that the other
function that this group mentioned consisted
in Interpersonal Infl uence (as a help-seeking
behaviour), we might also question if, on their
perspective, when self-harm is directed towards
others, it encompasses a cry for help, as if their
distress has become too unbearable to deal on
their own through intrapersonal functions.
In summary, our study provides relevant
information regarding the social representations
about the functions of deliberate self-harm in
adolescents and its diff erences in the three groups
of participants. First of all, we must underline
the presence of two new functions not described
in the literature, which can contribute to further
understanding concerning the motivations of
deliberate self-harm. Secondly, the diff erences
found between the three groups of interviewees
revealed that there is a gap between the
representations of adults without a history of
deliberate self-harm and the representations of
adolescents with and without a history of these
behaviours. Clinically, the fact that peers were
more aware of the functions of these behaviours
is relevant, since it indicates that friends and
close peers can play a signifi cant role in clinical
work (Bresin et al., 2013). Also, our results
underline the need to psycho-educate parents
and other adults potentially involved in clinical
interventions (such as other family members,
teachers or healthcare workers), considering
Duarte, E., Gouveia-Pereira, M., Sampaio, D.
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Trends Psychol., Ribeirão Preto, vol. 27, nº 4, p. 879-894 - December/2019
that their social representations about this
phenomenon are sometimes biased and can
have negative eff ects on treatment and recovery.
In this context, our ndings suggest that there
is the need to develop prevention programs
focusing on deliberate self-harm, namely
through psycho-education. This approach might
be important to contribute to the building and
modifi cation of social representations, and also
to avoid subsequent negative attitudes towards
adolescents who engage in deliberate self-harm.
Limitations and Directions for Future
Research
Although the qualitative methods used in the
current study allow a comprehensive approach to
this subject, certain limitations should be noted.
First of all, this study was limited by its sample
size and by the selection of the participants, that
was mostly made through personal contacts and
consisted of a convenience sample. A larger
sample, with more diversity, would allow more
representative results. Also, the inclusion of
adults with a history of deliberate self-harm
would allow its comparison with the other
groups’ representations and contribute to further
understanding.
Our ndings off er some important insight
concerning the social representations about
the functions of deliberate self-harm, but more
research is clearly needed in this area. In a rst
stance, since there is still scarce information
regarding the social representations of individuals
that did not have direct contact with these
behaviours, future research could involve the
comparative study of the representations about
the functions of deliberate self-harm in diff erent
social groups. This could include individuals
from diff erent ethnic groups, with diff erent
professional backgrounds (such as education
staff , or mental health workers), with distinct
“proximities” to deliberate self-harm (namely
the family members of those who present these
behaviours), amongst others. Furthermore, other
social representations about the phenomenon of
deliberate self-harm could be explored.
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Received: 28/11/2018
1st revision: 26/02/2019
Accepted: 27/03/2019
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... Sendo forte campo de interesse da psicologia social, centrada no domínio da ciência, a TRS cumpre uma funcionalidade comportamental, a partir do entendimento dos indivíduos sobre temas que afetam o seu cotidiano (17)(18) . Em vista disso, as RS apresentam um objetivo prático que implica ações, tal como evidenciado em diferentes pesquisas (23)(24)(25)29) , desenvolvidas, inclusive, no âmbito internacional (36)(37) . ...
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