Non-Suicidal Self-Injury: Defining Recovery and Understanding Naturalistic Improvement

Abstract

Paper one is a systematic review and meta-ethnography of qualitative studies investigating personal meanings of recovery for individuals with lived experience of non- suicidal self-injury. Four databases were systematically searched using key words and index terms to identify qualitative literature exploring personal recovery narratives. Thirteen studies, comprising of 159 participants, met the inclusion criteria and were critically appraised and synthesised. Three themes were developed. Whilst ceasing self- injury was an important aspect of recovery for some, recovery was typically viewed more holistically, encompassing developments within the self and relationships. Recovery was regarded an ongoing non-linear journey. The personal and multifaceted nature of the recovery process emerged through a line of argument synthesis. Clinical implications include improved understanding of the importance of expanding self-injury recovery beyond cessation within research and clinical practice. Collaborative and person-centred approaches should be embraced when supporting those who self-injure. Paper two explored factors influencing naturalistic improvements in non-suicidal self-injury. Semi-structured interviews were conducted with 16 individuals who believed their difficulties with self-injury had improved due to factors not attributed to psychological or medical intervention. A reflexive thematic analysis revealed four main themes. Increased insight into self-injury experiences promoted self-compassion and self- acceptance and enabled participants to reflect on the conflicting role of their self-injury. Safe and supportive relationships helped alleviate loneliness and developing alternative coping strategies increased control over self-injury. Rebuilding a life consistent with personal values and needs promoted independence, choice, and self-esteem. The findings highlighted several internal and external naturalistic processes deemed meaningful in improving difficulties with self-injury. Clinical implications include the importance of developing and embedding approaches informed by these factors within services and interventions to improve outcomes for individuals who self-injure. Paper three provides a critical appraisal of the research conducted in papers one and two. Approaches to the design, implementation and analyses of the data are reviewed, with personal reflections from the researcher on the research process offered throughout.

Date of Award	31 Dec 2023
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Peter Taylor (Supervisor)