Paving the way for a new conceptualisation of nonsuicidal self-injury

: a mixed methods sequential exploration

Abstract

Nonsuicidal self-injury (NSSI) refers to the act of purposely injuring oneself without the intent to die, a behaviour linked to numerous psychopathologies and suicide. Despite its prevalence, affecting an estimated 20% of individuals in the UK, NSSI remains poorly understood, due in part to debates surrounding its definition, measurement, and its status as a psychiatric or psychological issue. This thesis aimed to explore how NSSI is conceptualised, both by individuals who engage in it and by UK public health institutions, as well as examining the relevance of individual cognitive representations of the behaviour.

The research was conducted sequentially in three stages. First, a systematic review and qualitative meta-synthesis examined how individuals with first-hand experience of NSSI conceptualise it, identifying diverse, socially embedded, and symbolic representations of the behaviour. These individualised conceptualisations often contrasted with top-down psychological and psychiatric models.

Second, a quantitative study drawing on the self-regulation model found that cognitive representations of NSSI were able to predict coping styles and attitudes towards accessing access mental health services. Cognitive representations of greater control and coherence were associated with positive coping and positive attitudes towards accessing support, whereas perceptions of severity and chronicity predicted negative outcomes.

Finally, a Foucauldian Discourse Analysis of psychoeducational leaflets from UK public health institutions identified a decontextualised conceptualisation of NSSI, which individualised responsibility and emphasised the severe consequences of the behaviour. It also found the way in which the discourses constructed NSSI and the ideal of recovery may risks marginalising some individuals and reproducing epistemic injustice.

This thesis makes a novel contribution by highlighting the contrast between individual and institutional conceptualisations of NSSI, and the power of cognitive representations of NSSI to predict outcomes. It also emphasises the need for a pluralistic, process-relational epistemology that fosters shared meaning-making and avoids epistemic injustice in conceptualising the behaviour.

Date of Award	2024
Original language	English
Awarding Institution	Aberystwyth University
Supervisor	Rachel Rahman (Supervisor) & Martine Robson (Supervisor)