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A Comprehensive Model of Deliberate Self-Harm Among Adolescents And

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A Comprehensive Model of Deliberate Self-Harm Among Adolescents And Youth deliberate self-harm: Interpersonal and intrapersonal vulnerability factors, and constructions and attitudes within the social environment. By Jessica Anne Garisch A thesis Submitted to the Victoria University of Wellington in fulfilment of the requirements for the degree of Doctor of Philosophy In Psychology Victoria University of Wellington 2010 Abstract Deliberate self-harm (DSH) is defined in this thesis as the intentional, culturally unacceptable, self-performed, immediate and direct destruction of bodily tissue that is of low-lethality and absent of overdose, self-poisoning and suicidal intent. DSH is a serious mental health problem among young people internationally (Hawton et al., 2006; De Leo & Heller, 2004) and is associated with multiple maladaptive psychological and social outcomes (D‟Onofrio, 2007; Hawton et al., 2006). This thesis utilised secondary school student (N=2068), teacher (N=109), guidance counsellor (N=8), and university student (N=2063) populations to assess factors relating to interpersonal and intrapersonal vulnerability to DSH, and how DSH is received and understood within young peoples‟ environment. Study 1 presents psychometric analyses, descriptive statistics and basic inferential statistics of surveys developed for secondary school student and university student populations. These surveys measured history of DSH and multiple correlates of DSH behaviour. Assessing the psychometric qualities of these surveys informed their later use in developing regression models of DSH in Study 2. Study 2 assessed predictors and functions of DSH behaviour using a variety of samples and methodologies. Study 2.1 presents cross-lag and structural equation models of DSH, where the most consistent direct predictor of DSH was low self-esteem, which was proximally impacted by internalising symptoms, and more distally by alexithymia and low mindfulness. Study 2.2a investigated functions of DSH, and how this related to psychological wellbeing. Engaging in DSH for emotional relief or control was associated with the poorest wellbeing among females (i.e. higher rates of DSH, sexual abuse and bullying), while engaging in DSH for multiple reasons was associated with the poorest wellbeing among males (i.e. higher rates of DSH, bullying, abuse history, and low resilience). Study 2.2b qualitatively investigated reasons given for youth DSH by secondary school students, university students, and secondary school teachers using content analysis; DSH was most often attributed to emotional issues (e.g. externalising emotional pain). Study 2.3 assessed the relationships between DSH, emotional experience, self-defeating thoughts, coping strategies, and substance abuse over a six i week period with a sample of university students. DSH was linked to having more self- defeating thoughts and general negative emotional experience, as well as having more negative, and less positive, emotions during salient events. Study 3 investigated social responses to DSH through interviews with eight secondary school guidance counsellors (Study 3.1), and a survey study on stereotypes and attitudes towards DSH (Study 3.2). A thematic analysis was conducted on the interview transcripts, indicating that DSH was commonly viewed as immature, attention seeking, abnormal and dangerous. The interviews suggested stigma in secondary schools towards DSH and fear and resistance around engaging the issue. The stereotypes and opinions survey was conducted with secondary school students, teachers and university students to assess common stereotypes of self-harmers, and willingness and confidence to help youth who self-harm. DSH was viewed negatively by all sample groups. Many participants felt unable and incompetent to help youth who self-harm. Across youth samples lifetime prevalence rates for DSH were consistently in the range of 39-49%. Overall the findings suggest that DSH is heterogeneous, with numerous possible factors contributing to vulnerability. Knowledge from this thesis can be applied to prevention of DSH (e.g. assisting youth with internalising symptoms and low self-esteem), intervention (e.g. teaching emotional coping strategies) and increasing social awareness and understanding to counter stereotypes and thereby ease disclosure. ii Acknowledgements Firstly, I would like to send a big thank-you to all the students, teachers and guidance counsellors who participated in this research. I have really appreciated the time they have taken to be part of this, and the experiences they have shared. Thank-you to all the participating schools, whose enthusiasm and commitment made this research possible. Thank-you to my supervisor, Dr. Marc Wilson, for his excellent guidance, support and encouragement. I have really valued his enthusiasm for this research, and the feedback he has given me. Thank you to my friends Clare, Pati, Annabelle, Veronica, Kerryanne and Marieke, who have been so wonderful in their faith in me, and providing opportunities for timely breaks away. Also I am grateful to my wonderful officemates over the past few years (Michelle, Tamsyn, Matt, Lisa, Caleb and Mel), who have given me supportive advice and friendship. I would like to thank Victoria University for a generous PhD scholarship, which has been immensely helpful over the past three years. Finally, thank you to my wonderful family. To my brother Simon, for the distractions, support, perspective and letting me have the car when I went out data- gathering. And many, many thanks to my parents, who have had endless belief in me and cheered me on from beginning to end. iii Contents Abstract .................................................................................................................... i Acknowledgements ............................................................................................... iii Contents................................................................................................................. iv List of Tables .......................................................................................................... x List of Figures ...................................................................................................... xii List of Appendices* ............................................................................................. xiv Overview ..................................................................................................................1 Introduction: What is DSH and why is it important? ............................................ 6 Defining Deliberate Self-Harm ............................................................................................ 6 Alternative Terminology ..................................................................................................... 7 DSH: The Importance of Intent .......................................................................................... 7 The Importance of Method of Self-Harm ...........................................................................10 Behaviours Not Considered to be DSH in this Thesis .........................................................12 Measures and Prevalence of DSH ....................................................................................................... 14 Self-report measures of DSH. ............................................................................................14 Prevalence of DSH. ...........................................................................................................16 New Zealand rates of DSH among adolescents and young adults. .....................................21 Sex differences in prevalence rates of DSH.......................................................................28 The vulnerability of youth. .................................................................................................29 Explanations for the present DSH „epidemic‟ among youth. ................................................31 Characteristics and Covariates of DSH .............................................................................................. 35 Multiple versus preferred method of DSH. .........................................................................35 Method and site of DSH: clue to underlying disturbance? ....................................................36 Secrecy surrounding DSH. .................................................................................................38 Correlates of DSH. ............................................................................................................41 Connecting correlates of DSH. ...........................................................................................47 Theoretical Models and Frameworks of DSH................................................................................... 49 Models of DSH. ...........................................................................................................50 iv Theoretical frameworks of DSH. ..................................................................................54 Personal Perspectives: Giving a Voice to Those Who Engage in DSH ..................................... 58 Overview of the Studies in this Thesis .............................................................................................. 63 Study One: Psychometric Analyses ...................................................................... 65 Choosing the Appropriate Measures ....................................................................................................
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