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A Q-Methodology Study The Functions of Self-harm: A Q-methodology study Roseanne O’Shea Submitted in accordance with the requirements for the degree of Doctor of Clinical Psychology (D. Clin. Psychol.) The University of Leeds School of Medicine Academic Unit of Psychiatry and Behavioural Sciences July 2019 1 The candidate confirms that the work submitted is his/her own and that appropriate credit has been given where reference has been made to the work of others. This copy has been supplied on the understanding that it is copyright material and that no quotation from the thesis may be published without proper acknowledgement. The right of Roseanne O’Shea to be identified as Author of this work has been asserted by her in accordance with the Copyright, Designs and Patents Act 1988. © <2019> The University of Leeds and <Roseanne O’Shea> 2 Acknowledgements I wish to thank the people who over the years have inspired me to want to understand more about self-harm; those I have known and met both personally and professionally. I am grateful for the depth and breadth of your knowledge and the opportunities you have presented me with. In particular I wish to thank Allan House and Louise Bryant for their impressive knowledge and skill in research and self-harm, I have appreciated your ongoing support and supervision over the three years. For those who I have known personally, you remain treasured and close to my heart, thank you for the inspiration and your beautiful spirit. Thank you too to Battle Scars and Jenny Groves in particular for your input and enabling the study to get off the ground. Thank you to my family and friends. In particular Mum, Dad, Patch, El and Christine; this would not be possible without you being there and catching me. Thank you to my DClin cohort as throughout training we have been in it together. Finally and most notably thank you to all those who took part in the study, for giving your time and sharing something deeply personal and instrumental. 3 ABSTRACT Current knowledge on the functions of self-harm understands this phenomenon as serving numerous, complex, contradictory and varied functions for individuals. Using Q- methodology this study sought to explore participant’s subjective viewpoint on the functions of self-harm that are outlined in the current existent academic literature. Q-methodology is a mixed methods approach to the scientific study of people’s viewpoint on a topic (their subjectivity). Using this approach, the current knowledge on the functions of self-harm was presented as a set of statements to people who self-harm. Twenty participants (aged 21-57, 14 female and 6 males) were recruited through the NHS, online forums and a third sector support group. These participants were asked to sort, rank and comment on these functions according to whether they agreed and disagreed with these as a personal reflection of their own functions for self-harm. The Q-methodology factor analytic findings revealed consensus between the participants on some of the functions of self-harm; specifically agreement was evident in self-harm managing negative internal experiences and disagreement was evident in self-harm serving sexual functions. The factor analytic findings also revealed two distinct and statistically robust factors. These two factors allow for an appreciation of differences in degree of agreement and disagreement on some of the functions of self-harm. These differences in viewpoint found that Factor 1 (named ‘increasing the positive’) endorsed positive and validating functions to a greater extent than Factor 2. In contrast, Factor 2 (named ‘removing the negative’) appeared to view the cleansing and self-punishment functions as more relevant. Additionally, Factor 2 also agreed with self-harm as a greater way to switch off memories and terminate depersonalisation. Such findings need to be considered in the context of the study’s strengths and weaknesses yet the findings have clinical implications for people who wish to reduce or stop self-harming. These include the flexible use of the factors as a clinical heuristic or framework during therapeutic assessment and formulation to help guide intervention. Implications are also evident for future research and the current understanding of the functions of self-harm. 4 Table of Content Acknowledgements ................................................................................................................................. 3 ABSTRACT ............................................................................................................................................ 4 Table of Content ..................................................................................................................................... 5 List of Tables .......................................................................................................................................... 8 List of Figures ......................................................................................................................................... 9 1. INTRODUCTION ............................................................................................................................ 10 1.1 Defining self-harm ...................................................................................................................... 11 1.1.1 What it is and what it is not: No simple definition .............................................................. 11 1.1.2 Characteristics of self-harm behaviour ................................................................................ 12 1.1.3 Conclusions .......................................................................................................................... 13 1.2 Associations with self-harm ........................................................................................................ 14 1.2.1 Self-harm and Suicide .......................................................................................................... 14 1.2.2. Self-harm and other behaviours .......................................................................................... 15 1.2.3 Self-harm and its risk factors ............................................................................................... 15 1.2.4 Self-harm and Psychiatric Diagnoses .................................................................................. 16 1.3 Conclusion to defining self-harm ................................................................................................ 17 1.4 Literature on the functions of self-harm ..................................................................................... 17 1.4.1 Early research: Bancroft, Skrimshire and Simkin (1976) .................................................... 18 1.4.2. Suyemoto’s (1998) Six functional models .......................................................................... 19 1.4.3 Klonsky’s (2007) Seven function model.............................................................................. 25 1.4.4 Nock’s (2009) Integrated theoretical model for self-harm.................................................. 27 1.4.5.Edmondson, Brennan & House (2016) review .................................................................... 29 1.4.6 How the reviews fit together ................................................................................................ 31 1.4.7 Conclusions .......................................................................................................................... 34 1.5. The current study ....................................................................................................................... 35 5 2. Method .............................................................................................................................................. 36 2.1 Introduction to method ................................................................................................................ 36 2.2 Overview of Q methodology: An inquiry into subjectivity ........................................................ 36 2.3. Overview of Research design in Q methodology ...................................................................... 38 2.4 The current study: Rationale for choosing Q methodology ....................................................... 43 2.4.1 Advantages of a Q methodology approach .......................................................................... 43 2.4.2. Criticisms and Limitations of Q methodology .................................................................... 45 2.5 The current study: Design ........................................................................................................... 46 2.5.1 Creating the Q set ................................................................................................................. 46 2.5.2 Selecting participants: the P-Set........................................................................................... 58 2.5.3 Ethical considerations .......................................................................................................... 60 2.5.4 Materials .............................................................................................................................. 61 2.5.5 Procedure ............................................................................................................................. 62 2.5.6 Analysis ...............................................................................................................................
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