As newly obtained figures from the NHS show a dramatic increase in the number of young people being hospitalised following self-harm, a timely study in Archives of Suicide Research has reviewed what we know so far about how people who self-harm manage to stop. Tess Mummé and her colleagues identified 9 relevant studies to review – three quantitative, four qualitative, and two using a combination of these approaches – together involving hundreds of people aged 12 to 60, the majority female. Among the key insights, the researchers found family support is crucial for stopping self-harming, perhaps more than support from friends or professionals. But ultimately the review concludes that we need more research.
The format of most of the studies contained in the new review was to contrast the interpersonal (i.e. social) and intra-personal (within-the-person) factors of people who used to self-harm but no longer do, with those found in people who are currently self-harming (the lack of longitudinal research, that follows the same people over time from when they self-harm to when they stop, is a key weakness in the literature).
Summarising the findings, Mummé and her colleagues report that family support was the “predominant interpersonal” factor associated with stopping self-harming, including in studies that involved adults, not just those with teens and children. The reasons for family support being so important appeared to be the benefits of a strong role model, as well as help finding the motivation to stop, and support finding professional help. Support from friends did arise as a factor, but was not reported as consistently as family support.
Regarding intra-personal factors, the following were all important in stopping self harming: self-esteem, self-efficacy, sense of hope and emotional regulation. Past self-harmers reported a “stronger ability to accept emotions, cognitive reappraisal and resilience” than current self-harmers.
Interestingly, one study found that past self-harmers saw their self-harm as a useful coping mechanism, but had been motivated to stop because their loved ones wanted them to stop. Other studies documented how some past self-harmers had found constructive new ways to control their emotions, such as dancing and writing, while others unfortunately had developed alternative “destructive coping behaviours”, such as substance abuse or eating problems.
It was also clear from the studies that interpersonal and intra-personal factors are connected – for example, a lack of family support can fuel feelings of low self-worth that appear to be related to the maintenance of self-harming.
Only one study actually asked people in-depth what it was like to go through the process of stopping self-harming. This pointed to a gradual, multi-stage experience that began with a focus on the self, such as building relationships and self-esteem, and that moved onto learning alternative forms of emotional regulation. Close personal relationships were seen as important throughout the stopping process.
Overall, Mummé conclude that much more research is needed to help inform the development of interventions to help confront the increasing rates of self-harm occurring in developed countries. We especially need more studies that delve into the experience of stopping self-harming, “based on the notion of the self-injurer being the expert in understanding the behaviour.” Such is the paucity of research that at present “it remains unclear how people reach the point of wanting to stop and then how they actually stop self-injuring.”
Image via Rolands Lakis/Flickr