Women's reflections on their adolescent self -injury in relation to grief and loss

The purpose of this study was to explore women's lived experiences with self-injury in relation to grief and loss. The primary research question was: What is the experience of grief and loss among women who have self-injured? Secondary questions were: (a) What are the lived experiences of women with a history of adolescent self-injury behaviors? (b) What, if any, are the roles of grief and loss in adolescent self-injury behavior? (c) How do participants understand and express their experience of therapy? (d) How can understanding participants’ experiences with grief and loss, and adolescent self-injurious behavior inform treatment? A semi-structured interview design included participants creating projective drawings, self-portraits during the time of self-injury and post-therapy. Four participants were interviewed and one potential participant opted out because of her fear of re-injuring. The age of participants when they self-injured was 14-17 years, with duration of self-injurious behavior of 2-4 years, and frequency of once a month to three times a day. Types of self-injury included: cutting, burning, carving, scratching, hair pulling, and head banging. All participants received inpatient treatment. Findings indicated that grief and loss invaded every aspect of participants' lives, including physical, emotional, relational, and psychological domains. Choice to self-injure is influenced by several factors, which may include age, previous experiences of abuse, family setting, type of parenting received (lacking or absent parent/s), failure of communication, lack of connections to school, suicidal ideation, and self-concept. Participants indicated that helpful aspects of treatment included peer support, self-affirmation and self-awareness activities, and writing assignments. Aspects deemed unhelpful included lockdown, group and family therapy. It was recommended that clinicians should explore the potential of grief and loss issues in the lives of adolescents who self-injure. The findings also revealed that the self-injurious lifecycle mirrors the grief cycle, which may include depression, anger, guilt, emptiness, pain, fear, confusion, resolution, and integration. Discussed are implications for treatment and areas warranting further research; contributions to our understanding of how self-injurious behavior is linked to grief and loss, lifecycle of self-injurious behavior; and suggestions for clinicians