https://doi.org/10.4081/qrmh.2024.12301
“It’s not avoiding anything”: Exploring avoidance in the context of non-suicidal self-injury
Submitted: 22 January 2024
Accepted: 25 June 2024
Published: 3 October 2024
Accepted: 25 June 2024
Abstract Views: 1011
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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Non-suicidal self-injury is a concerning and prevalent behavior, particularly among adolescents and university students. Most theoretical models focus on the role avoidance plays in self-injury but, there is no consensus on what is being avoided. The aim of this study was to gain insight from individuals with lived experience of self-injury to better understand the role of avoidance in NSSI. Thirtyfive interviews were conducted with individuals with lived experience of NSSI (18 – 44 years) and analyzed using reflexive thematic analysis. Three themes were developed to address our aim: active not passive; a short term distraction; externalizing inner turmoil. Our analysis suggests that avoidance is not a term that resonates with individuals with lived experience of NSSI. The theoretical and methodological implications of these findings are that we need to use language that resonates with individuals with lived experience and improve the way avoidance is conceptualized.
Anderson, N. L., & Crowther, J. H. (2012). Using the experiential avoidance model of non-suicidal self-injury: Understanding who stops and who continues. Archives of Suicide Research, 16(2), 124–134.
DOI: https://doi.org/10.1080/13811118.2012.667329
Braun, V., & Clarke, V. (2022). Thematic analysis: A practical guide for beginners. Sage Publications.
DOI: https://doi.org/10.53841/bpsqmip.2022.1.33.46
Briere, J., & Gil, E. (1998). Self-mutilation in clinical and general population samples: Prevalence, correlates, and functions. American Journal of Orthopsychiatry, 68(4), 609–620.
DOI: https://doi.org/10.1037/h0080369
Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self-harm: The experiential avoidance model. Behaviour Research and Therapy, 44(3), 371–394.
DOI: https://doi.org/10.1016/j.brat.2005.03.005
D’Zurilla, T. J., & Nezu, A. M. (1999). Problem-solving therapy: A social competence approach to clinical interventions (2nd ed.). Springer Publishing Company.
Darche, M. A. (1990). Psychological factors differentiating self-mutilating and non-self-mutilating adolescent inpatient females. The Psychiatric Hospital, 21, 31–35.
DiClemente, R. J., Ponton, L. E., & Hartley, D. (1991). Prevalence and correlates of cutting behavior: Risk for HIV transmission. Journal of the American Academy of Child & Adolescent Psychiatry, 30(5), 735–739.
DOI: https://doi.org/10.1016/S0890-8567(10)80007-3
Gámez, W., Chmielewski, M., Kotov, R., Ruggero, C., Suzuki, N., & Watson, D. (2014). The Brief Experiential Avoidance Questionnaire: Development and initial validation. Psychological Assessment, 26(1), 35–45.
DOI: https://doi.org/10.1037/a0034473
Gámez, W., Chmielewski, M., Kotov, R., Ruggero, C., & Watson, D. (2011). Development of a Measure of Experiential Avoidance: The Multidimensional Experiential Avoidance Questionnaire. Psychological Assessment, 23(3), 692–713.
DOI: https://doi.org/10.1037/a0023242
Hasking, P., Whitlock, J., Voon, D., & Rose, A. (2017). A cognitive-emotional model of NSSI: using emotion regulation and cognitive processes to explain why people self-injure. Cognition and Emotion, 31(8), 1543–1556.
DOI: https://doi.org/10.1080/02699931.2016.1241219
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. Guilford Press.
Haywood, S. B., Hasking, P., & Boyes, M. E. (2022). We have so much in common: Does shared variance between emotion-related constructs account for relationships with self-injury? Journal of Affective Disorders Reports, 8, 100332.
DOI: https://doi.org/10.1016/j.jadr.2022.100332
Howe-Martin, L. S., Murrell, A. R., & Guarnaccia, C. A. (2012). Repetitive nonsuicidal self-injury as experiential avoidance among a community sample of adolescents. Journal of Clinical Psychology, 68(7), 809–829.
DOI: https://doi.org/10.1002/jclp.21868
International Society for the Study of Self-injury. (2022). What is self-injury? Available from: https://itriples.org/about-self-injury/what-is-self-injury.
Juarascio, A., Manasse, S., Clark, K. E., Schaumberg, K., Kerrigan, S., Goldstein, S. P., Evans, B. C., Wyckoff, E., Murray, H. B., Felonis, C. R., Forman, E., Wycko, E., Murray, H. B., Felonis, C. R., & Forman, E. (2020). Understanding the overlap and differences in terms describing patterns of maladaptive avoidance and intolerance of negative emotional states. Personality and Individual Differences, 158, 109859.
DOI: https://doi.org/10.1016/j.paid.2020.109859
Kiekens, G., Hasking, P., Claes, L., Boyes, M., Mortier, P., Auerbach, R. P., Cuijpers, P., Demyttenaere, K., Green, J. G., Kessler, R. C., Myin-Germeys, I., Nock, M. K., & Bruffaerts, R. (2019). Predicting the incidence of non-suicidal self-injury in college students. European Psychiatry, 59, 44–51.
DOI: https://doi.org/10.1016/j.eurpsy.2019.04.002
Klonsky, E. D., & Olino, T. M. (2008). Identifying Clinically Distinct Subgroups of Self-Injurers Among Young Adults: A Latent Class Analysis. Journal of Consulting and Clinical Psychology, 76(1), 22–27.
DOI: https://doi.org/10.1037/0022-006X.76.1.22
Lloyd, E. E., Kelley, M. L., & Hope, T. (1997). Self-mutilation in a community sample of adolescents: Descriptive characteristics and provisional prevalence rates. [Poster Presentation]. New Orleans, LA.
Madill, A., Jordan, A., & Shirley, C. (2000). Objectivity and reliability in qualitative analysis: Realist, contextualist and radical constructionist epistemologies. British Journal of Psychology, 91(1), 1–20.
DOI: https://doi.org/10.1348/000712600161646
Muehlenkamp, J. J., Xhunga, N., & Brausch, A. M. (2019). Self-injury Age of Onset: A Risk Factor for NSSI Severity and Suicidal Behavior. Archives of Suicide Research, 23(4), 551–563.
DOI: https://doi.org/10.1080/13811118.2018.1486252
Najmi, S., Wegner, D. M., & Nock, M. K. (2007). Thought suppression and self-injurious thoughts and behaviors. Behaviour Research and Therapy, 45(8), 1957–1965.
DOI: https://doi.org/10.1016/j.brat.2006.09.014
Nemiah, J. C., & Sifneos, P. E. (1970). Psychosomatic Illness: A Problem in Communication. Psychotherapy and Psychosomatics, 18(1–6), 154–160.
DOI: https://doi.org/10.1159/000286074
Nock, M. K. (2009). Why do people hurt themselves?: New insights into the nature and functions of self-injury. Current Directions in Psychological Science, 18(2), 78–83.
DOI: https://doi.org/10.1111/j.1467-8721.2009.01613.x
Nock, M. K., Holmberg, E. B., Photos, V. I., & Michel, B. D. (2007). Self-Injurious Thoughts and Behaviors Interview: Development, Reliability, and Validity in an Adolescent Sample. Psychological Assessment, 19(3), 309–317.
DOI: https://doi.org/10.1037/1040-3590.19.3.309
Nock, M. K., & Prinstein, M. J. (2004). A functional approach to the assessment of self-mutilative behavior. Journal of Consulting and Clinical Psychology, 72(5), 885–890.
DOI: https://doi.org/10.1037/0022-006X.72.5.885
North, P. (2011). The problem of distraction. Stanford University Press.
DOI: https://doi.org/10.1515/9780804778978
Ottenbreit, N. D., & Dobson, K. S. (2004). Avoidance and depression: The construction of the Cognitive-Behavioral Avoidance Scale. Behaviour Research and Therapy, 42(3), 293–313.
DOI: https://doi.org/10.1016/S0005-7967(03)00140-2
Selby, E. A., & Joiner, T. E. (2009). Cascades of emotion: The emergence of Borderline Personality Disorder from emotional and behavioral dysregulation. Review of General Psychology, 13(3), 219–229.
DOI: https://doi.org/10.1037/a0015687
Swannell, S. V, Martin, G. E., Page, A., Hasking, P., & St John, N. J. (2014). Prevalence of nonsuicidal self-injury in nonclinical samples: Systematic review, meta-analysis and meta-regression. Suicide and Life-Threatening Behavior, 44(3), 273–303.
DOI: https://doi.org/10.1111/sltb.12070
Synodinos, N. E. (2003). The “art” of questionnaire construction: Some important considerations for manufacturing studies. Integrated Manufacturing Systems, 14(3), 221–237.
DOI: https://doi.org/10.1108/09576060310463172
Taylor, P. J., Jomar, K., Dhingra, K., Forrester, R., Shahmalak, U., & Dickson, J. M. (2018). A meta-analysis of the prevalence of different functions of non-suicidal self-injury. Journal of Affective Disorders, 227(November 2017), 759–769.
DOI: https://doi.org/10.1016/j.jad.2017.11.073
Supporting Agencies
Research Training Program (RTP) Scholarship from Curtin University, National Health and Medical Research Council Australia (Investigator Grant 1173043)How to Cite
Haywood, Sophie, Penelope Hasking, and Mark Boyes. 2024. “‘It’s Not Avoiding anything’: Exploring Avoidance in the Context of Non-Suicidal Self-Injury”. Qualitative Research in Medicine and Healthcare 8 (s1). https://doi.org/10.4081/qrmh.2024.12301.
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