Witcher Millie, Rowe Sarah, Marlow Sally, Heath Jennifer
Doctorate Programme in Clinical Psychology, School of Health, Medicine and Life Sciences, University of Hertfordshire, Hatfield, Hertfordshire, United Kingdom.
Mental Health Sciences Programme, Division of Psychiatry, University College London, London, United Kingdom.
PLoS One. 2025 Aug 14;20(8):e0328914. doi: 10.1371/journal.pone.0328914. eCollection 2025.
There is limited empirical research to suggest repetitive self-harm can be understood or conceptualised as an addictive behaviour. However, few empirical studies have investigated this and yielded conflicting results. This study aims to explore to what extent can repetitive self-harm be conceptualized as an addictive behaviour.
The study employed the principles of Constructivist Grounded Theory to guide the collection and analysis of data from 15 adults with current or past experience of repetitive self-harm.
Thirteen categories were identified within the data that depicted participants journeys with self-harm over time. 'Starting' to self-harm (category 1) and participants' description of 'needing to punish myself' (category 2) led to self-harm 'feeling addictive' (category 3). Once self-harm had become repetitive, 'having the urge to self-harm' (category 4) and experiencing a 'conflicting relationship with self-harm and self' was ongoing for participants (category 5). Throughout each incidence of self-harm, participants described a "cycle of self-harm", in which self-harm had different functions and consequences: 'managing emotions' (category 6), 'allowing me to function' (category 7), 'caring for myself' (category 8), 'controlling' (category 9) and 'feeling guilt and shame after self-harm' (category 10). All participants described 'responding to other's reactions' to their self-harm (category 11), six discussed 'breaking the self-harm cycle' (category 12) and six participants described 'relapsing' (category 13) and returning to self-harm following a period of abstinence.
This study has provided a conceptual model of processes that maintain engagement in repetitive self-harm, discussed in relation to addiction literature. Clinical practice could consider working alongside the client to identify where they feel they are within the self-harm cycle in relation to changing their self-harm behaviours.
仅有有限的实证研究表明，重复性自我伤害可被理解或概念化为一种成瘾行为。然而，很少有实证研究对此进行调查，且结果相互矛盾。本研究旨在探讨重复性自我伤害在多大程度上可被概念化为一种成瘾行为。
本研究采用建构主义扎根理论的原则，指导对15名有当前或过去重复性自我伤害经历的成年人的数据收集和分析。
数据中识别出13个类别，描述了参与者随时间推移的自我伤害历程。“开始”自我伤害（类别1）以及参与者对“需要惩罚自己”的描述（类别2）导致自我伤害“感觉成瘾”（类别3）。一旦自我伤害变得重复，参与者会持续“有自我伤害的冲动”（类别4），并经历“与自我伤害和自我的矛盾关系”（类别5）。在每次自我伤害事件中，参与者描述了一个“自我伤害循环”，其中自我伤害具有不同的功能和后果：“管理情绪”（类别6）、“让我能够正常生活”（类别7）、“照顾自己”（类别8）、“控制”（类别9）以及“自我伤害后感到内疚和羞耻”（类别10）。所有参与者都描述了对他人对其自我伤害的“反应”（类别11），6人讨论了“打破自我伤害循环”（类别12），6名参与者描述了“复发”（类别13），即在一段时间的戒除后又恢复自我伤害。
本研究提供了一个关于维持重复性自我伤害行为过程的概念模型，并结合成瘾文献进行了讨论。临床实践可以考虑与服务对象合作，确定他们在自我伤害循环中所处的位置，以帮助他们改变自我伤害行为。
