The interpersonal processes of non-suicidal self-injury: a systematic review and meta-synthesis

Peel-Wainwright, KM, Hartley, S, Boland, A, Rocca, E, Langer, S ORCID: https://orcid.org/0000-0003-3036-430X and Taylor, PJ (2021) The interpersonal processes of non-suicidal self-injury: a systematic review and meta-synthesis. Psychology and Psychotherapy: theory, research and practice, 94 (4). pp. 1059-1082. ISSN 1476-0835

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Abstract

Background: Understanding the processes underlying non-suicidal self-injury (NSSI) is important given the negative consequences of this behaviour. Qualitative research has the potential to provide an in-depth exploration of this. There has been limited research regarding the interpersonal processes associated with NSSI; therefore, a meta-synthesis was conducted to investigate this. Methods: A search of PsycINFO, MEDLINE, Web of Science, and CINAHL electronic databases from date of inception to November 2020 was conducted. In total, 30 papers were included in the final review. A meta-ethnographic approach was utilized to synthesize the data. Results: Two overarching themes were found. Within ‘Powerful relational dynamics’, NSSI was cited as a response to participants becoming stuck in aversive or disempowering relational positions with others. Within the ‘Taking matters into their own hands’ subtheme, NSSI was reported as a way for participants to get interpersonal and emotional needs met. Limitations: Several included papers did not comment on the researcher–participant relationship, which may have affected qualitative results. A small number of potentially eligible papers were unavailable for synthesizing. Conclusion: Findings provide a more nuanced investigation of the interpersonal processes underlying NSSI. Consistent with relevant theories, NSSI appears to be a way of mitigating difficult interpersonal experiences or getting interpersonal needs met. NSSI may be engaged in as a substitute to other, less damaging ways to cope. An argument is made for a more empathetic understanding of NSSI and the use of relational interventions. Practitioner points: Self-injury may occur in response to interpersonal stressors Self-injury can be a means to get interpersonal needs met Self-injury may replace other means of coping that become blocked or thwarted Emotional distress can be closely linked with interpersonal factors for this group Relational therapies may be beneficial where interpersonal processes are linked to NSSI.