“The pen is the blade, my skin the paper”: risk factors for self-injury in adolescents

Moraes, Danielle Xavier; Moreira, Érika de Sene; Sousa, Johnatan Martins; Vale, Raquel Rosa Mendonça do; Pinho, Eurides Santos; Dias, Paula Cândida da Silva; Caixeta, Camila Cardoso

doi:10.1590/0034-7167-2020-0578

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 73 (suppl 1) • 2020 • https://doi.org/10.1590/0034-7167-2020-0578 copy

“The pen is the blade, my skin the paper”: risk factors for self-injury in adolescents

“La pluma es la hoja, mi piel el papel”: factores de riesgo para la automutilación en adolescentes

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to describe the risk factors that influence the self-injury behavior of adolescents assisted at a Psychosocial Care Center for Children and Adolescents, according to subjects’ own perceptions.

Method:

a descriptive, exploratory, qualitative study carried out through medical records and a focus group with 07 adolescents. The statements were submitted to thematic content analysis.

Results:

in the risk factors category, four subcategories emerged: Family adversity factors; Social contagion; Adverse life events; Personal characteristics. Conflicts, lack of support, drug use in the family, meeting someone who cuts themselves, social networks, religiosity, history of sexual violence and bullying were identified as risk factors that influence self-injury.

Final Considerations:

adolescents pointed out the need for prejudice-free dialogues in schools, in health and family devices, configuring protective factors to avoid this practice that comes from several negative events throughout life.

Descriptors:
Adolescent; Self Mutilation; Risk Factors; Mental Health; Community Mental Health Services

Units of meaning	Illustrative statements
Family conflict	The last time I cut myself, I was upset about some things that had happened at home, some fights between my parents. (A3)
Lack of family support	One thing that differentiates people who self-harm others is that everyone goes through problems, but we don't have support from the family when we go through these problems. (A6) I told my mother that I needed help, that if I didn't have help, I would die, she didn't care, she said it was a adolescent thing. (A3)
Separation of parents	My father and my mother separated when I was four years old, I missed him a lot, I think it hindered me too much, I felt abandoned, divided, sad. (A3)
Maternal rejection	My mother said that I ruined her life, that I shouldn't have been born, that I should have died in childbirth, it made me sad and I cut myself, I felt like garbage. (A1)
Alcohol and other drug use in the family	I feel angry when there is a fight at home, then I cut myself. I started cutting myself because of so much fighting at home. I saw my father using drugs, my mother fighting, breaking things at home, I was getting sad, I felt a huge pain inside me. Since I was little, I have wanted to change my reality, but I feel that it is not just up to me and I feel helpless for it. (A1)

Units of meaning

Illustrative statements

Knowing someone who cuts himself or herself

I have virtual friends and real friends who cut themselves. (A4)
At my school, there are a lot of people who cut themselves. In my room, there are two more girls who are getting hurt. (A5)

Internet/social network

Self-injury started because I kept watching videos of people cutting themselves. They said they felt better, and I thought it would ease my anxiety. (A1)
I was already cutting myself when I joined a Facebook self-injury community. I thought that, talking to people who feel the same things that I feel, could help me. It is very difficult to talk about self-injury with someone who doesn't do it, the person thinks it's cool, that we're trying to get attention, that nothing justifies doing it. (A2)
I think these groups made me worse, they said that the people who cut themselves are angels who want to go home and that encourages people to commit suicide. They post a lot of sad songs, with sad subtitles, sad images, they are groups of bad mood. (A7)

Units of meaning	Illustrative statements
Bullying	I started cutting myself after I was a victim of bullying and sexual abuse. (A7) Attending school has always been difficult for me, they called me a monkey, they were bullied because of my hair, because of my color. I felt the worst of all the girls, I felt like nothing. (A4)
Loss of loved one	It started after my mother died, I was very young, I still needed her. I started to feel alone or abandoned, I can't really say what I felt, I just know it was bad. (A1)
Sexual abuse	I was abused by my father. After that, I cut myself the first time. We even expect other people, but we expect protection from beloved ones. (A3) I was raped for three years and was never able to say anything. My biggest pain is not being able to speak, but I have a diary: the pen is the blade, my skin is the paper. (A6)

Units of meaning	Illustrative statements
Anxiety	I have anxiety crisis, I feel short of breath, chest pain, my head hurts. (A2)
Low self-esteem	The word that defines me is loser.I'm a loser. (A1)
Difficulty expressing verbally	I wanted my family to talk to me, so I could open up, I know I have a hard time talking, but if they tried very well, but they don't even try. (A3)
Social isolation	I hardly stay in the middle of the family, I only stay in the room. (A4)
Suicidal ideation	I read a book that the girl cut herself and then she committed suicide, I identified with her feelings. (A2)
Sexual orientation	I'm a homosexual, I suffer a lot because my family doesn't accept it, I started cutting myself for it. It is very difficult to live with a family that does not accept you. (A3)
Religiosity	I was not happy looking for help in the evangelical church, they let me down. (A2) My family is also evangelical, they don't consider depression a disease, they think everything is the devil. The pastor said I had a devil in my body, my whole family believed, I left the church sadder. (A3)
Anger	I feel angry when there is a fight at home, then I cut myself. I started cutting myself because of so much fighting at home. (A1)
Suicide attempt	I told my mother that I was going to die, I said I couldn't take it anymore, she didn't believe it. Twice I took several medications and needed to go to the hospital. (A3) After I took several medications and almost died, my mother sought help here. (A7) After I lost my mother, I tried to kill myself several times. (A4)
Sadness	I drew myself just as I am, with short, curly hair, a smile like this, slightly sideways, forced, because I can't stand smiling without wanting to. People think that because I'm smiling, I'm happy, but my heart is sad. (A6)

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[1] Corresponding author: Danielle Xavier Moraes. E-mail: daniellemoraes@discente.ufg.br