This investigation aimed to identify some of the personal and interpersonal processes involved in deliberate self-harm at a residential treatment setting for adolescents with mental health problems. A qualitative approach was used, which included interviews and participant observation. Six adolescents with a history of deliberate self-harm were interviewed about their perceptions of deliberate selfharm. The interviews were analysed using interpretative phenomenological analysis. Process notes from observations at the unit community meeting were used to provide support for the themes generated in the interviews. Deliberate selfharm was identified as a response to conflict or feeling distressed or angry. It left other patients feeling angry, upset and burdened with a sense of responsibility. Sub-groups of ‘self-harming for genuine reasons’ and ‘self-harming for attention’ emerged as a central theme. Adolescents competed to be a genuine self-harmer: this led to feeling a need to cause a certain level of damage when self-harming and to harm in secret. Seeking help was difficult. The study concluded that group treatment methods were indicated, as well as challenging the traditional response to deliberate self-harm of not giving attention.
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