Naturalistic Recovery from Nonsuicidal Self-Injury: A Phenomenological Inquiry

Nonsuicidal self-injury (NSSI) refers to the self-inflicted, deliberate, direct damaging of a superficial or moderate amount of body tissue without the intent to die and without social sanction (Favazza, 1998). In recent years, researchers have increasingly studied the etiology of this behavior (Adrian, Zeman, Erdley, Lisa, & Sim, 2011; Heilbron & Prinstein, 2010; Weierich & Nock, 2008). Less is known about how individuals recover from it (Andover, 2012). A review of NSSI prevalence rates suggests that most individuals who self-injure recover by middle adulthood; rates are highest among adolescents and young adults. For example, Yates, Tracy, and Luthar (2008) reported that 37.2% of adolescents (N = 1,036; no mean age was provided) from a high school setting engaged in NSSI during the past year. Similarly, in a study of young adults (N= 390; mean age = 20.3 years) from a college setting, approximately 40% of participants engaged in NSSI on multiple occasions and/or with multiple methods in the past year (Buser & Hackney, 2012). By contrast, Briere and Gil (1998) reported that only 4% of adults (N= 927; mean age = 46 years) from a nonclinical setting performed NSSI in the past 6 months. Researchers have found that the majority of individuals who perform NSSI do not seek treatment by health care providers (Deliberto & Nock, 2008; Whitlock, Eckenrode, & Silverman, 2006). Therefore, these findings indicate that most individuals who self-injure follow a naturalistic course of recovery (i.e., unaided by health professionals) over time. However, few investigations have explored how individuals reduce or cease engagement in NSSI without the assistance of psychotherapy or medical intervention. Qualitative researchers have alluded to naturalistic recovery processes as part of a broader exploration of NSSI (Alexander & Clare, 2004; Moyer & Nelson, 2007). For example, Moyer and Nelson (2007) conducted a qualitative study with six adolescents who engaged in NSSI (66.7% female; mean age = 15.3 years). In one of the major themes pertaining to "how they wish to be treated" (p. 47), participants indicated that harsh critiques about their use of NSSI sometimes precipitated more engagement in the behavior, whereas open, nonjudgmental dialogue with others was helpful in reducing the behavior. Similarly, Alexander and Clare (2004) investigated the experiences of 16 lesbian or bisexual women (mean age = 29 years) with a history of NSSI. Among the main themes was participants' experience of recovering as a result of improved social relationships as well as professional help. According to participants, they reduced engagement in NSSI because of concerns about how the behavior affected significant others. Additionally, some participants recovered because the behavior failed to deliver the affect regulation previously associated with its use. Shaw (2006) carried out a qualitative study of the recovery experiences of six women (mean age =19.8 years) who engaged in NSSI and other self-injurious behaviors (e.g., suicide attempts, eating disorders). In addition to noting the value of professional help, participants attributed their recovery to the achievement of educational and career-related goals. These activities led participants to recognize that self-injury conflicted with long-term plans (e.g., the possibility that physical scars could negatively affect one's employment prospects). Furthermore, the decision to stop self-injurious behaviors was often grounded in participants' desire to avoid disappointing or worrying others. In a mixed methods study with 94 adolescents (78% female; mean age =17.1 years), Deliberto and Nock (2008) examined the reasons why individuals who self-injure might like to stop NSSI use. Most of the participants who self-injured (56%) wanted to cease the behavior because they viewed it as unhealthy. Seventeen percent of these participants described "unwanted attention" (p. …