A systematic review and qualitative meta-synthesis of first-hand conceptualisations of nonsuicidal self-injury (NSSI)

Nonsuicidal self-injury (NSSI) is a growing phenomenon that correlates with significantly negative outcomes including psychopathology, hospitalisation and suicide; however, there exists little consensus on how to best understand it. This lack of conceptual consensus risks inconsistent clinical practice in a population that often reports poor experiences of professional support, therefore an understanding of how individuals conceptualise their own NSSI without attempting to fit it into existing causal and functionalist models is needed. This review sought to examine and synthesise first-hand conceptualisations of NSSI in existing qualitative literature using interpretive phenomenological synthesis. A systematic database search of qualitative literature was conducted, including interviews with individuals with experience of NSSI across all ages and settings, published in English from 1950 to 2022. Twenty-three studies were included in the final meta-synthesis. Three superordinate themes were generated via the synthesis: (1) NSSI is embedded in the social world; (2) NSSI is symbolic and communicative; and (3) NSSI represents taking back agency. This synthesis, comprised of both reported data and the themes identified by the researchers in the papers, highlighted that NSSI is a diverse behaviour that is inextricably linked with sociocultural context and that, paradoxically, it can be simultaneously communicative and private. This research urges an introspective examination of how clinicians and researchers in the field conceptualise NSSI and how this juxtaposes with how individuals who engage in the behaviour conceptualise it.