Aggression and anxiety in the development of destructive drives to self-harm

High rates of self-harm and its prevalence amongst adolescents are an on-going cause for concern. Where many studies were found to link self-harm with suicide, the participants in this study enable self-harm to be viewed in isolation of suicide. Self-harm is commonly associated with trauma or as a consequence of adverse childhood experiences (ACEs) whereas this study explores both the impact of psychical trauma outside of ACEs and trauma from sexual abuse. This study adapted Braun and Clarke’s (2006) method of Thematic Analysis for analysis of case-study data. A psychoanalytical, object-relations perspective investigated self-harm as a phenomenon occurring in three adolescents who had previously undergone Child and Adolescent Psychotherapy treatment in an outpatient Child and Adolescent Mental Health Service. The study addressed the lack of research on self-harm being comorbid with other mental health conditions, specifically exploring connections of self-harm with OCD, Tics, anxiety and depression. Aggression was found to be a driver of self-harm and associated with the mental health conditions of the participants. As a result of one participant belonging to an ethnic minority community, the issues relating to culture and cultural conflicts contributing to self-harm came into focus. The study supports the concepts of trauma from abuse as relevant to self-harm in acts of cutting, burning and overdosing. However, the study found that early experiences of object loss in the absence of overt neglect or abuse can have a traumatic effect on the psyche as psychical trauma. The study finds psychical trauma leads to enactments of aggression in the form of self-harm.