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Recovery

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From List-Serve to Leaders

Treatment and recovery for self-injury can mean different things to different people. In recent years, there has been a greater focus both academically and clinically on the lived experience of self-injury. Part of this focus has drawn attention to the varied conceptualisations of recovery.

Clinical conceptualisations

According to the proposed diagnostic criteria for non-suicidal self-injury disorder (NSSI-D), an individual may be considered "recovered" after self-injury has been ceased for 12 months. As identified by Lewis and Hasking (2020), this may be unrealistic and does not reflect individuals' lived experience of recovery. 

Lived experience conceptualisations

Not surprisingly, individuals' conceptualisations of NSSI recovery are vast and varied. 

Theoretical conceptualisations

Recent developments in the research field have led to new theoretical conceptualisations of NSSI recovery, including that proposed by Lewis and Hasking (2021). In their framework, Lewis and Hasking capture the following in their person-centred model of self-injury recovery: 

  • Emphasis realistic expectations

    • ​Recovery is non-linear and "relapses" are common

    • Viewing recovery in absolute terms may be unrealistic and unhelpful

  • Normalise thoughts and urges

    • Continued thoughts about self-injury and urges to self-injure are common​

    • These thoughts and urges may persist indefinitely

  • Foster self-efficacy

    • Recognition of times when urges have been overcome can strengthen self-efficacy to resist NSSI in the future​

  • Identify strengths

    • Identifying and leveraging strengths can foster self-efficacy and support other coping strategies​

  • Find alternatives

    • Finding strategies as effective as NSSI takes time and involves trial and error​

    • There is no one-size-fits all, and alternative strategies that work for one individual may not work for another

  • Address underlying adversities

    • There are many possible difficulties and adversities underlying self-injury; these need to be addressed to support NSSI recovery​

  • Address and accept scarring

    • While not relevant to all individuals, scarring can be a significant concern ​

    • Scarring may contribute to ongoing psychological distress/urges, but can also represent strength and resilience

    • For individuals with scars, accepting scarring may be particularly important in their recovery

  • Prepare for navigating disclosures

    • Disclosure may be voluntary, unwanted, or unintentional​

    • Disclosure may be necessary to recovery (accessing support)

    • Considering how to navigate these disclosures may be useful for recovery

  • Foster self-acceptance

    • Through the above, self-acceptance can be fostered​

 

References

 

Lewis, L. P., & Hasking, P. A. (2020). Rethinking self-injury recovery: A comentary and conceptual reframing, BJ Psych Bulletin44, 44-46. https://doi.org/10.1192/bjb.2019.51

Lewis, S. P., & Hasking, P. A. (2021). Self-injury recovery: A person-centred framework. Journal of Clinical Psychology77, 884-895. https://doi.org/10.1002/jclp.23094