| Abstract | Objective
This thesis addresses the question of why people who self-harm score more highly on alexithymia, a trait characterised by difficulties identifying and describing feelings and an externally-orientated thinking style. With rates of self-harm increasing, understanding this complex phenomenon remains a research priority.
Method
A mixed-methods, convergent design was used. Following a systematic literature review and meta-analysis (Study 1), two separate online surveys of adults investigated the mediating role of, first, dispositional mindfulness (Study 2), and, second, emotion dysregulation (Study 3). An exploratory study investigated the functions of self-harm in the context of alexithymia (Study 4). Finally, eight interviews, exploring the experience of self-harm among young adults who reported difficulties identifying and describing feelings, were analysed using Interpretative Phenomenological Analysis (Study 5). The results of the individual studies were integrated using a joint display and an analysis of convergent and divergent findings.
Results
The meta-analysis confirmed a significant, positive relationship between self-harm and alexithymia, with a medium effect size (g = 0.57, 95% CI 0.45 to 0.71). The mediation studies found evidence to support a model in which heighted perception of physical sensation contributes to a lack of emotional clarity, leading to facets of emotional dysregulation and engagement in self-harm. Analysis of the functions of self-harm revealed that, although affect regulation was the most commonly endorsed function across all participants, the use of self-harm to generate feeling was significantly associated with alexithymia. The qualitative study found that difficulty understanding the self and describing feelings prevented participants from conveying their subjective experience to others, increasing their isolation.
Conclusions
The results support a model in which self-harm is used by people with high alexithymia to regulate an emotional experience that is poorly understood and therefore difficult to accept without judgment. That experience is exacerbated by the difficulties in communicating to other people. The thesis concludes with a discussion of the implications for clinical practice and future research. |
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