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The purpose of this paper is to examine the current state of the literature on the variables associated with self-harm and aggression in women who committed a criminal offence.

Studies were identified through online databases, namely, PsycINFO, PubMed, ERIC and EBSCOhost, as well as manual searches of reference lists of the selected studies. The target population included women who committed a criminal offence and have engaged in self-harm and aggressive behaviors during their incarceration, either in correctional institutions or in forensic psychiatric settings.

Of the 1,178 studies identified, nine met inclusion criteria. The studies were conducted in six different countries and included data from 6360 female participants. Few studies examine self-harm and aggression in women who committed a criminal offence which speaks to the still sparse literature on this topic. This review of the association between self-harm and aggression in women offenders highlights the finding that a small group of women is often involved in both self-harm and aggression. The authors have identified possible psychological factors associated with women engaging in both self-harm and aggression. The findings also reveal a possible connection between types of aggressive behaviors and specific time periods during sentences or stays in forensic psychiatry.

The findings of this scoping review have clinical implications which may be considered by both researchers and the case management teams of women involved in both self-harm and aggression.

Despite the limited number of studies examining self-harm and aggression in women, this scoping review highlights gaps in the literature as well as notable psychological correlates of women who engage in self-harm and aggression.

Previous research into health care professionals' perceptions of self‐harm has found that, although complex, in some cases their perceptions can be somewhat negative and unsympathetic towards individuals who harm themselves. However, it is presently unclear whether these perceptions reflect more general attitudes to self‐harm in broader social groups. The present study aims to represent a preliminary investigation into perceptions of self‐harm in the general public. First, since there is no universal agreement on which behaviours constitute self‐harm, this study aims to investigate public perceptions of this, including whether participants identified more controversial behaviours such as eating disorders and body modification as methods of self‐harm in addition to the more commonly identified behaviours such as cutting and burning. Secondly, it aims to identify whether attitudes towards individuals who self‐harm in a small sample of the general public were similar to the sometimes negative and unsympathetic perceptions of health care professionals demonstrated in some previous studies.

Semi‐structured interviews were conducted with seven participants, none of whom had any professional or academic experience or knowledge of self‐harm, who were recruited via second acquaintances of the first author. A matrix‐based thematic analysis method was used to analyse the data collected.

The main findings of this study were that eating disorders were generally perceived as forms of self‐harm while body modification was not, and that participants generally showed sympathy towards individuals who self‐harm, especially when they perceived the behaviour to be associated with mental illness.

Although, given the small size of the sample, this should be considered a preliminary study, the findings suggest that developing a greater understanding of public perceptions of self‐harm could have important implications for understanding mental health professionals' perceptions of the phenomenon. The authors suggest that stigma and negative perceptions of people who self‐harm may not be inevitable and that further research in this area could be of value in informing public and professional education campaigns in this area.

Prison institutional conditions affect risk for self-harm among detainees. In particular, prison overcrowding may increase the likelihood of self-harm by creating competition for resources, space, and enhancing a “deprivation state.” The purpose of this paper is to examine the association between overcrowding and prisoner acts of self-harm.

This cross-sectional study took place at Geneva’s pre-trial prison (capacity:376) between 2006 and 2014. Outcomes were acts of self-harm that required medical attention, and self-strangulation/hanging events (combined into one group, as these are difficult to differentiate). Dichotomous predictors were overcrowding index- annual mean daily population divided by capacity ( > 200 percent vs < 200 percent), and year group (2006-2009 vs 2011-2014).

Self-harm and self-strangulations/hangings increased in 2011-2014 compared to 2006-2010 (p < 0.001). Overcrowding in excess of 200 percent was associated with self-strangulation/hangings (p < 0.001) but not with all self-harm events. In terms of pertinent demographics that would affect self-harm, there was no prison change in gender, area of origin, foreign residency, religion, or psychiatric treatment.

The present study is limited by the definition and identification of self-harm. The distinction between self-strangulation and self-hanging, and the precise classification of an intent to die is difficult to make in practice, especially with limited prison data records available. The relevant literature addresses the complexity of the association between non-suicidal and suicidal behavior. Despite this, the combined category self-strangulations/hangings gives some indication of severe self-harm events, especially since the methodology of categorization employed was consistent throughout the entire period of the study. Other limitations include the small sample size and the lack of individual patient data and prison data to help control for confounding factors. Despite these drawbacks, pertinent data (socio-demographics and number of prisoners treated for mental health and drug abuse) remained stable over the years. Thus, there are no apparent changes in the inmate population that could be linked to an increase in self-harm. High-security placements and mean prisoner stay have increased over time, with a decrease in staff to prisoner ratio – and these must be looked into further as contributors. Additionally, qualitative methods such as semi-structured interviews and focus groups could delineate the impact of overcrowding on prisoner well-being and self-harm potential.

The authors observed a significant increase in self-harm and self-strangulation/hangings over time, and overcrowding was significantly associated with self-strangulation/hangings (but not with all self-harm events). Overcrowding can impose destructive effects on the psychological and behavioral well being of inmates in prison, influencing a myriad of emotional and livelihood factors that predispose to harmful behavior.

This report should alert public health and prison authorities to this issue, and garner resources to address such an alarming rise. The findings from this short report demonstrate the need for a further examination of the mechanisms affecting self-harm among prisoners in this population, particularly the relationship between self-strangulations/hangings and overcrowding.

This article reviews the international literature of the last two decades on self‐injurious behaviour in prisons and jails and introduces the risk factors associated with this behaviour. Studies from a variety of countries investigated different samples (e.g. in jails or prisons; female or male inmates). We only chose those studies using a control group of inmates without self‐injurious behaviour. The findings on potential risk factors for self‐injurious behaviour are largely contradictory because of the differences in sample selection and dependent variables (deliberate self‐harm without suicidal intent vs. suicide attempts). We also discuss some methodological problems in predicting self‐injurious behaviour.

Rates of self-harm are elevated in prison, and there is limited evidence to support the efficacy of brief risk screening at reception to predict and prevent self-harm. This study aims to examine the predictive validity of the self-harm/suicide screening items embedded in a prison mental health screening tool from two key domains strongly associated with risk: previous suicidal/self-harm behaviour, and recent ideation.

A sample of men and women were screened on entry to prison, with eight screening items covering the two key domains of risk. Follow-up data on self-harm incidents were collected for 12 months post-screening. The predictive validity of individual screening items, item combinations and cumulative screening score was examined for the overall sample and for men and women separately.

Individual screening items across the two domains were all strongly associated with self-harm in the follow-up period, with odds ratios varying from 2.34 to 9.24. The predictive validity of both individual items, item scores and item combinations demonstrated high specificity but low to moderate sensitivity, and modest area under the curves (AUCs). Predictive validity was generally better for men than women; however, differences were not statistically significant.

Identifying those at risk of self-harm in prisons remains challenging and brief universal screening at prison entry should be only one component of a broader prison risk assessment and management strategy.

To the best of the authors’ knowledge, this study is one of very few to prospectively examine self-harm behaviour following risk screening. Predictive validity was examined in a representative sample of individuals in custody, and for men and women separately.

The purpose of this paper is to understand the needs and motivations of incarcerated men who self-harm with no apparent suicidal intent. These have received little attention in research and policy, despite men accounting for a high and increasing proportion of self-harm in prisons.

Semi-structured interviews were conducted with 20 adult male prisoners with a recent history or thoughts of non-suicidal self-harm. The interviews were analysed drawing on principles of thematic analysis and discourse analysis.

Against a backdrop of early traumatic experiences and more recent adverse events (including prison-related ones), self-harm was described by many as a desperate – but meaningful – coping strategy; both a means of releasing tension, sadness and frustration, and of being heard in an unresponsive system.

These findings echo those of research conducted with women (including women prisoners) who self-harm, but challenge some of the more negative ways in which non-suicidal male prisoner self-harm has been portrayed in the (scant) previous literature. As well as pointing to the need for greater awareness of the complex needs of men in prisons, they underscore the importance of (also) exploring – and perhaps addressing – the issue of self-harm separately from suicide, and of striving to make prisons, as well as prisoners, “healthier” and better able to cope with pressure.

Without exception, research on the contribution of the Prison Listener Scheme as a form of peer support for those who self-harm in custody has focussed on men in prison. Women’s experience of custody is shaped by their experiences of hegemonic masculinity that also mediate through women’s roles as mothers and caregivers. Women’s self-harm is similarly influenced by these gendered experiences. The purpose of this paper is to explore how the Listener Scheme as a form of peer-to-peer support for women contributes to women managing their self-harm in a female prison.

The paper used a case study design with a mixed-methods approach using a quantitative questionnaire with prison staff (n = 65) and women in custody who had self-harmed (n = 30). Qualitative methods included a focus group with Prison Listeners (n10) and semi-structured interviews with women who self-harm (n10) and prison staff (n10). Four days were also spent observing the prison environment.

Findings suggest that women seek support from other women as peer Listeners for three main reasons; their previous difficult experiences with men, a displacement of the mother role and their attachment needs in custody. Research suggests that women often have significant addictions and mental health concerns and are more likely than their male counterparts to engage in self-harm (Prison Reform Trust, 2017). In addition, women’s self-harm acts as a coping method for “intrapersonal issues” which documents self-harm as a result of frustration and lack of control in custody as opposed to “interpersonal issues” which documents self-harm as a result of relationship difficulties with partners (Walker et al., 2017). This paper suggests that peer support schemes internationally should be tailored to providing support for these types of gendered experience to support women who self-harm in custody. This has implications for the training and support of Listeners in women’s prisons.

This exploratory research was conducted in one female prison and while can be considered to test proof of concept is limited in its generalisability.

This paper suggests that Listeners providing peer-to-peer support for women in custody who self-harm may encounter triggers for this behaviour based on women’s experiences including; how women relate to men; women’s experience of the way custody displaces their role as mothers and women’s need for safe attachments in custody. These gendered experiences have implications for the training and development of peer support schemes in women’s prisons, such as the Listener scheme. Further research is needed to compare the gendered types of support Prison Listeners provide depending on whether they are in male or female prisons.

Non-suicidal self-injury (NSSI) is reasonably common, particularly among young people with prevalence rates of up to 25 per cent reported. Many factors contribute towards NSSI, including depression, anxiety and history of abuse and NSSI is a risk factor for suicide. Many people who engage in NSSI do not seek help, potentially due to concern about sigmatising attitudes. The purpose of this paper is to investigate the impact of gender and disclosure on stigmatising attitudes towards individuals who engage in NSSI.

Participants were 384 first-year university students (77.4 per cent female; mean age 19.50 years (SD=3.53)) who completed measures of stigmatising attitudes in response to vignettes featuring individuals who engaged in self-harming behaviour. Vignettes varied in the gender of the individual as well as whether the NSSI was disclosed or not.

The results support the attribution model of public discrimination in relation to NSSI stigma. Perceptions of higher personal responsibility for NSSI behaviour and higher levels of danger and manipulation were positively associated with stigmatizing attitudes and behaviours. Male research participants reported significantly higher levels of stigmatizing attitudes and behaviours than females.

The level of stigmatising attitudes towards individuals who engage in NSSI is significant and may impact on help-seeking behaviour.

Between 10 and 25 per cent of adolescents engage in some form of NSSI, but only a minority seek help to address this behaviour. This study suggests that attitudes by peers may influence help-seeking. Further research is required outside of tertiary education settings.

The internet plays an important role in the lives of self-harming and suicidal young people yet little is known about how internet use influences this behaviour. The purpose of this paper is to examine the evidence base with a view to determining directions for future research and practice.

Literature relating to self-harming and suicidal behaviour, young people, and the internet is reviewed with a focus on content and methodology.

The internet provides access to: “how-to” descriptions of suicide; unregulated/illegal online pharmacies; forums to spread this information; access to others seeking to end their own lives. Such sites are believed to elevate risk amongst vulnerable individuals. Conversely, the internet provides access to intervention and prevention activity, online support groups, advice, and personal chat. These can be a key resource in helping young people. There is a lack of consensus on what constitutes harmful and helpful online exchange, often evidenced in disparity between the perceptions of professionals and users.

Research is needed to map out a more accurate picture of suicide and self-harm resources on the internet and to establish a consensus about what constitutes harmful and helpful exchange. This needs to be based on: a comprehensive and informed range of search terms; a clear distinction between types of resource; a clear and consistent rationale for distinguishing and categorizing sites; a systematic replicable methodology for plotting the scope, content, accessibility, and popularity of web resources at a given point in time; the views of young people who use these sites, as well as practitioners and professionals.

Practitioners need to: regularly assess the quantity, quality, and nature of self-harm/suicide focused internet use amongst service users; be aware of which sites are most appropriate for particular individuals; promote sites directed at young people that enhance effective coping. Professional mental health organizations need to find ways of ensuring that: they are consistently well represented amongst search results online; sites are readily accessible; more practitioners are trained in text-based communications.

This paper offers a framework and rationale for future research and for those involved in service provision, policy, and practice.

Autism spectrum conditions (ASC) and borderline personality disorder (BPD) have overlapping symptom profiles. Dialectical behaviour therapy (DBT) is an established treatment for self-harm and BPD, but little research has investigated the outcomes of DBT for ASC populations. This exploratory service evaluation aims to investigate the outcomes of a comprehensive DBT programme for adolescents with a diagnosis of emerging BPD and a co-occurring ASC diagnosis as compared to those without an ASC diagnosis.

Differences from the start to end of treatment in the frequency of self-harming behaviours, BPD symptoms, emotion dysregulation, depression, anxiety, the number of A&E attendances and inpatient bed days, education and work status, and treatment non-completion rates were analysed for those with an ASC diagnosis, and compared between those with an ASC diagnosis and those without.

Significant medium to large reductions in self-harming behaviours, BPD symptoms, emotion dysregulation and inpatient bed days were found for those with an ASC diagnosis by the end of treatment. There were no significant differences between those with an ASC and those without in any outcome or in non-completion rates. These findings indicate that DBT may be a useful treatment model for those with an ASC diagnosis, though all results are preliminary and require replication.

To the best of the authors’ knowledge, this is the first study to report the outcomes of a comprehensive DBT programme for adolescents with an ASC diagnosis, and to compare the changes in outcomes between those with a diagnosis and those without.