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Motives for self-harm: views of nurses in a secure unit


  • P.T. Sandy RMN, BSc (Hons), PGDipED, PGCertED, MSc, PhD

    Senior Lecturer, Corresponding author
    • Health Studies, University of South Africa, Pretoria, South Africa
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  • Funding: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
  • Conflict of interest: No conflict of interest has been declared by the authors.

Correspondence address: Dr Peter Thomas Sandy, Health Studies, University of South Africa, 6-184 Theo van Wijk, Muckleneuk Ridge, Pretoria 0003, South Africa; Tel: +27(12)429-8224; +27(17)202-715; Fax: +27(12)429 3361; E-mail:



Self-harm is a widespread behaviour among people with mental health problems. Although guidance on how to manage self-harm is offered, it is still a behaviour that is misunderstood by many nurses. Such misunderstanding is generally attributed to the perceived motives for self-harm and lack of specialized education to manage the behaviour. As a consequence, the care provided is usually inadequate and inappropriate. Yet, research concerning nurses' reasons of users' self-harming behaviours is limited.


This paper reports on a study that explores nurses' explanations of the motives for self-harm in a secure adolescent unit in England.


The study utilized a phenomenological methodology with semi-structured individual interviews (n = 25). The data were analysed thematically using interpretative phenomenological analysis.


The findings indicate that the behaviour of self-harm has multiple motives. Examples of these include affect regulation, coping with distress, averting death, regaining control and attention seeking.


Self-harm is a complex behaviour commonly experienced in secure environments. Nurses assume that users who self-harm are motivated by a desire to seek attention and manipulate others. Users may find these beliefs humiliating. Such feelings may increase users' risks for further self-harm. Most adolescents who self-harm experience unbearable emotions because of their past sexual abusive encounters. They self-harm to regulate these emotions. These affect regulatory functions may act as reinforcers of self-harming behaviours.


Improved understanding of self-harm and its motives may result in improved nurse–user relationships and thus safer and more effective care provision.