A Narrative Synthesis of Qualitative Studies on Self-harming Behavior in the Correctional Setting

• DOI: http://doi.org/10.1177/00328855221136199
• Published date: 01 December 2022
• Date: 01 December 2022
• Subject Matter: Articles

A Narrative Synthesis of

Qualitative Studies on

Self-harming Behavior in

the Correctional Setting

Julie Ann R. Clemente-Faustino

1

and Allan B. de Guzman

1

Abstract

Non-suicidal self-injurious or deliberate self-harming behavior is a signif‌icant

mental health issue, particularly among vulnerable incarcerated people expe-

riencing the psychological stresses of imprisonment. Drawing on a database

search strategy focused on 15 years of qualitative research on self harming in

the forensic setting, this narrative synthesis study integrates the f‌indings of

views on self harming by inmates and prison management staff and develops

the Yin-Yang of Self-Harming Behavior in Prison model to illustrate the duality.

The f‌indings support the need for intensive prison staff training in the man-

agement of self-harmers and the development of inmate programs geared

towards awareness and promotion of mental health.

Keywords

incarceration, non-suicidal self-injurious behavior, self-harming behavior,

narrative synthesis, qualitative studies

1

University of San Tomas, Espana, Manilla, Phillippines

Corresponding Author:

Allan B. de Guzman, The Graduate School Research Center for Social Sciences & Education,

Room 211, Thomas Aquinas Research Complex, España, Manila 1015, Philippines.

Email: abdeguzman@ust.edu.ph

Article

The Prison Journal

2022, Vol. 102(6) 718–744

© 2022 SAGE Publications

Article reuse guidelines:

sagepub.com/journals-permissions

DOI: 10.1177/00328855221136199

journals.sagepub.com/home/tpj

Introduction

Non-suicidal self-injury (NSSI), also known as deliberate self-harm, has

become an emergent clinical and public health concern (Cipriano et al.,

2017). It is a behavior that refers to the intentional self-inf‌licted destruction

of body tissue without suicidal intent (Hooley & Franklin, 2018; Masana

et al., 2020) as in the incidence of self-cutting and self-burning (Green

et al., 2018). Addressing the issue in 2018, the International Society for the

Study of Self-injury excludes socially accepted behaviors such as body pierc-

ing, tattooing, and cultural or religious rituals; risky behaviors that may result

to injury such as engagement in extreme sports; behaviors that do not directly

cause harm like food restriction, as the detrimental effects appear after quite

some time; and suicidal thoughts and behaviors, in which the persons pur-

posely aim to end their lives. Moreover, the Diagnostic and Statistical

Manual of Mental Disorder, 5

th

Edition (DSM-5) has categorized this behav-

ior under a new diagnostic entity in Section 3 as “condition for further study“

(Hooley & Franklin, 2018), making it a distinct entity from Borderline

Personality Disorder and Suicidality (Liljedahl & Westling, 2014). Clinical

studies, however, suggested that self-harming behavior is comorbid with

some mental disorders. Some of these include bipolar disorder (Andover

et al., 2017), major depression and psychotic illness (Fazel et al., 2016),

and post-traumatic stress disorder (Arthurs & Tan, 2017). Additionally, pre-

vious studies have indicated that these deviant behaviors are caused by feel-

ings of frustration, guilt, rage, abandonment, emptiness, loneliness, low

self-worth, and self-blame (Chen & Chun, 2019); negative affect, negative

emotionality, def‌icits in emotional skills and self-derogation (Green et al.,

2018), trauma, stress, familial or interpersonal strife (Mann et al., 2019),

and maladaptive coping mechanisms (Oxley et al., 2017).

Persons deprived of liberty display higher rates of self-harming behavior

(Winicov, 2019). Chammah and Meagher (2015) found that upon initial

detention, jail inmates usually experience heightened distress. The experience

in jail is found to be traumatic to inmates (Winicov, 2019). This contributes to

self-injurious behavior being the most persistent problem (Wakai et al., 2014)

and most common reason for mental health treatment within correctional set-

tings (Dixon-Gordon et al., 2012). NSSI is a complex act that calls for action

(Smith et al., 2019) as it poses a serious threat to the safety and well-being of

detained offenders (Power et al., 2016). Research literature, specif‌ically in the

United Kingdom and United States of America, has explored much on these

behaviors in the correctional setting (e.g., Kaba et al., 2014; Reid & Listwan,

2018; Winicov, 2019). Undoubtedly, an integration of the similarities and dif-

ferences among the f‌indings of these studies is both relevant and timely, as

Clemente-Faustino and de Guzman 719