Repeated self-wounding: women's recollection of pathways to cutting and of the value of different interventions.

BACKGROUND: More information is needed on the processes that result in self-wounding and how these are modulated by the selection and delivery of interventions available to those working in non-specialist settings.
METHODS: Ten women participated in a semi-structured interview where they recalled their experiences of cutting and the helpfulness of specific interventions. Transcripts of these self-reports were analysed using grounded theory methods.
RESULTS: Having a long-term relationship with a key worker and being encouraged to express feelings were viewed as the most helpful strategies, whereas relaxation was often reported as making self-injury worse. The helpfulness of a given intervention was reduced when delivered by someone perceived as underconcerned, overprotective or incompetent. Two pathways to self-wounding were identified: cutting may result when there is a steady increase of tension until a threshold is reached (the 'spring' path), or as a result of the 'switching on' of the impulse (the 'switch' path). Dissociation during cutting and a craving for cutting were more often associated with switching to the impulse. Different management strategies are called for when the switch path has developed, which appears particularly the case for individuals who have been repeatedly self-wounding over a substantial period of time.