Psychological processes and abilities for ceasing sex as self-injury – a qualitative study

Abstract

Abstract Background The term sex as self-injury (SASI) refers to sexual behaviors that are used as a means of self-injury, with motives such as emotional regulation comparable to other self-injurious behaviors, including burning or cutting the skin. The aim of this study was to explore which psychological processes and abilities made it possible to cease SASI, in order to contribute to the knowledge that underpins psychological interventions and treatments. Method The study was based on an open-ended questionnaire published on the websites of Swedish NGOs offering help and support to women and youths. In total 196 individuals with experience of SASI were included in the study. The age of the participants was 15–64 years (mean age 27.9 years), and most of the participants were women. Thematic analysis with an inductive approach was used for the study, but with prerequisites that drew on cognitive behavioral therapy treatment and functional analysis. Results Five abilities were seen as important for cessation of SASI; 1) Revised core beliefs about the self which were achieved through new experiences or cognitive restructuring. 2) Evolved emotional competence achieved through understanding or acceptance of emotions or new coping skills. 3) Increased relational competence via new relationship experiences or new communication skills. 4) Acquired meta-perspective through insight and knowledge of SASI. 5) Strengthened psychological empowerment through new relationship to the body and sexuality, transfer of responsibility or norm-critical perspective. Conclusions Based on the results regarding psychological processes, acquired abilities and alternative behaviors, proposals for therapeutic interventions that may activate these processes were discussed.