Critically Exploring Self-Harm Through Lived Experience Perspectives: A Survivor-Controlled Integrative Review...

In psychiatric knowledge, self-harm is commonly understood as an individual, self-destructive behaviour arising from emotional dysregulation where sociocultural context is referred to briefly but typically overlooked. Conversely, many with lived experience (LE) highlight relational and systemic trauma, abuse and violence as inseparable from self-harm. This survivor-controlled integrative review was led by a LE researcher and employed participatory methodology with people with LE to explore self-harm. Our research question was 'How is self-harm conceptualised?'.

Evidence was identified from a systematic search of MEDLINE, EMBASE, PsycINFO, CINAHL and Global Health. Eligible studies must have explored self-harm subjectivity, used qualitative methodology and PPI. PPI was assessed based on NIHR 'Levels of Involvement'. 36 articles were appraised using CASP, GRIPP-2 and an adapted Equity, Diversity and Inclusion framework. Reflexive thematic analysis within social constructionism and a survivor approach were employed.

Findings were organised into two themes. Theme 1: What is self-harm? describes how researchers variably constructed self-harm across the included studies. Theme 2: The web of self-harm explores its 'trajectory', exploring how social experiences and circumstances work to induce chaotic embodied sensations, leading to self-harm as an emotional practice to negotiate with oneself and one's experiences. As an embodied practice, self-harm reflects the liminality between the personal/social and speaks to what it means to exist in social life.

This review explores how self-harm can be constructed as an embodied practice mediated by social circumstances, highlighting how psy-knowledge overlooks social life. In identifying this, we highlight how common clinical responses that individualise and pathologise LE are rationalised. Through PPI and survivor methods, this work offers significant methodological contribution, demonstrating how LE inclusion supported critical, interdisciplinary understanding, enhancing knowledge to reconnect people to their experiences.

This was a survivor-controlled research project. The lead author, CdCL, is a LE researcher, and general nurse, who centralises experiences of complex trauma, mental distress and self-harm in their work. AS is also a survivor researcher with extensive experience in trauma-informed approaches. UF is a LE researcher with significant expertise in eating distress and qualitative methods. CdCL collaborated with a PPI advisory board throughout the research project to ensure greater inclusivity and transferability to others with LE. PPI peers SB, GJ and EM, are co-authors to this work, and supported the refinement of research objectives, interpretation, naming and development of themes and edited the manuscript.