Locating Meaning: Health Professionals’ Views on the Psychological and Clinical Significance of Self-Injury Sites

Abstract

Background: This study explored how health professionals construct clinical and psychological meaning based on the location of self-injury on the body, particularly in relation to concealed or visible injuries and how they might inform attributions about risk, self-injury functions, and distress. Methods: This study used qualitative thematic analysis of semi-structured interviews with 19 health professionals with experience working with self-injury, exploring perceptions and attributions about self-injury in different body locations. Results: Seven themes emerged. In some cases, staff’s attributions aligned with the findings from studies of those who self-injure, such as injuries to areas such as the neck are higher risk. Location was one factor among others, such as injury severity, that staff considered when assessing the risk of infection or suicide. Staff often viewed visible injuries as less risky and attributed them to interpersonal communicative functions, and concealed injuries to intrapersonal factors, though not all staff shared these perspectives. Some staff considered other potential drivers of injury location, including past experiences such as trauma, demographic factors, mental health diagnoses, and exposure to social influences. Some staff described the practical determinants of injury location, such as ease of access, and considered the impact of self-injury location on themselves and their colleagues. Conclusions: Injury location can influence staff perceptions of risk, self-injury functions and distress, underscoring the need for individualized assessment and formulation of each self-injury episode to ensure appropriate risk management. Staff training should be adapted to address injury location to improve understanding, raise awareness of related attributions, and enhance the development of clinical skills. Organizations should support staff in their role due to the potential emotional impact of working with individuals who self-injure and are at risk of suicide. Future research should investigate whether location-based attributions are associated with unintended clinical consequences, such as inaccuracies in risk assessment and formulation.