A Thematic Analysis Psychosocial and Cultural Determinants of Intentional Indirect Self-Harm Among Adolescents: A Qualitative Approach

Abstract

Intentional Indirect Self-Harm (IISH) is an emerging but under-researched concern in adolescent mental health, particularly in South Asian contexts like Pakistan. Unlike direct self-injury, IISH involves covert, harmful behaviors such as substance abuse, disordered eating, and emotional withdrawal.1 This qualitative study investigates the Psychosocial and cultural factors contributing to IISH among 20 adolescents (ages 12–18) from Islamabad and Rawalpindi, using an ethnographic approach. Thematic analysis of semi-structured interviews revealed key psychological themes: stress, depression, anxiety, anger, and emotional instability, rooted in family pressure, academic burden, and cultural constraints. Findings highlight how adolescents internalize distress and engage in self-harming behaviors as maladaptive coping strategies, often unrecognized by themselves or others. The study emphasizes the need for culturally sensitive mental health interventions, early screening, and school-based support systems. It contributes to the literature by contextualizing IISH within Pakistani socio-cultural norms, offering insights for educators, clinicians, and policymakers aiming to address adolescent psychological well-being.