Uncovering key patterns in self-harm in adolescents: sequence analysis using the card sort task for self-harm (CaTS)

Townsend, Ellen and Wadman, Ruth and Sayal, Kapil and Armstrong, M. and Harroe, C. and Majumder, P. and Vostanis, P. and Clarke, David (2016) Uncovering key patterns in self-harm in adolescents: sequence analysis using the card sort task for self-harm (CaTS). Journal of Affective Disorders, 206 . pp. 161-168. ISSN 1573-2517

PDF - Requires a PDF viewer such as GSview, Xpdf or Adobe Acrobat Reader
Available under Licence Creative Commons Attribution Non-commercial No Derivatives.
Download (749kB) | Preview



Self-harm is a significant clinical issue in adolescence. There is little research on the interplay of key factors in the months, weeks, days and hours leading to self-harm. We developed the Card Sort Task for Self-Harm (CaTS) to investigate the pattern of thoughts, feelings, events and behaviours leading to self-harm.


Forty-five young people (aged 13-21 years) with recent repeated self-harm completed the CaTS to describe their first ever/most recent self-harm episode. Lag sequential analysis determined significant transitions in factors leading to self-harm (presented in state transition diagrams).


A significant sequential structure to the card sequences produced was observed demonstrating similarities and important differences in antecedents to first and most recent self-harm. Life-events were distal in the self-harm pathway and more heterogeneous. Of significant clinical concern was that the wish to die and hopelessness emerged as important antecedents in the most recent episode. First ever self-harm was associated with feeling better afterward, but this disappeared for the most recent episode.


Larger sample sizes are necessary to examine longer chains of sequences and differences in genders, age and type of self-harm. The sample was self-selected with 53% having experience of living in care.


The CaTs offers a systematic approach to understanding the dynamic interplay of factors that lead to self-harm in young people. It offers a method to target key points for intervention in the self-harm pathway. Crucially the factors most proximal to self-harm (negative emotions, impulsivity and access to means) are modifiable with existing clinical interventions.

Item Type: Article
Keywords: self-harm; adolescence; sequence analysis; card sort; negative emotions; impulsivity
Schools/Departments: University of Nottingham UK Campus > Faculty of Science > School of Psychology
Identification Number: https://doi.org/10.1016/j.jad.2016.07.004
Depositing User: Eprints, Support
Date Deposited: 26 Jul 2016 13:51
Last Modified: 16 Sep 2016 18:14
URI: http://eprints.nottingham.ac.uk/id/eprint/35043

Actions (Archive Staff Only)

Edit View Edit View