This article describes qualitative research with women survivors of potentially lethal self-harm in prison. In-depth interviews were carried out during 2002/03 with 15 women, (adults and young offenders), from six establishments. The interviews focused on the women's own accounts of the 'near miss' incident, including intentions and motivations, factors leading up to the incident, experiences of care and support, current self-harm and suicidality, and suggestions for prevention. Recommendations include: improvements to the general prison regime; training and support for staff; specialist help for women with histories of abuse, mental illness, or borderline personality disorder; improved support following stressful life events.Most prisoners who kill themselves in custody are male, reflecting the larger male prison population. However, the last decade has seen a disproportionate rise in the number of female self-inflicted deaths (SIDs) in prison, from one death in 93/94 to ten in 2003/04, with 13 in 2002/03. The average female prison population increased by approximately 165% between 1993 and 2003, while the rate of female SIDs (per 100,000 of the average daily population, ADP) increased by almost 500% during that period. Calculating rates by ADP underestimates the number of women actually passing through the prison system, many of whom are on remand or serving short sentences, and thus inflates the 'true' rate. Nevertheless, the increase in numbers is a matter of considerable concern.Women in prison also have disproportionately high rates of self-harm. For example, in 2003, women constituted 6% of the prison population but were responsible for 46% of recorded self-harm incidents. Previous research has attempted to distinguish between prisoners who attempt suicide and those who harm themselves for other reasons. Coid et al. (1992) used cluster analysis of interviews to identify two groups of women who harmed themselves while on remand. The first and larger group selfharmed to relieve symptoms of anger, depression, and anxiety, linked to histories of childhood deprivation, abuse, and impulse disorders. They were frequently diagnosed with borderline personality disorder. The second group tended to self-harm in reaction to life-events or psychotic experiences and were more likely to engage in serious, potentially lethal, self-harm. Snow (2002) focused explicitly on prisoners' motives for selfharming behaviour, identifying gender and age differences. Participants who injured themselves without suicidal intent described precipitating factors related to negative emotions and the need to relieve anger and frustration, whereas those who had attempted suicide were more likely to report specific events or experiences which had acted as triggers.A small study analysing investigation reports in the self-inflicted deaths of 13 women in prison identified both individual 'vulnerability' factors known to increase suicide risk and the occurrence of specific precipitating events (Mackenzie, Oram and Borrill 2003). Vulnerability fac...

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This paper presents a systematic review of the literature concerning the relationship between alexithymia and self-harm. Fifteen studies were selected following a systematic search of relevant databases. Results indicate significantly higher levels of alexithymia in women who self-harm compared with women who do not self-harm. Studies of men were less conclusive and require further investigation. A subsample of the studies found that childhood abuse and bullying were more likely to be associated with self-harm if alexithymia was present as a mediator. Other studies found that depression mediated between alexithymia and self-harm. The results indicate that the poor emotional cognition and expression associated with alexithymia may increase vulnerability to self-harm, particularly in women.

Half of the women in the sample reported at least one act of self-harm in their life and 46% reported making a suicide attempt at some time. Lifetime self-harm was associated with a history of harmful drinking and with being a victim of violence, including physical assault, sexual assault and violence from family and friends. Lifetime suicide attempts were associated with reported violence from family or friends. Current high suicide risk was most common among women on remand. Drug dependence and reported violence from family or friends were both more common amongst white women than black/mixed race women. Self-harm and attempted suicide were generally more common among white women, but black/mixed race women dependent on drugs had the highest proportion of women reporting self-harm. There was tentative support for a three-way association between ethnicity, dependence and self-harm; this raises the possibility that drug dependence may be a predictor of self-harm in the black female prison population.

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