Adolescents Selling Sex and Sex as Self-Injury

Abstract

Participants 23 Procedure 24 Studies I-III 24 Study IV 24 Measures 26 Studies I-III 26 Study IV 30 Data analysis 31 Ethical considerations 33 Funding for the studies 34 RESULTS OF THE EMPIRICAL STUDIES 35 Studies I-II -Adolescents selling sex 35 Studies III-IV -Sex as self-injury 37 GENERAL DISCUSSION 41 Summary and strengths -Adolescents selling sex 41 Summary and strengths -Sex as self-injury 44 Methodological considerations and limitations 46 Clinical implications 50 Future directions 53 CONCLUSIONS 55 SAMMANFATTNING PÅ SVENSKA 57 ACKNOWLEDGEMENTS IN SWEDISH 59 REFERENCES 61 APPENDIX: Questionnaire used for Study IV 75 Abstract 1 AbstractThere are today only a few population-based studies in the world investigating the prevalence of and associated risk-factors with adolescents selling sex and so far no earlier populationbased study has been found investigating adolescents motives for selling sex. Further, to use sex in means of self-injury (SASI) is a behaviour that has been highlighted in Sweden the last years but it is a new field of research and a behaviour in need of conceptualizationThe aim of this thesis was to investigate the prevalence of, associated risk factors with, motives for and manifestations of adolescents selling sex and the use of sex as self-injury (SASI). For the thesis, two nationally representative cross-sectional population surveys with third year students at Swedish high schools were collected in 2009 (n = 3498, mean age 18.3 +/-0.6 years, response rate 60.4%) and in 2014 (n = 5839, mean age 18.0 +/-0.6 years, response rate 59.7%). Further, the motives and manifestations of SASI were investigated in an anonymous self-selected, open-ended questionnaire published on websites of nongovernmental organizations offering help and support to women and adolescents (n = 199, mean age 27.9 +/-9.3 years). Quantitative and qualitative methods were used for data analyses.In the 2009 population-based survey, 1.5% (n = 51) of the adolescents reported having sold sex on at least one occasion, but in 2014 the prevalence was slightly lower at 0.9% (n = 51). SASI was reported by 3.2% of girls (n = 100) and 0.8% of boys (n = 20). Both selling sex and SASI were associated with various adverse factors such as experience of sexual abuse, emotional and physical abuse, poor mental health and self-injury. Adolescents selling sex had sought help and support for different problems and worries to a greater extent compared to peers. Contact with healthcare for various psychiatric problems such as suicide attempts, depression and eating disorders was common for adolescents using SASI. Further analysis showed that adolescents selling sex are a heterogeneous group in regard to underlying motives for selling sex, which included emotional and material reasons as well as pleasure.Depending on their underlying motives, adolescents selling sex were found to differ in regard Abstract 2 to compensation received, age of the buyer, means of contact with the buyer, sexual orientation, experience of sexual abuse and the use of SAS...

Hiding in the open: Consideration of nonsuicidal self‐injury by proxy as a clinically meaningful construct

“…Likewise, although researchers have recently proposed the construct of sex as self‐injury (SASI; Fredlund, 2018; Fredlund et al, 2020; Jonsson et al, 2019; Zetterqvist et al, 2018), this construct overlaps with but is distinct from sexual activity as a form of NSSI by proxy. Specifically, because SASI encompasses both psychological and physical harm in sexual situations, as well as self‐inflicted sexual injury (Fredlund et al, 2020), SASI does not necessarily have to involve the direct elicitation of physical injury from one's sexual partner during sexual activity, as it may involve self‐inflicted harm or indirect or psychological harm.…”

Sex as self-injury: The appearance of a new diagnostic category in Sweden

“…The absence of a scientifically grounded definition affects the conclusions that can be drawn by the results, as there is uncertainty about what it really is the participants respond to when they confirm that they are supposedly harming themselves with sex. Also, none of the participants in Fredlund et al’s (2017) study and only two thirds of the participants in Fredlund’s (2019) doctoral dissertation were given the opportunity to define “sex as self-injury” themselves, and this would arguably limit the researchers’ ability to draw any valid conclusions.…”

“…The media discourse on “sex as self-injury” thus emerged before any research about it had been conducted, and this media discourse formed the research that was conducted after the phenomenon had become part of the public discourse in Sweden. Fredlund’s (2019) thesis, covering both new and earlier studies, is an example of how the questions given to the participants were directly connected to the discourse in the media. For example, the participants in Fredlund (2019) were asked about the gender and age of the people they usually had sex with to allegedly self-harm—two central ingredients of the media discourse.…”

Perceived Help and Support for Sex as Self-Injury: A Qualitative Study of a Swedish Sample

“…The pilot study participants requested more precise follow-up questions, and the questionnaire was amended accordingly. The questionnaire included open-ended questions concerning coping strategies for negative feelings, experiences of sex as self-injury, and the reasons why SASI started, continued, and stopped, and can be read in full (see Fredlund, 2019). The questions concerning experiences of help and support and reasons for exiting SASI were formulated as follows: (1) If you have stopped, what made you stop?…”