# Psychological processes and abilities for ceasing sex as self-injury– a qualitative study

## TL;DR

This study explores psychological processes and abilities that help individuals stop using sex as a form of self-injury, offering insights for therapeutic interventions.

## Contribution

The study identifies five key psychological abilities that contribute to ceasing SASI, providing a framework for targeted psychological interventions.

## Key findings

- Revised core beliefs about the self were achieved through new experiences or cognitive restructuring.
- Increased relational competence was linked to new relationship experiences or communication skills.
- Strengthened psychological empowerment came from new relationships to the body and sexuality or norm-critical perspectives.

## Abstract

The term sex as self-injury (SASI) refers to sexual behaviors that are used as a means of self-injury, with motives such as emotional regulation comparable to other self-injurious behaviors, including burning or cutting the skin. The aim of this study was to explore which psychological processes and abilities that made it possible to cease SASI, to contribute to the knowledge that underpins psychological interventions and treatments.

The study was based on an open-ended questionnaire published on the websites of Swedish NGOs offering help and support to women and youths. In total 196 individuals with experience of SASI were included in the study. The age of the participants was 15–64 years (mean age 27.9 years), and most of the participants were women. Thematic analysis was used for the study, with the preunderstunding of cognitive behavioral therapy treatment and functional analysis.

Five abilities were seen as important for cessation of SASI; (1) Revised core beliefs about the self which were achieved through new experiences or cognitive restructuring. (2) Evolved emotional competence achieved through understanding or acceptance of emotions or new coping skills. (3) Increased relational competence via new relationship experiences or new communication skills. (4) Acquired meta-perspective through insight and knowledge of SASI. (5) Strengthened psychological empowerment through new relationships to the body and sexuality, transfer of responsibility or norm-critical perspective.

Based on the results regarding psychological processes, acquired abilities and alternative behaviors, proposals for therapeutic interventions that may activate these processes were discussed.

The online version contains supplementary material available at 10.1186/s12888-025-07029-2.