title: Self-reported frequency of sex as self-injury (SASI) in a national study of Swedish adolescents and association to sociodemographic factors, sexual behaviors, abuse and mental health.
abstract: BACKGROUND
  Sex as self-injury has become a concept in Swedish society; however it is a largely unexplored area of research, not yet conceptualized and far from accepted in the research field. The use of sex as a way of affect regulation is known in the literature and has, in interviews with young women who sell sex, been compared to direct self-injury, such as cutting or burning the skin. The aim of this study was to investigate the self-reported frequency of sex as self-injury and the association to sociodemographic factors, sexual orientation, voluntary sexual experiences, sexual risk-taking behaviors, sexual, physical and mental abuse, trauma symptoms, healthcare for psychiatric disorders and non-suicidal self-injury.
  
  
  METHODS
  A representative national sample of 5750 students in the 3rd year of Swedish high school, with a mean age of 18 years was included in the study. The study was questionnaire-based and the response rate was 59.7%. Mostly descriptive statistics were used and a final logistic regression model was made.
  
  
  RESULTS
  Sex as self-injury was reported by 100 (3.2%) of the girls and 20 (.8%) of the boys. Few correlations to sociodemographic factors were noted, but the group was burdened with more experiences of sexual, physical and emotional abuse. Non-heterosexual orientation, trauma symptoms, non-suicidal self-injury and healthcare for suicide attempts, depression and eating disorders were common.
  
  
  CONCLUSIONS
  Sex used as self-injury seems to be highly associated with earlier traumas such as sexual abuse and poor mental health. It is a behavior that needs to be conceptualized in order to provide proper help and support to a highly vulnerable group of adolescents.
authors.affiliation: Child and Adolescent Psychiatry, Department of Clinical and Experimental Medicine, Faculty of Medicine, Linköping University, 581 85 Linköping, Sweden.
authors.forename: Cecilia
authors.identifier: 0000-0003-3772-6377
authors.initials: C
authors.lastname: Fredlund
authors.affiliation: Barnafrid, Child and Adolescent Psychiatry, Department of Clinical and Experimental Medicine, Faculty of Medicine, Linköping University, 581 83 Linköping, Sweden.
authors.forename: Carl Göran
authors.initials: CG
authors.lastname: Svedin
authors.affiliation: Barnafrid, Child and Adolescent Psychiatry, Department of Clinical and Experimental Medicine, Faculty of Medicine, Linköping University, 581 83 Linköping, Sweden.|Department of Psychology, Lund University, 221 00 Lund, Sweden.
authors.forename: Gisela
authors.initials: G
authors.lastname: Priebe
authors.affiliation: Barnafrid, Child and Adolescent Psychiatry, Department of Clinical and Experimental Medicine, Faculty of Medicine, Linköping University, 581 83 Linköping, Sweden.
authors.forename: Linda
authors.initials: L
authors.lastname: Jonsson
authors.affiliation: Child and Adolescent Psychiatry, Department of Clinical and Experimental Medicine, Faculty of Medicine, Linköping University, 581 85 Linköping, Sweden.
authors.forename: Marie
authors.initials: M
authors.lastname: Wadsby
keywords: Adolescents; Indirect self-injury; Non-suicidal self-injury (NSSI); Revictimization; Self-harm; Selling sex; Sex as self-injury (SASI); Sexual abuse; Trauma