Self-Injury and the Internet




Deliberate nonsuicidal self-injury is the intentional harming of one’s own body, and may include cutting, burning, scratching, minor overdosing, banging, or hitting. New research finds that images and live-action videos depicting self-injury permeate the internet. The images are accessible to youth at risk for this dangerous behavior, and reinforce, glamorize, and provoke self-destructive behavior.

The research, published a recent issue of Pediatrics, evaluated the presence and viewing patterns of self-injury videos on YouTube. The authors searched the video-sharing website using the key words “self-injury” and “self-harm” and analyzed the content and viewership of  the top 50 most-viewed videos showing a live person (character videos) and the top 50 videos without a live person (noncharacter videos). In total, 28% of the character videos had in-action footage of self-injury and 90% of the noncharacter videos had photographs of the same.

On average, the individuals who uploaded the videos to YouTube were 25 years old, though many admitted lying about their age on previous occasions, so the reliability of the data is questionable. Also, 95% of the video uploaders were female.  Overall, the top 100 videos analyzed were viewed more than 2 million times. More than three-quarters of the videos were accessible to a general audience with no viewer restrictions; 58% of the videos did not warn viewers of the content. The videos were positively ranked by viewers, with an average score of 4.6 out of 5.0; the self-injury videos were rated as viewer “favorites” more than 12,000 times.

The accessibility and graphic content of self-injury videos are worrisome. The rate of self-injury among adolescents and young adults ranges from 14% to 24%, and individuals who self-injure are more likely to have other mental health disorders, including depressive disorders and attention-related issues, and a higher risk of suicide. Exposure to photographs and videos of others who self-injure fosters a feeling of normalcy, and may actually educate or provoke self-injury and teach new methods of self-injury or concealing the self-injury. The same phenomenon is seen with pro-eating disorder websites among young girls at risk for anorexia nervosa and bulimia. Reportedly, individuals who self-injure do so to alleviate negative emotions, express self-directed anger, or resist suicidal thoughts.

More than half of the videos analyzed in the Pediatrics research presented an educational tone, providing statistics and facts about self-injury. A few actively discouraged self-injury. Most videos had a melancholic tone, depicting sadness, hopelessness, or crying. Noncharacter videos were more popular in this analysis, and these videos were much richer in artistic expression, using music, art, and text to discuss self-injury. This glamorization and artistic representation makes a destructive behavior that much more attractive to individuals who engage in self-injury. The individuals who make or appear in the videos also gain a sense of identity and garner a large following of “fans” based on their self-injury behavior.

YouTube is the largest video-sharing website available today, and it receives the third most traffic of any website on the internet. Adolescents and young adults, the same population at risk for self-injury, use the internet and video-sharing applications more than any other age group. The internet, and other modern media, has caused society to become desensitized to harmful and unsafe behavior. Dangerous activities are now sensationalized, and individuals can become internet celebrities for performing injurious acts. Clinicians who treat individuals who self-injure must be aware of the prevalence of these harmful videos on the internet and the role they play in encouraging self-injury.

References

Borzekowski DL, Schenk S, Wilson JL, & Peebles R (2010). e-Ana and e-Mia: A content analysis of pro-eating disorder Web sites. American journal of public health, 100 (8), 1526-34 PMID: 20558807

Jett S, LaPorte DJ, & Wanchisn J (2010). Impact of exposure to pro-eating disorder websites on eating behaviour in college women. European eating disorders review : the journal of the Eating Disorders Association, 18 (5), 410-6 PMID: 20572210

Klonsky ED, & Muehlenkamp JJ (2007). Self-injury: a research review for the practitioner. Journal of clinical psychology, 63 (11), 1045-56 PMID: 17932985

Lewis SP, Heath NL, St Denis JM, & Noble R (2011). The scope of nonsuicidal self-injury on YouTube. Pediatrics, 127 (3) PMID: 21339269

Nixon MK, Cloutier P, & Jansson SM (2008). Nonsuicidal self-harm in youth: a population-based survey. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 178 (3), 306-12 PMID: 18227450

Tuisku V, Pelkonen M, Kiviruusu O, Karlsson L, Ruuttu T, & Marttunen M (2009). Factors associated with deliberate self-harm behaviour among depressed adolescent outpatients. Journal of adolescence, 32 (5), 1125-36 PMID: 19307015

  • I think one has to be careful about how one approaches self-injury.

    First, let’s recognise that there are forms of self-injury which are socially acceptable or even encouraged. Tattooing and ear piercing are two examples. The definitions for social acceptability vary dramatically between cultures: ritual scarification is very common in many places. The above discussion focuses on youth, but does not seem to consider the possibility that youth subculture simply has a different set of standards for (in)appropriate self-injury. Even if you ultimately decide to stop these behaviors, I think that a more nuanced discussion of their cultural context is necessary to do so.

    I’m a cutter and a burner, and I have been for about a decade. (I am 25, no, for real.) When I read this article, the author’s preconceptions stand out clear as day: ‘youth at risk … dangerous behavior … self-destructive behavior.’ My first reaction to this sort of attitude is typically: Screw you! they’re my arms; I know best what to do with them. Again, if you want to stop me from putting matches out on my skin, I don’t think that this attitude is going to help you.

    ‘Dangerous’? Playing soccer is dangerous; so is crossing the street. I know how not to cut an artery and how not to get an infection. I’m not stupid, nor is your typical cutter. Now, what would be interesting is if there were educational videos explaining how to safely self-injure – YouTube could play a positive role in a harm reduction strategy! ‘Self-destructive’? Only in the most shallow of analyses (Is BDSM a ‘destructive’ behavior? The distinction between it and self-injury seems hazy at best. What’s the difference between scratching oneself and agreeing to have a partner do it?). I cut and burn for a number of reasons, none of which I would describe as ‘self-destructive’. The discussion above would seem to acknowledge that the behaviors can actually be acts of self-preservation: ‘individuals who self-injure do so to alleviate negative emotions, express self-directed anger, or resist suicidal thoughts.’

    Quite frankly, my self-injury has been a more effective tool for managing my psyche than any drug I’ve been prescribed.

  • Barbara Stott

    Self harm has more than one cause, and it is important to understand the motivation, even if the person hurting himself doesent, if it is going to be prevented or reduced.
    I spoke to one man in psychiatric hospital who burned himself with cigarettes. He did not want attention. He did not want to hurt himself. He wanted to make a mark, a statement about himself, for himself.
    What he was doing was motivated in the same way that one would immagine someone would be motivated to obtain a tattoo. Something that would not be considered likely to be associated with mental illness.
    He wanted the mark to be permanent at the time, but knew that he would regret it if it actualy was permanent.
    He agreed that a henna tattoo lasts for months, and would disappear, not long after he started to regret it. He was more than happy for it to be safe and painless, and for him it was a perfect solution to that problem.
    This is a motivation for self harm that is rarely mentioned. Does anyone know of similar cases, whether from experience or in psychiatric literature?
    In this case it was associated with obsessive compulsive behaviours which had been emphasised by psychiatric abuse(and misdiagnosed as shizophrenia).

    Another motivation for self harm is as an excuse to seek comfort.

    It could be to express phsically how much someone is hurting the person emotionally. This experssion could be to the person huring the injured or to someone else.

    It is often considered attention seeking in the same way that making a loud noise might be.

    These three reasons are often grouped together as a cry for help. They all show how much more seriously physical harm is treated than psychological harm. Self harm is often a way to display emotional neglect or psychological abuse.

    Depictions on the internet are unlikely to lead to self harm, unless someone is in an emotional state where they are highly predisposed to it anyway.

    Should the first response to self harm be to treat the injury and investigate the family and social situation of the injured person?

    A person who is subjected to psychological abuse or neglect, may not be aware that they are, or may feel it is impossible to express how they are mistreated.

    On the other hand it is easy to assume that someone has the standard motivation, and push them into expressing a sense of mistreatment that is not the cause of the problem.

    When someone crys for help, shouldn’t you help? Of course you don’t want to reinforce the problem by rewarding the behavoiur. Both the immediate distress and the route cause needs to be dealt with.

    As well as avoiding rewarding the behaviour, it can also be important to avoid punishing the behavoiur. If someone hurts themself physically, because they don’t feel justified in seeking comfort, the last thing they need is for the comfort they seek to continue to be refused.

    Self harm can be used as a controlling or passive aggressive pattern of behaviour. That may or may not mean that the person is excessively controlling in nature. People use all sorts of differnt means to secure a their place in society. Self harm could be exhibited in an extreme situation by someone who in normal circumstances uses inteligent more than aggressive means to ensure that there interests are not disregarded to a threatening extent.

    In families with rare blood groups, donors sometimes sell blood with a differential pricing($10,000 unless released), so that the authorities are strongly motivated to release someone who needs blood from an institution. This is an indicator of a family or race group fighting against state repression. If a child deliberately loses a pint of blood to get out of state care, can they really be receiving care?

    Is loss of a pint of blood actually worse for a child than ongoing psychological mistreatment?

    Is it the family or the sate that is excessively controlling?

    That leads on the the question ‘Is passive aggressive behavoiur necessarily unacceptable behaviour?’:but that’s a separate topic.

Jennifer Gibson, PharmD

Jennifer Gibson, PharmD, is a practicing clinical pharmacist and medical writer/editor with experience in researching and preparing scientific publications, developing public relations materials, creating educational resources and presentations, and editing technical manuscripts. She is the owner of Excalibur Scientific, LLC.
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