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J. Indian Assoc. Child Adolesc. Ment. Health 2021; 17(1):137-141

Letter to Editor

Digital self-harm in adolescents: Strategies of Prevention

Sujita Kumar Kar, S.M. Yasir Arafat

Address for correspondence: Dr Sujita Kumar Kar, King George’s Medical University,
Lucknow, Uttar Pradesh, India. Email: drsujita@gmail.com

To the Editor

Digital self-harm is a form of digital aggression which is directed towards self [1]. In digital

self-harm behaviour, information technology largely influences this dangerous activity [2]. The

information technology may induce or support or exacerbate the ideas of self-harm in an

individual resulting in self-harm behaviour. Individuals posting, sending and or sharing

contents about hurting self, amounts to digital self-harm [2]. The purview of digital self-harm

is not limited to posting information related to hurting self; it also includes demean oneself, or

show oneself in a bad light, or cyberbullying oneself.

There is a single article found after a search of the PubMed database from the time of inception

till end of August 2020, using the search term “Digital self-harm” signifies the dearth research

on it. Here we aimed to discuss digital self-harm behaviour among adolescents [2].

Various risk factors have been identified in the context of digital self-harm, which is, to a larger

extent, modifiable. These factors are depression, cyberbullying, substance use, bullying and

abuse at school (which also includes issues related to sexual abuse & sexual bullying) as well

as deviant behaviours associated with adolescent age (juvenile delinquency) [2]. It has been

reported that the use of slangs (verbal abuse, bullying) is not uncommon in society, including

prestigious organizations like school [3]. The psychological trauma sustained through such

abuse may trigger self-harm behaviour.

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Media sometimes plays a detrimental role in digital self-harm; so, cautious and responsible

media coverage may be helpful in the prevention of digital self-harm. Strict media regulations

through cyber legislation may help prevent this emerging sensitive issue. It could be beneficial

to impose regulations on media reporting on self-harm and to encourage media to be involved

in promoting good mental health as well as suicide prevention [4]. Though various cyber laws

exist, there is a need for intense monitoring to ensure successful implementation of these laws.

It has been reported that multiple apps (e.g., Yik Yak, Whisper & Secret) promote

cyberbullying [5,6]. There are also groups with similar behaviour (cutting communities, other

self-harm behaviours) that are engaged to share detrimental behaviours (1). The government

should keep a close watch on such apps and websites. Putting restriction on such websites and

educating the possible harmful consequences to children and adolescents at the school may be

helpful in combating the issues.

Digital self-harm in adolescents is also a matter of concern in India. Reports suggest that many

Indian adolescents increasingly indulge in sexting, body shaming, traumatizing with vulgar

jokes and planning sexual assault in the online chat boxes, like other countries [7]. Such

cyberactivity (abuse) may traumatize the person (or group of persons) targeted and may

develop shame and guilt, which may, in turn, result in digital self-harm. The victim may display

the self-harm behaviour in an online platform, to punish or take revenge from the perpetrator.

Selection of a particular method of suicide largely influences the outcome of suicide. It has

been reported that people with self-harm behaviour often search for various means of

committing self-harm or suicide from online resources. Restricting the availability of such

information may be helpful in the prevention of digital self-harm [8].

The World Health Organization (WHO) had proposed certain recommendations for the

management of self-harm and suicide [9]; which are very relevant in the context of digital self-
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harm, too. The table below summarizes the recommendations by WHO for the prevention of

self-harm and its utility in the prevention of digital self-harm (table-1).

Also, there is a need to understand the self-harm behaviour under the umbrella of Antecedent-

Behaviour- Consequence model. Antecedents may be – cyberbullying, substance use,

relational difficulty, stress, role models, provocation (stimulus). Individuals who go for digital

self-harm anticipate certain consequences (e.g., revenge, getting attention). Prevention of self-

harm, including suicide among adolescents, is the ultimate goal of management, which can be

achieved by addressing the antecedents, which led to self-harm behaviour in the first place.

Specific treatment of digital self-harm is a narrow domain of prevention, and the existing

evidence reveals that psychosocial as well as pharmacological treatment has little role in the

management of self-harm [10]. The factors that attribute to self-harm need to be identified in

adolescents, and it needs to be addressed universally. Parenting does play a role in the

regulation of digital self-harm among children and adolescents. Neglectful and authoritarian

parenting may promote digital self-harm; whereas the authoritative parenting (allowing the

child as well as controlling the behaviour of the child; caring attitude towards the emotional

needs of the child and setting limits) is associated with better regulation of digital self-harm

[11,12]. There is a need to regulate the selling of alcohol to adolescents as well as parental

control of adolescents to use alcohol in their home settings. Alcohol use increases the risk of

violence, abuse, bullying, as well as sexual crimes, which in turn increases the risk of self-harm

behaviour.

The challenges in dealing with digital self-harm behaviour are that there are no consensus or

guidelines or evidence in terms of its management. As digital self-harm is an extension of the

self-harm / suicidal behaviour, the strategies followed in dealing with suicidal or self-harm

behaviour are to be adopted for its management. There is a need to formulate recommendations

for the prevention of digital self-harm, as it is not the replica of suicide or deliberate self-harm.
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Table-1: Prevention strategies of Digital Self-harm

WHO recommendations Utility for prevention of Digital Self-harm

Self-harm /suicide risk assessment Identification of risk factors for digital self-harm
among patients with psychiatric disorders and appropriate intervention
including substance use disorder
Removal of means and access to self- Access to online / digital means that portray self-
harm and suicide harm and suicide in a sensational manner need to
be restricted
Regular contact and enhancing social Encouraging the individuals at risk to speak their
support problem and socialize with close ones then
spending time online*
Restricting availability of alcohol Strict prohibition of alcohol selling to the
adolescents
Parents need to monitor the adolescents to limit
alcohol use at home settings
Problem solving approach & school Providing life-skill training at schools to deal with
interventions common challenges of the adolescent life
School interventions focussing on suicide
prevention, and behavioural management
Conducting life-skill training workshops
periodically for the parents, who can guide their
children
Cautious and responsible reporting of Ensuring that media adheres to the WHO suicide
suicide by media reporting guidelines to prevent copy-cat suicides.
Also, regulating the content social media posts on
suicide
Admission to hospital for self-harm Many individuals with self-harm behaviour need
behaviour hospitalization for proper evaluation of their
mental health issues and conflicts; it also limits the
accessibility to means of suicide
*Offline socialization is not advisable during this COVID-19 pandemic. During this COVID-
19 pandemic, the adolescents may interact offline following the principles of physical
distancing.

Conflict of interest: None declared

References
1. Pater J, Mynatt E. Defining digital self-harm. In: Proceedings of the 2017 ACM
Conference on Computer Supported Cooperative Work and Social Computing. 2017.
p. 1501–13.
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61:761–6.
3. Kar SK, Arafat SY, Menon V. Psychological Underpinning of Slanging. Indian J
Psychol Med. 2020.
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to Adjust Media Recommendations on Reporting Suicidal Behavior to New Media
Developments. Arch Suicide Res 2014, 18:156–69.
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Emotions, and Digital Self-Harm: Testing a Theoretical Model of Indirect Effects.
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Indian J Psychiatry. 2018, 60:384.
8. Biddle L, Gunnell D, Owen-Smith A, Potokar J, Longson D, Hawton K, et al.
Information sources used by the suicidal to inform choice of method. J Affect Disord
2012, 136:702–9.
9. WHO | Self harm and suicide [Internet]. [cited 2020 Feb 12]. Available from:
https://www.who.int/mental_health/mhgap/evidence/suicide/en/
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2012, 379:2373–82.
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technological development. New Media & Society. 2020.
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cyberbullying across adolescence. Cyberpsychol Behav Soc Netw. 2018, 21:294–303.

Sujita Kumar Kar, Associate Professor, Department of psychiatry, King George’s Medical
University, Lucknow-226003, Uttar Pradesh, India. S.M. Yasir Arafat, Assistant Professor,
Department of Psychiatry, Enam Medical College and Hospital, Dhaka-1340, Bangladesh.