Youth, Self-Harm and the

Internet

ISABEL CHECA
SOUTHERN JAMAICA PLAIN HEALTH CENTER
03/17/2015
 Outline

 Scope and importance of topic.

 Positive effects regarding use of internet sites that focus on self harm.

 Negative effects regarding use of internet sites that focus on self harm.

 Overview of Internet Platforms.

 Specific questions.

 General questions to ask patients?

 Resources.
 Scope and Importance of Topic

Self-harm.
 For this presentation, we are going to talk about self-harm
without suicidal intent, or non-suicidal self-injury.

Why is it important to look at the internet use of

youth who self-harm?
 International studies suggest that 14-24% of youth self harm.
 (Hawton et al., 2012; Lewis et al., 2011; Lewis et al., 2012b).
 Youth who self-harm use the internet more frequently than
their peers (Lewis et al., 2012b).
 Positive Effects

Access to recovery-focused content.

 Most self-injury queries into search engines lead to recovery-
focused content (Swannel et al., 2010).

 Various studies have found that most posts in self-injury

forums display positive views of mental health treatment
(Jones et al., 2011; Whitlock et al., 2006).

 Discussion of treatment options (Bell 2014, Whitlock et al.,

2006).
 Positive Effects

Decrease in self-harm.
 40% (Harris & Roberts, 2013) to 73% of subjects (Murray & Fox, 2006)
depending on study.
 Decrease sense of isolation.
 Distraction (Baker & Fortune, 2008; Harris & Roberts, 2013).

Sense of community (Baker & Fortune, 2008; Harris &

Roberts, 2013; Johnson et al., 2010).
 Validation, understanding (Baker & Fortune, 2008; Jones et al, 2011;
Rodham et al. 2007).
 Allowed individuals to seek support and advice from others.
 Observed in participant reports and examination of posts.
 For examination of posts see Rodham et al., 2007; Smithson et al., 2011;
Whitlock et al., 2006.
 Negative Effects

Some participants in studies claimed that visiting e-

platforms related to self-harm increased their self-
harming behaviors.
 13-33% of participants depending on study (Johnson et al.,
2010; Harris & Roberts, 2013).

Relapse due to triggering material.

 Even among those who reported a decrease in self-harm.
 49% participants in one study (Murray & Fox, 2006).
 Negative Effects

 Normalization of self-harming behaviors (Lewis et al., 2012b;

Rodham et al., 2007; Whitlock, 2006).
 Characterizing relapses as “slip-ups” (Rodham et al., 2007, p. 426).

 Attempting to trigger emotional state to self-harm (Sueki, 2012;

Swannel et al., 2010; Whitlock et al., 2006).
 10% of participants stated that they went on message boards to trigger themselves
(Harris & Roberts, 2013).

 Looking up methods to self-harm.

 10% of participants in same study stated that they viewed message boards for self-
injury (Harris & Roberts, 2013).
 ~10% of participants in another study stated that they inputted self-harm queries
in a self-engine with the intent of looking up methods to harm themselves (Sueki,
2012).
Brief Overview of Various Internet Platforms

 Forums.
 Still widely used.

 Most studies regarding internet-use and self-harm study forums.

 Different levels and types of moderating posts.

 High to low.
 Non-professional to professional (moderated by mental health clinicians).

 Various “threads” or conversations between users.

 Can be open or closed.

 Open= anyone can make an account and post.
 Closed= have to be invited or request access.
 Most are open.
Forums.
 Questions to ask:
 Name of forum?
 What threads do they visit? What is the content of those threads?

 From forum name, one can find out if it is professionally

moderated or not.
 Patients may not know this.
Tumblr.
 Blogging platform.
 Can follow other bloggers- see their original posts and their
reposts from other bloggers on your “dashboard”.
 Dashboard is the equivalent of Facebook’s newsfeed.
 Posts can be pictures, texts, videos, etc.
 Can follow anyone and see their posts.
 Unless blogger blocks user.
 Unless person makes a private post (only original blogger can see).
Tumblr.
 Tags
 Can search your own, and tags of other bloggers.
 Unless blocked or private.
 Can save tags,
 Tumblr will alert you of how many new posts have been made
with that tag.
 Tumblr’s tags are not well-moderated.
 Triggering depictions of self-harm are often not deleted, even
when they violate Tumblr’s guidelines.
Tumblr.
 Questions to ask?:
 What types of blogs do you follow? What are their content?
 What types of tags do you search for? What types of tags do you
save?
Facebook.
 Purpose: Connect online with family, friends, colleagues, etc.
 Features:
 See postings (text posts, images, videos) of “friends” and users
with public profiles.
 Security settings.
 Can message users.
 Security settings.
Groups and Pages.
 Can be in “groups” with people you are “friends” with, as well
as people that are not your “Facebook friends.”
 Open or closed.
 Follow “pages.”
 Usually have a theme.
 Always open.
Facebook-
 Questions to ask:
 What are their “friends” posting?
 What “groups” are they in? What “pages” do they follow? What is
the content of those “groups” and “pages”?
Instagram-
 Like a picture/video-blog.
 Your account can be private or public.
 Can send people direct pictures/videos.
 Instagram direct
 Well-moderated platform.
Instagram-
 Can put hashtags (#) so others can see photos when they
search for that hashtag.
 On instagram, one can search other people’s hashtags if you have
used that hashtag before.
 However, even if you have not used that hashtag before, you can
google that hashtag and see what others have posted.
 I.E. Google “instagram #selfharm”

 If account is public, then everyone can see that picture when

looking at account or searching hashtag.
 If account is private, only approved followers can see picture when
looking at account or searching hashtag.
Instagram-
 Questions to ask:
 Who do they follow? Friends, family, other people?
 What type of posts do they make?
 What type of posts do the people they are following make?
 What hashtags do they search for?
 General Questions to Ask Patients

 Social Networking
 What social networking websites are you affiliated with?

 Do you have friendships/connections with people online surrounding NSSI?

 If yes, what is the nature of the relationship(s)

 Are you a member of any group related to NSSI?

 If yes, what are the themes surrounding that group (against NSSI, pro NSSI, neutral)?
 If yes, is this group public or private?
 If yes, is it moderated?

 Are there any visual representations of NSSI among these groups?

 What specific activities do you engage in on these websites (live chat, messaging, posting,
information seeking)?

 From Lewis, S., Heath, N., Michal, N., & Duggan, J. (2012). Non-suicidal self-
injury, youth, and the Internet: What mental health professionals need to
know. Child and Adolescent Psychiatry and Mental Health, 6(13), 1-9.
 Video/Picture Sharing:
 What specific websites do you visit?

 Do you create videos/photos related to NSSI?

 If yes, discuss themes/content of videos created.
 If yes, are these videos character or non-character videos?
 If yes, what purpose does creating these videos serve (creative outlet)?

 What types of videos/photos do you watch?

 Are these character or non-character videos?
 What are the general themes in these videos (against NSSI, pro NSSI, neutral)?

 Do these videos present visual presentations of NSSI?

 If yes, are these visual presentations accompanied by a warning?
 Are these visual presentations of NSSI triggering?
 If yes, discuss nature, intensity and degree of triggering material.

 What other specific activities do you engage in on these websites (messaging, commenting, following channels)?

 From Lewis, S., Heath, N., Michal, N., & Duggan, J. (2012). Non-suicidal self-injury,
youth, and the Internet: What mental health professionals need to know. Child and
Adolescent Psychiatry and Mental Health, 6(13), 1-9.
 II. Frequency
 Review log: Discuss frequency of NSSI online activities (explore usage, during week and
weekend).

 III. Functional Assessment of NSSI behaviors in relation to

Internet activities
 Review log: When/why did you first start engaging in NSSI online activities? Explore first
episode.
 Has your self-injury increased/decreased/remained the same since you began engaging in
NSSI online activities?
 What are events/interactions, thoughts, and feelings that preceded/occur during/follow the
online activity?
 Do you self-injure before/after engaging in NSSI online activities?
 If yes, explore online activities that may confer/reduce NSSI risk.

 From Lewis, S., Heath, N., Michal, N., & Duggan, J. (2012). Non-suicidal self-injury,
youth, and the Internet: What mental health professionals need to know. Child and
Adolescent Psychiatry and Mental Health, 6(13), 1-9.
 Resources

 http://au.reachout.com/
 Well-moderated forum to talk to others.

 http://whatworks4u.org/
 Where young people can see what type of treatment works for others, and post about
what works for them.

 http://www.teencentral.net/
 Pre-teens.
 Have to create/access an account.
 Can read other’s stories.
 Well-moderated, stories need to be submitted and approved.

 From Lewis, S., Heath, N., Michal, N., & Duggan, J. (2012). Non-suicidal self-
injury, youth, and the Internet: What mental health professionals need to
know. Child and Adolescent Psychiatry and Mental Health, 6(13), 1-9.
 Resources

http://teenmentalhealth.org/
 Information on mental health and illness.
 Has own youtube channel, where youth tell their journey
regarding their mental health.

 From Lewis, S., Heath, N., Michal, N., & Duggan, J. (2012). Non-suicidal self-
injury, youth, and the Internet: What mental health professionals need to
know. Child and Adolescent Psychiatry and Mental Health, 6(13), 1-9.
 References
 Baker, D., & Fortune, S. (2008). Understanding Self-Harm and Suicide Websites. Crisis- The Journal of Crisis Intervention and
Suicide Prevention, 29(3), 118-122.
 Bell, J. (2014). Harmful or helpful? The role of the internet in self-harming and suicidal behavior in young people. Mental Health
Review Journal, 19(1), 61-71.
 Harris, I., & Roberts, L. (2013). Exploring the Use and Effects of Deliberate Self-Harm Websites: An Internet Based
Study. Journal of Medical Internet Research, 15(12), 285-303.
 Hawton, K., Saunders, K., & O'Connor, R. (2012). Self-harm and suicide in adolescents. Lancet, 379, 2373-2382.
 Johnson, G., Zastawny, S., & Kulpa, A. (2010). E-Message Boards for those who self-injure: Implications for health. International
Journal of Mental Health and Addiction, 8, 566-569.
 Jones, R., Sharkey, S., Ford, T., Hewis, E., Smithson, J., Sheaves, B., & Owens, C. (2011). Online discussion forms for young people
who self-harm: User views. The Psychiatric Bulletin, 35, 364-368.
 Lewis, S., Heath, N., Denis, J., & Noble, R. (2011). The scope of nonsuicidal self-injury on
 YouTube. Pediatrics, 127, 552-557.
 Lewis, S., Heath, N., Michal, N., & Duggan, J. (2012a). Non-suicidal self-injury, youth, and the Internet: What mental health
professionals need to know. Child and Adolescent Psychiatry and Mental Health,6(13), 1-9.
 Lewis, S., Heath, N., Sornberger, M., & Arbuthnott, A. (2012b). Helpful or harmful? An examination of viewer's responses to
nonsuicidal self-injury videos on YouTube.Journal of Adolescent Health, 51, 380-385.
 Murray, C.D. and Fox, J. (2006) Do internet self-harm discussion groups alleviate or exacerbate self-harming behavior?
Australian e-Journal for the Advancement of Mental Health, 4(1), 1-9.
 Rodham, K., Gavin, J., & Miles, M. (2007). I hear, I listen, I care: A qualitative investigation into the function of a self-harm
message board. Suicide and Life-Threatening Behavior, 37(4), 422-429.
 Smithson, J., Sharkey, S., Hewis, E., Jones, R., Emmens, T., & Ford, T. (2011). Membership and boundary maintenance on an
online self-harm forum. Qualitative Health Research, 21(11), 1567-1575.
 Sueki, H. (2012). Association between deliberate self-harm related Internet searches and the mental states and lifetime suicidal
behaviors of Japanese young adults. Psychiatry and Clinical Neurosciences, 66, 451-453.