Stephen P. Lewis

Non-suicidal self-injury, youth, and the Internet: What mental health professionals need to know.

Non-suicidal self-injury (NSSI) content and related e-communication have proliferated on the Internet in recent years. Research indicates that many youth who self-injure go online to connect with others who self-injure and view others’ NSSI experiences and share their own through text and videos platforms. Although there are benefits to this behaviour in terms of receiving peer support, these activities can introduce these young people to risks, such as NSSI reinforcement through the sharing of stories and strategies, as well as, risks for triggering of NSSI urges. Due to the nature of these risks mental health professionals need to know about these risks and how to effectively assess adolescents’ online activity in order to adequately monitor the effects of the purported benefits and risks associated with NSSI content. This article offers research informed clinical guidelines for the assessment, intervention, and monitoring of online NSSI activities. To help bridge the gap between youth culture and mental health culture, these essentials include descriptions of Community, Social Networking, and Video/Photo Sharing websites and the terms associated with these websites. Assessment of these behaviours can be facilitated by a basic Functional Assessment approach that is further informed using specific recommended online questions tailored to NSSI online and an assessment of the frequency, duration, and time of day of the online activities. Intervention in this area should initially assess readiness for change and use motivational interviewing to encourage substitution of healthier online activities for the activities that may currently foster harm.

The Possible Risks of Self-Injury Web Sites: A Content Analysis

The goal of this study was to examine the content of non-suicidal self-injury (NSSI) Web sites, often shared via e-communities. Using a content analysis, 71 Web sites were investigated. Web sites depict NSSI as: an effective coping mechanism (91.55%), addictive and difficult to stop (87.23%), and not always painful (23.94%). Almost all Web sites had melancholic tones (83.10%); several contained graphic photography (29.58%). Most NSSI messages (61.97%) were ambivalent (NSSI-accepting and deterring). Finally, several Web sites (11.27%) provided testimony that NSSI-content is triggering. Findings mirror recent work and NSSI material on these Web sites may normalize and reinforce NSSI. Professionals may need to assess the online activity of individuals who self-injure. Despite its risks, the Internet may serve as a vehicle to reach those who self-injure.

Searching for Thinspiration: The Nature of Internet Searches for Pro-Eating Disorder Websites

Pro-eating disorder (Pro-ED) Websites are widespread and easily accessible. The risks associated with these Websites (e.g., reinforcing and encouraging eating disordered behaviors) have received interest from researchers, media, and mental health professionals. However, little is known about how these Websites are found, which may provide insight into prevention and intervention initiatives. Using Google AdWords Keywords in February 2011, a series of search terms (based on previous research) were entered to generate search-related data regarding actual pro-ED terms used in Google, including the corresponding search results, which were coded for degree of potential harm. Results indicated that Pro-ED search terms are sought out more than 13 million times annually, with pro ana receiving the most searches monthly. Overall, different terms are associated with varying numbers of monthly searches and regional interest. Search terms with references to thinspiration and thinspo are associated with the most harmful Website content. To provide those who seek pro-ED content with helpful, research-supported resources, it may be important to intervene before the point of access by targeting the search results corresponding with pro-ED search terms. Efforts may need to pay particular attention to terms such as thinspiration and thinspo.

Seeking validation in unlikely places: the nature of online questions about non-suicidal self-injury

Recent research points to the salience of the Internet as a means to seek information about non-suicidal self-injury (NSSI) but no research has explored what is asked about NSSI online. The current study examined the nature of NSSI questions asked on Yahoo! Answers. One hundred and eight questions were analyzed using a content analysis. The most frequently asked questions pertained to seeking validation for NSSI experiences (30.56%); however, the responses provided were sometimes quite invalidating. Other common questions included those related to general NSSI information (17.59%), scar concealment (11.11%), and NSSI-related media (11.11%). Efforts are needed to provide NSSI resources and support online but websites may need to be monitored to safeguard against unhelpful responses.

Responses to Online Photographs of Non-Suicidal Self-Injury: A Thematic Analysis

There is concern that graphic pictures of non-suicidal self-injury (NSSI) may detrimentally impact vulnerable viewers—namely those who may self-injure. How individuals (most who have, but some of whom have not, self-injured) respond to photographs of NSSI is currently unknown. Thematic analysis was used to assess testimony regarding NSSI imagery online. Analysis of testimony regarding NSSI photographs revealed a dichotomy. Individuals reporting positive perceptions said the photographs reduced loneliness and NSSI enactment. People reporting negative perceptions argued photographs reinforce and encourage NSSI. Experiences of being triggered by NSSI images were described by several participants. Photographs of NSSI posted online may have several risks for viewers. It is important to achieve a greater understanding of the effects of various forms of online NSSI content and to develop supportive NSSI resources on the Internet.

Googling Self-injury: The State of Health Information Obtained Through Online Searches for Self-injury

IMPORTANCE Nonsuicidal self-injury (NSSI), the deliberate destruction of ones body tissue without suicidal intent, is a significant issue for many youth. Research suggests that adolescents and emerging adults prefer the Internet as a means to retrieve NSSI resources and that important others (eg, caregivers) may also seek this information online. To our knowledge, no research to date has examined the quality of health information regarding NSSI on the Internet. OBJECTIVES To examine the scope and nature of web searches for NSSI websites and to evaluate the quality of health-information websites found via these online searches. DESIGN, SETTING, AND PARTICIPANTS Ninety-two NSSI-related search terms were identified using the Google AdWords Keywords program. The first page of Google search results for each term was content-analyzed for website type and health-information websites were further coded for credibility, NSSI myth propagation, and quality of health information. MAIN OUTCOMES AND MEASURES Frequency of NSSI web searches and indices of health information quality. RESULTS Nonsuicidal self-injury-related search terms were sought more than 42 million times in the past year and health-information websites were the most common website type found (21.5%). Of these, a health and/or academic institution endorsed only 9.6%. At least one NSSI myth was propagated per website, including statements that NSSI indicates a mental disorder (49.3%), a history of abuse (40%), or the notion that primarily women self-injure (37%). The mean quality of health information score on these websites was 3.49 (SD = 1.40) of 7. CONCLUSIONS AND RELEVANCE Nonsuicidal self-injury-related search terms are frequently sought out worldwide and are likely to yield noncredible and low-quality information that may propagate common NSSI myths. These data suggest health professionals need to be aware of what information is online and should refer young patients and their families to reliable online resources to enhance NSSI literacy. Efforts to facilitate peoples access to credible NSSI resources via the Internet are also needed.

An Investigation of the Motivations Driving the Online Representation of Self-Injury: A Thematic Analysis

The objetive of the study was to identify a) the motivations for communicating about non-suicidal self-injury (NSSI) in a publicly accessible online forum, b) The significance (if any) of the “publicness” of the behavior. Using a Thematic Analysis of 423 text-based posts from an online NSSI forum, 5 motivations for using the site were identified: confessional, marking a turning point, acting as a deterrent, dispelling myths and offering or seeking support. Motivations for using the site differ markedly from motivations for engaging in NSSI and tend to be more outwardly focused. The publicness of the site therefore seems to be significant in terms of bearing witness, providing the opportunity to confront negative stereotypes, and the ability to seek and offer support to like-minded individuals.

Self-harm reasons, goal achievement, and prediction of future self-harm intent.

Self-harm may have several reasons, and these reasons may have corresponding implied goals. The current study examined reasons for self-harm and whether the a priori goals intended by these reasons were achieved. Fifty-seven individuals with a history of self-harm were recruited online and volunteered their time to complete a series of online questionnaires assessing past self-harm frequency, self-harm reasons, whether the goal associated with these reasons was achieved, and future self-harm intent. Reasons to reduce tension and dissociation associated with more past self-harm, a higher intent to self-harm again, and it was reported that the goals associated with reasons were achieved (i.e., these internal states were extinguished). Achievement of these goals (i.e., reported reductions in tension and dissociation) mediated the relation between corresponding self-harm reasons and intent to self-harm in the future. Findings support the view that self-harm is a maladaptive coping strategy and the reinforcement component of the experiential avoidance model of self-harm. Results have clinical implications and heuristic value for future research, which are discussed.

Rumination and Emotions in Nonsuicidal Self‐Injury and Eating Disorder Behaviors: A Preliminary Test of the Emotional Cascade Model

OBJECTIVE This study examined relations between repeated rumination trials and emotions in nonsuicidal self-injury (NSSI) and eating disorder behaviors (EDBs) within the context of the emotional cascade model (Selby, Anestis, & Joiner, 2008). METHOD Rumination was repeatedly induced in 342 university students (79.2% female, Mage = 18.61, standard error = .08); negative and positive emotions were reported after each rumination trial. Repeated measures analyses of variance were used to examine the relations between NSSI and EDB history and changes in emotions. RESULTS NSSI history associated with greater initial increases in negative emotions, whereas EDB history associated with greater initial decreases in positive emotions. Baseline negative emotional states and trait emotion regulation mediated the relation between NSSI/EDB history and emotional states after rumination. CONCLUSION Although NSSI and EDBs share similarities in emotion dysregulation, differences also exist. Both emotion dysregulation and maladaptive cognitive processes should be targeted in treatment for NSSI and EDBs.

Every scar tells a story: Insight into people’s self-injury scar experiences

Scarring, a common and salient consequence of non-suicidal self-injury (NSSI), remains an under-explored issue in the field. Thus, the current investigation explored NSSI scar perspectives using online testimony from members of a popular NSSI message board; focus was attenuated to a series of message board posts pertinent to people’s experiences with scars resulting from NSSI. Data (message board posts) were collected using the website’s search function. A total of 53 posts involving discussion of people’s NSSI scar perceptions and experiences were retained. A thematic analysis of the data indicated that individuals viewed their scars in a number of ways. Many viewed scars in a resilient manner, often in the context of a self-narrative. Others, however, were unaccepting of their scars (e.g. expressed feelings of shame, hatred, or disgust). For some, they were able to gradually accept their scars but only after a period of difficulty. And, finally, some individuals expressed mixed feelings toward their scars (e.g. a love/hate relationship). Hence, scars stemming from NSSI seem to differentially impact individuals who self-injure. Possible implications for research and clinical practice are discussed.