The role of social media in deliberate self-harm (DSH) behaviours among adolescents and young adults

1. The role of social media
in deliberate self-harm
(DSH) behaviours
among adolescents and
young adults
Michelle Teo, Principal Investigator
& Professor Barbara Hannigan,
Research Supervisor
Trinity College Dublin

2. Research question
and study aims
• Research question:
• What is the role of social media in
deliberate self-harm behaviours among
adolescents and young adults?
• Research aim:
• Gain a better understanding of how
adolescents and young adults (AYAs)
feel social media usage impacted on
their deliberate self-harm behaviours
• Dissemination of research to mental
health professionals working with
adolescents and young adults

3. Defining self-harm
Self-harm: an act with non-fatal outcome in which an individual deliberately
initiates a non-habitual behaviour, that without intervention from others will cause
self harm, or deliberately ingests a substance in excess of the prescribed or
generally recognised therapeutic dosage, and which is aimed at realising changes
that the person desires via the actual or expected physical consequences (Perry
et al., 2012)
▪ Behaviours: Cutting, biting, abrading, severing, inserting, burning, ingesting
or inhaling, hitting and constricting (Ross & McKay, 1979)
▪ Nonsuicidal self-injury (NSSI), self-injurious behaviour, deliberate self-harm
(DSH), non-fatal suicide behaviour, self-mutiliation, self-abuse

4. Study definition of social media
Social media: forms of electronic communication (such as
websites for social networking and microblogging) through which
users create online communities to share information, ideas,
personal messages, and other content (such as videos) (Social
media, n.d.)
▪ Facebook, Twitter, Snapchat, Instagram, Reddit, YouTube,
Whatsapp, etc.
▪ 95% teens have smartphone, 45% going online “almost
constantly” (Anderson & Jiang, 2018)

5. Social media
and DSH in
the literature:
Positives
Dyson et al. (2016): systematic review of 26
publications around social media use to view and
discuss self-harm behaviours among children and
young people
▪ Sense of community that is supportive,
empathic, encouraging
▪ High value on “authenticity”
▪ One study found that 41.8% of respondents
indicated that membership in a social media
group based around self-harm had reduced
their self-harming behaviours
Lewis and Seko (2016): literature on perceived
benefits of NSSI
▪ Engaging with groups online to share
personal experiences that they could not in
real life due to stigma
▪ Those successful in recovery encouraged and
supported others who still engaged in self-
harm behaviours

6. Social media and DSH in the
literature: Negatives
Study in Finland (n = 555) and United States (n = 1032): AYA’s aged 15 to 30 years
▪ Approximately 12% had visited sites dedicated to Non-suicidal Self Injury
(NSSI), 10% visited suicide sites and 22% visited sites promoting eating
disorders.
▪ More exposure to harm-advocating sites were more likely to report lower
subjective wellbeing (Keipi, Oksanen, Hawton, Nasi, & Rasanen, 2015)
Lewis and Knoll (2015) examined YouTube content around self-harm
▪ 11 videos indicated that NSSI was acceptable if “safety” precautions were
taken (e.g. cleaning tools, tending to wounds)
▪ 39 out of the 40 videos did not advocate for help-seeking behaviours

7. Social media and DSH in the
literature: Negatives continued
Jacob, Evans & Scourfield (2017): qualitative interviews, AYA’s
aged 16 to 24, influence of online images of DSH
▪ Community that encouraged or reinforced behaviours
▪ Searching for triggering content eg. graphic image of deep cuts
▪ Social comparison hoping to emulate or improve upon
images/techniques viewed online
▪ Lack of scrutiny and moderation on Tumblr vs. other sites

8. Method
▪ Recruitment:
▪ Bodywhys, Kildare Youth Services, Trinity College Dublin
▪ Participants:
▪ Ten adolescents and young adults with previous engagement in
deliberate self-harm behaviours
▪ Exclusion criteria: engaged in DSH behaviours in last 18 months
▪ 8:2 female to male, mean age 21.3 years
▪ Data collection:
▪ Adapted Brief COPE Questionnaire (Carver, 1997)
▪ Nine categories: self-distraction, active coping, denial, substance
use, use of emotional support, use of instrumental support,
behavioural disengagement, venting, positive reframing, planning,
humour, acceptance, religion, and self-blame
▪ Face-to-face, in-depth, semi-structured qualitative interview
▪ Analysis: Descriptive and Interpretative Thematic Analysis (Elliott & Timulak,
2005)
▪ Domains, Themes, and Categorical descriptions and interpretations of
the data

9. Interview schedule
Part 1: Social media
1. What social media sites or applications do you use?
2. Do you use any on a daily basis? If so, which ones?
3. What are your views now on social media in general?
4. What do you feel are the benefits of using social media?
5. What do you feel are the risks or negative effects of social media?
Part 2: DSH behaviours
6. What is your understanding of self-harm?
7. What are your current views on self-harm?
8. Are these views new or is this what you have always thought?
9. Did you or do you currently know of other young people who have self-harmed?
10. Why do you think that some young people self-harm?
11. In your opinion, what are some of the triggers for self-harm amongst young people?
Part 3: Relationship between social media and DSH
12. Did you use social media at the time when you were self-harming and if so, how?
13. Which social media site or applications would you have used most frequently at that time?

10. 14. Did you ever try to learn more about SH behaviours or explore self-harm online or through social
media?
If yes: What was your motivation and/or goal in this learning or exploration?
To clarify: Why were you going online to learn more about or explore self-harm? What did this do for
you?
15. What is your experience of how self-harm is shared, seen or portrayed on social media?
Part 4: Coping mechanisms
16. When you were actively engaging in self-harm behaviours, did you talk to and confide in anyone about
your feelings?
17. When you were engaging in self-harm behaviours, what did you use for emotional support or to deal
with problems and difficulties?
18. What do currently you use for emotional support and to help you deal with problems or difficulties?
Part 5: Social media trends/movements/campaigns
19. In general, do you believe there a connection between social media and young peoples’ behaviours,
whether they are related to self-harm or not?
20. Did you ever hear about the social media trend ‘#CutforBieber’? If yes, what do you know about it?
21. Can you tell me what you know about this or other similar social media campaigns or movements?
22. Are there social media campaigns or online movements that you think are beneficial for young
people?
23. Are there social media campaigns or online movements that you think may negatively impact young
people?
24. Before we finish up, is there anything else you would like to say or add that might be important for our
understanding of how social media and self-harm might be connected?

11. Results: Adapted Brief COPE
Questionnaire (Carver, 1997)
12 predominant coping styles
▪ All ten participants endorsed at least one
▪ Some endorsed up to five
▪ Four coping styles used by at least half of participants (n=5)
• Self-distraction, active coping, planning, acceptance
Six non-predominant coping styles
▪ Four used by at least half (n=5)
• Denial, substance use, behavioural disengagement, religion

12. Results:
Qualitative
interview
analysis
Domains Categories
I. Experiences of Using Social Media
Platforms – mixed findings
I. Conflicting experiences engaging with social media
II. Positive social media experiences
III. Social comparison and belonging within the community
IV. Experiences of social media platforms with a ‘bad
reputation’
II. Social Media & Deliberate Self-Harm
Relationship
I. The role of social media in maintaining self-harm
behaviours
II. Self-harm as often hidden, and an unseen private
behaviour – fear of stigmatisation
III. AYA’s use self-harm to cope with painful feelings
IV. Reactions to #CutforBieber and other self-harm related
social media trends
III. Recovery from Deliberate Self-Harm I. Difficulties encountered in overcoming self-harm
behaviours – easy access to DSH promoting sites
II. Satisfaction and pride in overcoming adversity
IV. Need for Relevant & Informed
Psycho-education
I. Disclosure, help-seeking, and healthier coping
mechanisms
II. A learning curve in engaging with social media and
content around self-harm

13. Domain I. Experiences of Using Social
Media
I. Conflicting experiences engaging with social media
“So, at first I thought Facebook was great and I still do because I think it's
solely communicative. But what I don't like about social media is the
explosion of, like, imagery on it. And these, like, fast moving images
because I think that they, for me anyway, that is what affected me most.
It’s kind of, social media just went from being used solely for connecting
people in a social sense to, you know, these heavily filtered kind of
portrayals of people online. And that's, at moments, that's what I don't like
about it.” (Lily)
II. Positive social media experiences
“Like I know that like I have family members and stuff that have moved
away so like they're living in like Australia or America and like, that is
really helpful because I can still keep in contact with them.” (Sophie)
III. Social comparison and belonging within the community
“But often, I get lots of my behaviour from Instagram or Facebook
because it’s just where I see a lot of stuff happening. And also,
reinforcement if you get like followers that you’re doing something right.
Or you’re not doing something that is right… I mean, even like today if I
do something and I put a nice picture up and it gets more likes, I feel like,
‘Oh wow, that was a really nice picture’. So, it’s kind of reinforcement in
that way, getting that, sort of, immediate validation almost.” (Ava)
IV. Experience of social media platforms with a ‘bad reputation’
“And, like, so I would use Instagram for like, they just feed you, you know,
it’s algorithms. So, the second you click on somebody that's like a fitspo
then you'll just be fed so many bikini models or like famous Instagram
models. Or else food. Like, so much. And I would just use those so much,
to like, stifle cravings, or just to like compare.” (Mia)

14. Domain II. Social Media and Deliberate
Self-Harm Relationship
I. The role of social media in maintaining self-harm behaviours
“There was probably a very strong period of time, maybe in like 2014-15 on
Tumblr where it was like actual soft, like pale skin and like, blood against it. It
wasn’t necessarily to do with personal self-harm or anything… Just like easy,
clean and like doesn’t show the build-up of anything. Just like, almost like…
pristine female, like slicing her pristine, porcelain skin.” (Mia)
II. Self-harm as often hidden, and an unseen private behaviour – fear of
stigmatisation
“You know, I didn't really want to come forward about it, at the time. And,
yeah, just given there was such a stigma towards it but, that didn't reflect the
way I felt I was feeling at the time. Obviously I had mental health issues, but
I didn't feel like it was severe enough, I thought, I just sort of felt like if I was
to go to someone when I was actively engaged with it, I'd be, I don't know,
sectioned or something. I was just very afraid.” (Jack)
III. AYAs use self-harm to cope with painful feelings
“I used it as an escape if I was feeling um, very down, if I was uh, I was
feeling very depressed, I would self-harm. And I always thought that that's
my way of not feeling my emotional pain. Because I was more focused on
what I was feeling physically. So, it is my escape.” (Jasmine)
IV. Reactions to #CutforBieber and other self-harm related social media
trends
“It was interesting because at the time it was quite similar to what my sister
was involved in. These kind of cultish self-harm groups. You know what I
mean? It wasn’t because it was really out in the open but, I remember I was
completed disgusted by it, and at the same time, to me, it was like, I looked
at it with disbelief because I was like, ‘Who… are young girls really going to
cut themselves for Justin Bieber?’... But then it was just what my sister was
doing but, on a far larger scale. You know what I mean: where people just
encourage each other.” (Lily)

15. Domain III. Recovery from Deliberate Self-Harm
I. Difficulties encountered in overcoming self-harm behaviours
– easy access to DSH promoting sites
“I had, as soon as I stopped self-harming, I started drinking way
too much, anytime I kind of got overwhelmed. And then I started to
realise that was a problem... So, it's not, it's hard to find like, a
healthy coping mechanism 'cause otherwise I just start getting
really angry at people and I started lashing out.” (Kate)
“I feel like Tumblr is a very big thing for maintaining self-harm. And
I don't really know anyone who's been able to recover unless
they've like, deactivated their Tumblr and got off it completely for at
least a couple of months. And I did that with mine and then I, like,
re-joined and I've just used it for looking at, like, whatever I want
but not those kind of things (self-harm content). Just because it
can, I don't know if it'd be triggering for me now, but it can be very
hard to recover if you have access to that as soon as you want it.”
(Ava)
II. Satisfaction and pride in overcoming adversity
“And I thought that, you know, anything to kind of further
understand those kinds of behaviours, like self-harm, I thought
would be something I’d be willing to participate in… Good,
yeah, yeah. I was a little bit nervous before, because I saw it
[advertised] in the bathroom and I was like, ‘I want to do that’,
because I want to like, you know, I want to help, I want to
share my experience.” (Jack)
“I kind of feel like for me like, kind of, now, it kind of affects me
in a positive way to like talk about all that kind of stuff because
it kind of just reminds me of like, 'cause for me it's such kind of
a distant memory, which is a good thing because obviously like
shows I've moved on a lot.” (Olivia)

16. Domain IV. Need for Relevant and Informed Psycho-
education
I. Disclosure, help-seeking, and healthier coping mechanisms
“So, I contacted Niteline and that was very beneficial and I was
considering contacting the counselling service, but then I was like,
‘No, because I've done CBT, I have this full bank in my head’. So,
I texted my old therapist and said, like, ‘Can you send me, can
you just refresh me for a sec? Like, what do I do?’ And she just
needs to use words. As in, she’s like, ‘Go into Wise Mind’, do this,
do that, and she sent me a list of like, do this, this, and this and
that sorted me out as well.” (Lily)
“Um, probably my parents. Yeah. I'm quite close with them. Which
is, it was so strange, because they were very like, open about
mental health, but at the time they didn't share any of that,
whereas it’s only since, now that I'm, you know, I feel like I can
talk to them now.” (Jack)
II. A learning curve in engaging with social media and content
around self-harm
Mia: I don’t mean to censor young people, I think people should
be aware of the hardships in the world and things like that, but I
also think there is a degree of like… forcing like, viewing certain
distressing stories and stuff like that, that maybe people aren’t like
mature enough to take on-
Interviewer: So, when you talk about seeing these things and it
being distressing in some way, what do you mean by that?
Mia: Not nice to see. Like, just uncomfortable. Like, feeling
uncomfortable behind the screen when you’re like reading certain
genuinely honest but, distressing stories. Say ‘In Her Shoes’ for
the Repeal movement or like, I saw pictures today on Facebook
just scrolling through my feed from the pro-life side. And they were
particularly vivid and I was just like, ‘Wow I really don’t wanna see
that. Like, at all’. That makes me wanna disengage and cry.

17. Additional
relevant
content in
qualitative
data
I. AYAs understanding of DSH is far-reaching
“Self-harm, well I see it as, you know, doing things, consciously
or unconsciously, subconsciously, that will in the long-run affect
you, affect your well-being.” (Ryan)
“I probably used to think it was like physically harming yourself,
but in a way that wasn’t maybe a suicidal attempt or anything
like that. But now I would say even lack of self-care and things
like that can definitely impact you just as much and might be
just as harmful.” (Mia)
II. AYAs perception of DSH triggers is wide-reaching
“Just reading about it and I find, like, if you go online and you
start looking up, you find, uh, they tend to attach like peoples’
stories and their own experiences and I’d find when I’m reading
that I’m, that’s just, I’m like, ‘Oh god’. It just triggers me, like it
reminds me of myself and then I just want to do it all over
again.” (Kate)
“You’ll try to be something that you can’t be and then it just
kind of makes you feel shit and then you blame yourself for it.
‘Cause you know, kids kind of blame themselves for
everything.” (Olivia).

18. Strengths and Limitations
▪ Strengths
▪ Semi-structured interview allows flexibility and
collaboration
▪ Diverse sample in ethnicity, nationality
▪ Insider status as researcher: sharing language,
identity and base of experience inferring rapport and
genuineness (Asselin, 2003)
▪ Limitations
▪ Insider status → potential for bias (role of cross case
analysis with supervisor).
▪ Only two male participants, bias towards female
experience
▪ Scope of generalizability (though not a primary goal
in qualitative research).

19. Conclusion
Research question: What is the role of social media in
deliberate self-harm behaviours among adolescents and
young adults?
▪ Social media can have both positive and negative impact
on adolescents and young adult users
▪ AYA’s engaging in DSH behaviours may find that social
media maintains, promotes, or normalises these
behaviours
▪ Cyclical nature of relationship between DSH and social
media necessitates relevant and informed psycho-
education around potential impact of social media usage
on vulnerable AYA’s
▪ Recovery from DSH behaviours can be difficult with
continued social media usage however, there is pride and
satisfaction in overcoming these behaviours
▪ Mental health professionals should be aware of these
impacts on young people in both research and clinical
practice

20. Questions?

21. References
Anderson, M. & Jiang, J. (2018). Teens, social media & technology 2018. Retrieved from
http://www.pewinternet.org/2018/05/31/teens-social-media-technology-2018/
Carver, C. S. (1997). You want to measure coping but your protocol’s too long: Consider the Brief COPE. International
Journal of Behavioral Medicine, 4, 92-100.
Dyson, M.P., Hartling, L., Shulhan, J., Chisholm, A., Milne, A., Sundar, P., …Newton, A.S. (2016). A systematic review of
social media use to disucss and view deliberate self-harm acts. PLoS ONE, 11(5): e0155813. doi:
10.1371/journal.pone.0155813
Elliott, R. & Timulak, L. (2005). Descriptive and interpretative approaches to qualitative research. In J. Miles & P. Gilbert
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Jacob, N., Evans, R., & Scourfield, J. (2017). The influence of online images on self-harm: A qualitative study of young
people aged 16-24. Journal of Adolescence, 60, 140-147. doi: 10.1016/j.adolescence.2017.08.001
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10.1080/13669877.2015.1100660

22. References
Lewis, S., & Knoll, A.K.I. (2015). Do it yourself: Examination of self-injury first aid tips on YouTube. Cyberpsychology,
Behavior, and Social Networking, 18(5), 301-304. doi: 10.1089/cyber.2014.0407
Lewis, S.P., & Seko, Y. (2016). A double-edged sword: A review of benefits and risks of online non-suicidal self-injury
activities. Journal of Clinical Psychology, 73(3), 249-262. doi: 10.1002/jclp.22242
Perry, I.J., Corcoran, P., Fitzgerald, A.P., Keeley, H.S., Reulbach, U., & Arensman, E. (2012). The incidence and repetition
of hospital-treated deliberate self harm: Findings from the world’s first national registry. PLoS ONE, 7(2): e31663. doi:
10.1371/journal.pone.0031663
Ross, R.R., & McKay, H.B. (1979). Self-Mutilation. Lexington, MA: Lexington Books.
Social media. (n.d.). In Merriam-Webster online. Retrieved from https://www.merriam-
webster.com/dictionary/social%20media