TORONTO - YouTube videos illustrating cutting, burning and other methods of self-injury may have an impact beyond the online world in normalizing and possibly even reinforcing the behaviour among viewers, a new Canadian study suggests.
Researchers from the University of Guelph and McGill University looked at depictions of non-suicidal self-injury, or NSSI, on the popular video-sharing website. NSSI is described as the deliberate destruction of body tissue without suicidal intent.
Lead author Stephen Lewis said researchers are aware teens and young adults use the Internet most compared to other age groups, particularly for social networking. The same demographic also seems to report the highest rates of self-injury — consistently ranging from 14 to 24 per cent — and there's been some recent research looking at self-injury communication online, he noted.
Lewis, an assistant professor of psychology at the University of Guelph, said this led researchers to want to understand whether young adults communicating about self-injury was also occurring in some context on YouTube, given that it is among the major social networks.
For the study, published in the journal Pediatrics, a search for key words "self-injury" and "self-harm" were entered into YouTube's search engine in December 2009, with results sorted by number of views.
The top 100 videos, collectively viewed more than two million times, were analyzed. Half were categorized as character videos featuring one or more people. Lewis said the other 50 identified as non-character videos had no person at all, and may have been driven more by photos and text, for example.
In 90 per cent of the non-character videos, there were photos of self-injury. In total, 64 per cent of all videos had visual depictions of non-suicidal self-harm.
Researchers found cutting was the most common form of self-injury, followed by embedding of objects under the skin and burning. Hitting, biting, skin picking and wound interference were also observed, albeit less frequently.
Injuries occurred most on wrists or arms, followed by legs and then torso, with a lesser number of injuries in other locations, such as the face and neck.
Lewis said individuals typically seeking out such content online may have a history of self-injury.
"In that regard, I would think some of the risks that might be salient in terms of what we found could be things like self-injury possibly being reinforced if, in fact, these videos are repeatedly viewed by certain people," he said.
"It might also in some cases — not all, but some cases — foster e-communities or virtual communities in which self-injury is accepted and in which (you're) not necessarily ... going to see a message about getting help or trying to seek out professional help for self-injury."
Lewis said another concern might be something known as "triggering," in which some more vulnerable individuals with a history of self-injury may have a stronger urge in the moment to self-injure after seeing related imagery. More than half the videos did not provide a trigger warning.
"I think in that regard, we have quite a bit to understand in terms of whether this happens, and if it does, how it happens," said Lewis, adding that one of the next stages in the research will be to understand how young people view these videos.
Wendy Lader, a psychologist and co-founder of S.A.F.E. Alternatives, a U.S. treatment program for self-injurers, is concerned about the possible negative impact such content may have on viewers.
"We know in the field that there is something called contagion, that when people know of or see other people who have used this technique — and it seems to`work for them,' help them to feel better or it looks like it's something that's cool for some reason — that other people will try it," she said from St. Louis, Mo.
"So I don't think there's any question that this can lead other people to self-injure."
Lewis said it's difficult to say what the motivation behind each video was since their focus was more on content. But he noted individuals were usually sharing their own personal stories and experiences.
In fact, Lewis noted the majority of the videos were not about promoting self-injury. He believes this underscores an important point in trying to understand why people might post such content, such as perhaps wanting to try to educate people about what self-injury is.
"One common theme that we did notice was that they seem to have an educational or factual theme, so they showed facts and figures about self-injury with the attempt maybe of wanting other people to understand what this behaviour entails, maybe trying to dispel some of the myths and the stigma that are often linked with self-injury."
While researchers found the videos overall tended to be neutral in purpose with an educational, factual or melancholic tone, they noted few of the videos actively discouraged self-injury behaviour.
With the proliferation of such content online, Lader said it will be difficult to rein in or contain. The best clinicians can do is offer help to those in need, as well as help teachers and other professionals to better understand self-injury, she said.
"A lot of people's parents think they just want to stop the self-injury. So they want to threaten, they want to punish their kids, they think it's the behaviour that's the important part," she said.
"But it's really about happiness, understanding that self-injury is a coping strategy, and it's not bad in and of itself. It's unhealthy, but these kids are not being bad. They're trying to cope. And so we need to focus on helping them to learn how to cope in healthier ways."