A Canadian study of nonsuicidal self-harm videos posted on YouTube suggests they could be reinforcing self-injury behavior and urges professionals working with young people to make themselves aware of their scope and content.

A report of the study, by researchers from the University of Guelph in Ontario and McGill University in Montreal, Quebec, appeared online on 21 February in the journal Pediatrics.

Lead researcher, Dr Stephen Lewis, Professor in the Department of Psychology at Guelph, told the media there was an alarming trend in teenagers posting videos on YouTube showing self-cutting and other forms of self-harm.

He and his colleagues suggested vulnerable teenagers might see this behavior as acceptable and difficult to overcome, leading them to harm themselves.

The study is thought to be the first to examine the effect, especially on young people, of the most popular depictions of self-harm shown on YouTube videos.

YouTube is a sharing Internet website where anyone can upload a video for others to view. You don’t have to be a registered user to view videos, but you have to register with the site to upload videos.

YouTube, now a subsidiary of Google, started in late 2005 and while no-one appears to know the exact number, today it is thought to contain tens of millions of videos, mostly uploaded by individuals.

The Internet can be a good and bad thing for vulnerable young people, as Lewis explained:

“Many youth who self-injure may go online to find support, but at the same time they may see videos that could be harmful if self-injury is depicted as typical behaviour or if viewing these videos triggers the behaviour.”

In their background information, Lewis and colleagues wrote that between 14 and 24% of teenagers and young adults have self-injured at least once. They define self-injury as the “deliberate destruction of one’s own body tissue”, for instance by cutting or burning, without intending to commit suicide.

Lewis said the idea that teenagers do it for attention is a “misconception” because it’s often secretive.

“Teenagers typically self-injure to cope with negative emotions,” said Lewis.

For their study, the researchers did Google searches of YouTube using the keywords “self-injury” and “self-harm” and selected the 50 most viewed videos showing an actual person (including some live footage of self-injury), and the 50 most viewed that did not show a person but descriptions and photographs of self-injury.

The 100 videos had been viewed more than 2 million times altogether, and most of them showed quite graphic photographs of self-injury.

From these top 100 videos, the researchers also found that:

  • Cutting was the most common form of self-injury shown in both types of video (the in-person ones and the description with images ones); 58% of them had no warning about this.

  • 80% were accessible to a general audience.

  • The viewers rated the videos highly (mean score out of 5.0 was 4.61, SD 0.61).

  • The videos were selected as favorites over 12,000 times.

  • 53% of the tone of the content was factual or educational.

  • 51% of the tone conveyed a message of hopelessness (described as “melancholic” in the study).

  • Explicit pictures of self-injury were common: 90% of the ones showing an actual person had them, while 28% of the description and photo ones had images of “in-action nonsuicidal self-injury”.

  • Videos containing description and images only received more views and comments than those depicting an actual person.

Lewis and colleagues concluded that the type of non-suicidal self-injury videos on YouTube may encourage viewers to regard this behavior as normal and because they can watch them again and again, may also reinforce self-harming behavior.

“Graphic videos showing nonsuicidal self-injury are frequently accessed and received positively by viewers .These videos largely provide nonsuicidal self-injury information and/or express a hopeless or melancholic message,” they added, and suggested that professionals who work with young people who perform acts of self-harm should be aware of them and what they contain.

In a press statement, Lewis emphasized that:

“These videos are worrisome because the nature of the images and tone may elicit an urge in those already at risk of self-injury to harm themselves, and may send the message that self-injury is acceptable or that there is little point in seeking help.”

He said young people are the most likely to use the Internet for social interaction, and this could be more pronounced among those who self-harm – they could be sharing this video content – something mental health workers and doctors who work with teens who self-harm should be aware of.

“Right now they might not think to ask youth about their Internet activity but its information that could be important to integrate into a person’s assessment and treatment plan,” he explained.

Parents should also keep themselves informed about these videos, said Lewis, so they can discuss issues of self-injury openly with their teenagers and talk about the risks that might be involved from looking at them online.

Lewis now plans to go on to find ways to reach and help teenagers who use the Internet to share their experiences of self-harm.

The Interdisciplinary National Self-Injury in Youth Network Canada (INSYNC), says that the most common forms of Non-suicidal Self-Injury (NSSI) include self-cutting, burning, scratching and hitting, and are among a broader set of self-injury behaviors that may also include swallowing more medication than the prescribed or generally recognized dose.

“The Scope of Nonsuicidal Self-Injury on YouTube.”
Lewis, Stephen P., Heath, Nancy L., St Denis, Jill M., Noble, Rick
Pediatrics, published online first 21 Feb 2011.
DOI:10.1542/peds.2010-2317

Additional sources: University of Guelph (news release, 21 Feb 2011), wikipedia (YouTube), INSYNC (website).

Written by: Catharine Paddock, PhD