by Nathan Lowry and Carol Ewert
Non-suicidal self-injury (NSSI) is a prevalent public health issue that affects millions of teenagers and young adults each year. With the ever-increasing use of social media among youth, it is important to understand how NSSI is represented online. The goal of the current study was to update the research of Lewis and colleagues (2010) to examine how NSSI is represented on YouTube via a content analysis. We also examined whether certain types of NSSI related videos may encourage or trigger viewers to engage in NSSI themselves by coding comments posted in response to videos. For this study, we searched “self-harm” and used the view count filter to select the top 25 most viewed videos within the past three years. We coded the content using categories from a previous study conducted by Dr. Colleen Jacobson’s research team (Tigershtrohm et al., 2016). Our results showed that 28% of all videos fell under the “bashing” category, 20% fell under the “providing support category” and 20% fell under the “current acts” category. Our results also showed that 36.8% of all comments were self-disclosure, 36.4% were feedback towards the poster and only 1% of all comments indicated the viewer was triggered. Our results lead us to the conclusion that, though the majority of videos fell under the category “bashing,” the majority of comments discouraged NSSI and did not trigger viewers.
Non-suicidal self-injury (NSSI), such as cutting or burning oneself without suicidal intent, is a prevalent public health issue that affects millions of teenagers and young adults each year. Those who engage in NSSI are at increased risk for various forms of psychopathology, including suicide attempts (Mitchel, Wells, Priebe& Ybarra, 2014). Lifetime prevalences for non-suicidal self-injury are as follows: 17% of adolescents, 13% of young adults, 5% of adults (Swannell et al., 2014). It has also been found that 27% of adolescents have engaged in at least one type of self-injury (Richardson, 2012). The current study is based on the Lewis and colleagues study (2010), and aims to update that study.
The internet is an ever-evolving landscape, requiring research to be revisited and updated consistently. In recent years, the internet has become even more accessible, and now 93% of American youth use the internet (Richardson, 2012). The internet has also become more popular with people who commit self-harm. 16% of people who admit to self-harm have visited suicide or self-harm related websites in the past year (Mitchell et al., 2014). In addition to that, 1% of 1,560 internet using youth had visited a website that encouraged self-harm and/or suicide (Mitchellet al., 2014). Therefore, though internet using youth may not be committing self-harm, they are visiting websites that encourage it, making them more susceptible to starting to commit self-harm. One website, YouTube, has seen an increased rise in popularity in the last decade. YouTube is a website that allows people to upload videos to share, accessible to anyone who visits it. According to the YouTube statistics page, “YouTube overall reaches more 18-34 and 18-49 year olds than any cable network in the U.S.”. This shows the accessibility and popularity websites like YouTube have gained. YouTube videos are also accessible to all ages and research has discovered that adolescents look to YouTubers as serious role models. “74% of 14-18 year-olds use YouTube, more than Facebook or Twitter” – The Intelligence Group.
The previous study conducted by Lewis and colleagues (2010) collected data on the types of non-suicidal self-injury videos and viewer comments. It concluded that there has been a normalization of NSSI through YouTube videos, which may reinforce NSSI behaviors. This is supported by information provided in the article “Self-Injury Behaviors in Cyberspace”, written by Jamie Marie Duggan. Originally, Duggan states NSSI was most frequently found among people with severe mental illness, such as psychotic disorders and borderline personality disorder. Duggan states, “during the 1990’s and early part of the new millennium, growing awareness of NSSI among community populations of youth prompted inquiry into the scope and nature of the “new” and “puzzling” disorder (Duggan, n.d.). Duggan goes on to say that this growing awareness and curiosity would eventually lead NSSI to be mentioned in music, movies, and news reports, further increasing its exposure to the public. In another research article Duggan states more specifically that, “Results suggest that peer driven, informal websites have a variety of triggering content and are accessed more often than professionally driven websites” (Duggan et al., 2011). Therefore, peer based websites, such as YouTube, appear to be a greater threat than professionally made websites to individuals with NSSI behavior. Like the previous studies conducted by Lewis and Duggan, the current study collected data on NSSI videos on YouTube, as well as comments associated with these videos, while going further and examining the relationship between video and comment types.
For this study, we searched “self-harm” within YouTube and used the view count filter to select the top 25 most viewed videos within the past three years, from 2013 to 2016. We then coded the content using categories from a previous study conducted by Jacobson’s research team (Tigershtrohm et al., 2016). Those ten categories were regret about past NSSI, current urges, positive effects of NSSI, relapse, recovery, providing support/encouraging against NSSI, clarifying misconceptions, bashing/making fun of self-harm, mention of co-morbid mental illness, and current acts (Table 1). We also noted how many views, likes, and dislikes each video had. After establishing the categories of the video posts, we also categorized 20 comments made about each video (n = 500). We used the categories from the Lewis et al. (2011) study to sort the comments (Table 2). Those categories were self-disclosure, feedback to poster, factual information, help related comments, NSSI methods and strategies, viewer does not engage in NSSI, triggers, and indecipherable. After coding the videos and comments, the coders compared their data. When there was a disagreement in coding a video or comment, the coders went back to the video or comment and made a decision together on how to code the video or comment.
The total number of views of the top 25 videos was 2,466,047. The total number of likes was 10,2310, and the total number of dislikes was 12,682. The three most common video categories were “Bashing” (28%), “Providing Support” (20%) and “Current Acts” (20%). The least common video category was “Regret about NSSI” (4%). The “Bashing” videos received an average of 47,366.9 “likes” and 6,637.3 “dislikes”. The “Providing Support” videos received an average of 30,847.6 “likes” and 464.8 “dislikes”. The “Current Acts” videos received an average of 12,363.7 “likes” and 1,179.8 “dislikes” (Figure 1 & 2).
NSSI Video Comments
The three most common comment categories were, “self-disclosure” (36.8%), “feedback to poster” (36.4%) and “Indecipherable” (22.2%). The least common comment type was “Triggers” (1%). (Figure 3).
Relation Between NSSI Video Type and Comment Type:
The two most common comment types for the “Bashing” category were, “feedback to uploader” (45.7%) followed by “self-disclosure” (32.9%). The two most common comment types for “Providing Support” were also “feedback” (44%) followed by “self-disclosure” (33%). The two most common comment types for “Current Acts” were “self-disclosure” (44.4%) followed by “feedback” (23.2%).
YouTube is a prevalent social media site, accessible to all ages. Adolescents and young adults look to YouTube not only for entertainment, but also for inspiration and role models. The current study sought to examine how NSSI is portrayed on YouTube. Unfortunately, the most common NSSI video category of the 25 most commonly viewed was “Bashing”. However, the most common comments towards that category were “feedback to poster”, and the feedback was primarily negative. Additionally, the “Bashing” video category received the most “dislikes” in comparison to the other common video categories, “Providing Support” and “Current Acts”, which received more “likes”. The most common comment responses to the most popular video categories were, “self-disclosure” and “feedback to uploader”. Viewers were either telling the YouTuber about themselves or providing them with feedback in regards to the video. Fortunately, the least common comment type was “triggers”. This shows that despite the many different kinds of videos and comments, hardly any of the viewers were triggered to engage in NSSI after watching the videos. Interestingly, in the Lewis study (2010), the top 100 videos were viewed 2,375,059 times, whereas now the top 25 videos in the last 3 years have been viewed 2,466,047 times. This shows an increased interest in NSSI. Similar to the Lewis study (2010), our results found that the most common comment categories were “self-disclosure” followed by “feedback to poster”. In regard to future research, further studies could explore the reason for the elevated viewing of NSSI videos on YouTube, and the context of the feedback to video poster; if it was positive or negative.
Limitations and Future Research
Due to the scale of YouTube, this study was only able to observe a limited amount of YouTube videos. All of these videos were interpreted and coded without the input of the poster. We were also only able to collect limited information about the posters themselves, and have no demographic information. Future research should get direct input from people who post and view regarding the impact of NSSI content.
The data presented in this study indicates that people who are utilizing social media sites for self-harm expression are likely using these sites as a confessional platform or as a way to reach out to others. Understanding the role that social media sites play in the expression and sharing of NSSI information could be essential in understanding this mental illness and how it is manifesting within our society. Clinicians should assess whether clients are posting/perusing on social media, and if so, encourage use of different coping mechanisms and self-soothing techniques.
Duggan, J. M., Heath, N. L., Lewis, S. P., &Baxter, A. L., (2011) An Examination of the Scope and Nature of Non-Suicidal Self-Injury Online Activities: Implications for School Mental Health Professionals. School Mental Health;March 2012, Volume 4, Issue 1, pp 56–67.
Duggan, J., M. (n.d.). Self-Injury Behaviors in Cyberspace.McGill University, Canada.
Lewis et al. (2012). Non-suicidal self-injury, youth, and the Internet: What mental health professionals need to know.Child and Adolescent Psychiatry and Mental Health 2012 6:13.
Lewis, S.P., Heath, N., St Denis, J., and Noble, R.(February 2011). The Scope of Nonsuicidal
Self-Injury on YouTube.Pediatrics 2011;127;e552
Mitchell, K. J., Wells, M., Priebe, G., & Ybarra, M. L. (2014). Exposure to Websites that Encourage Self-Harm and Suicide: Prevalence Rate and Association with Actual Thoughts of Self-Harm and Thoughts of Suicide in United States. Journal of Adolescence, 37(8).
Richardson, B. G. (2012). Minimizing Social Contagion in adolescents who self injure: Considerations for group work, residential treatment, and the internet. Journal of Mental Health Counseling, 34(2), 121-132.
Swannell, S., Oam, G. M., Krysinska, K., Kay, T., Olsson, K., & Win, A. (2010). Cutting on-line: Self-injury and the internet. Advances in Mental Health
Tigershtrom, A., Waldron, L., & Jacobson, C. M. (April 2016). Examining the presence of non-suicidal self-injury on social media websites. Poster presentation at the Biennial Meeting of the society for Research on Adolescence: Baltimore, MD.
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