Digital Self-Harm Among Adolescents

Abstract

Purpose:
Despite increased media and scholarly attention to digital forms of aggression directed toward adolescents by their peers (e.g., cyberbullying), very little research has explored digital aggression directed toward oneself. "Digital self-harm" is the anonymous online posting, sending, or otherwise sharing of hurtful content about oneself. The current study examined the extent of digital self-harm among adolescents.

Methods:
Survey data were obtained in 2016 from a nationally representative sample of 5,593 American middle and high school students (12-17 years old). Logistic regression analysis was used to identify correlates of participation in digital self-harm. Qualitative responses were also reviewed to better understand motivations for digital self-harm.

Results:
About 6% of students have anonymously posted something online about themselves that was mean. Males were significantly more likely to report participation (7.1% compared to 5.3%). Several statistically significant correlates of involvement in digital self-harm were identified, including sexual orientation, experience with school bullying and cyberbullying, drug use, participation in various forms of adolescent deviance, and depressive symptoms.

Conclusions:
Digital self-harm is a new problem that demands additional scholarly attention. A deeper inquiry as to the motivations behind this behavior, and how it correlates to offline self-harm and suicidal ideation, can help direct mental health professionals toward informed prevention approaches.

Full text

Original article
Digital Self-Harm Among Adolescents
Justin W. Patchin, Ph.D.
a
,
*
, and Sameer Hinduja, Ph.D.
b
a
University of Wisconsin-Eau Claire, Eau Claire, Wisconsin
b
Florida Atlantic University, Jupiter, Florida
Article history: Received February 24, 2017; Accepted June 15, 2017
Keywords: Cyberbullying; Self-cyberbullying; Digital self-harm; Self-harm; Suicide; Depressive symptoms
ABSTRACT
Purpose: Despite increased media and scholarly attention to digital forms of aggression directed
toward adolescents by their peers (e.g., cyberbullying), very little research has explored digital
aggression directed toward oneself. “Digital self-harm”is the anonymous online posting, sending,
or otherwise sharing of hurtful content about oneself. The current study examined the extent of
digital self-harm among adolescents.
Methods: Survey data were obtained in 2016 from a nationally representative sample of 5,593
American middle and high school students (12e17 years old). Logistic regression analysis was used
to identify correlates of participation in digital self-harm. Qualitative responses were also reviewed
to better understand motivations for digital self-harm.
Results: About 6% of students have anonymously posted something online about themselves that
was mean. Males were significantly more likely to report participation (7.1% compared to 5.3%).
Several statistically significant correlates of involvement in digital self-harm were identified,
including sexual orientation, experience with school bullying and cyberbullying, drug use,
participation in various forms of adolescent deviance, and depressive symptoms.
Conclusions: Digital self-harm is a new problem that demands additional scholarly attention. A
deeper inquiry as to the motivations behind this behavior, and how it correlates to offline self-
harm and suicidal ideation, can help direct mental health professionals toward informed pre-
vention approaches.
Ó2017 Society for Adolescent Health and Medicine. All rights reserved.
IMPLICATIONS AND
CONTRIBUTION
This study empirically ex-
plores digital self-harm be-
haviors among middle and
high school aged youth with
a large nationally represen-
tative sample. Several sig-
nificant covariates were
identified, including expe-
rience with bullying,
depression, and adolescent
problem behaviors.
Over the last decade, teens have embraced and exploited
social media and the online world to engage in self-expression
and self-construction, explore the boundaries of their identity,
and come into their own [1e3]. During this transformative sea-
son of life, many youth are using communications technology in
predominantly positive and productive ways to meet certain
psychological, emotional, social, and relational needs [4].
Others, however, are meeting those needs in maladaptive ways
that trouble the professionals and families who care for them.
One newly identified online behavior of concernedigital
self-harm occurs when an individual creates an online account
and uses it to anonymously send hurtful messages or threats
to oneself. These behaviors first entered the public spotlight in
2013 when it was learned that 14-year-old Hannah Smith, from
Leicestershire, England, had anonymously sent hurtful messages
to herself on the social media platform Ask.fm in the weeks
leading up to her suicide [5].
Author Biographies: Justin W. Patchin is a Professor of Criminal Justice at the
University of Wisconsin-Eau Claire. He received his Ph.D. in Criminal Justice from
Michigan State University. Since 2002, he has been exploring the intersection of
teens and technology, with particular focus on cyberbullying, social networking,
and sexting. Sameer Hinduja is a Professor of Criminology and Criminal Justice at
Florida Atlantic University. He received his Ph.D. in Criminal Justice from
Michigan State University. His research seeks to understand the causes and
consequences of various forms of online victimization and to identify best
practices in prevention and response.
*Address correspondence to: Justin W. Patchin, Ph.D., University of
Wisconsin-Eau Claire, 105 Garfield Avenue, Eau Claire, WI 54702-4004.
E-mail address: patchinj@uwec.edu (J.W. Patchin).
www.jahonline.org
1054-139X/Ó2017 Society for Adolescent Health and Medicine. All rights reserved.
http://dx.doi.org/10.1016/j.jadohealth.2017.06.012
Journal of Adolescent Health xxx (2017) 1e6

Much attention in clinical, school, and community settings
has been given to traditional forms of self-injury among teens
(e.g., cutting and burning) [6], not only because of the damage
that is physically done and the internal turmoil it betrays, but
also because self-harm has been linked to suicide [7e11 ]. The
online variant of self-harmdalso known as self-cyberbullying,
cyber self-harm, or self-trollingdhas only recently been identi-
fied and has therefore not yet been adequately examined despite
preliminary evidence that a nontrivial amount of youth have
engaged in the behavior [12,13]. We use the term “digital
self-harm,”which we define as the “anonymous online posting,
sending, or otherwise sharing of hurtful content about oneself.”
This conceptualization encompasses self-harm as it occurs
through SMS, email, social media, gaming consoles, web forums,
virtual environments, and any other online platform yet to be
conceived.
In the text that follows, we briefly summarize the extant
literature on adolescent self-harm with particular focus on
prevalence rates and motivations. This serves as the backdrop for
the current work, which utilizes a nationally representative
sample of U.S. youth to determine the extent to which those aged
12e17 years are engaging in digital self-harm. Apart from parsing
out how certain demographic variables differentiate participant
behaviors, we examine the relationship to several salient cova-
riates such as bullying and cyberbullying victimization, drug use,
participation in traditional forms of deviance, and depressive
symptoms. After discussing the findings, we provide suggestions
for future work to help society better understand and address
this emerging behavior.
The nature and extent of adolescent self-harm
Research among general samples of adolescents across the
world suggests that approximately 13%e18% engage in self-
injurious behaviors during their lifetime and that this behavior
has been on the rise over the last two decades [14,15]. To be sure,
prevalence rates have varied based on what behaviors are
considered. Typical conceptualizations include cutting, scratch-
ing, biting, or hitting (oneself); abusing pills; eating disorders;
and/or reckless or bone breaking behaviors [16].
An adolescent’s decision to self-harm may not be as much a
call for help as a demonstration of felt pain and distress. Indeed,
an analysis of studies examining self-reported reasons for
physical self-harmdincluding those featuring adolescent
samplesdfound a widespread theme of affect regulation. Spe-
cifically, top reasons endorsed were the desire to stop bad feel-
ings (such as emptiness, abandonment, guilt, or desperation), to
release tension and stress, or because the respondent was un-
happy or depressed [17]. Other explanations include self-hatred
and self-punishment and to a lesser extent antidisassociation
(the desire to feel something other than numbness),
interpersonal-influence (to get others to act differently or to care
more), sensation seeking (to feel excitement or stimulation), to
prevent suicidal behavior or attempts, or to exert control and
ownership over one’s body [18].
Social media researcher boyd [13] first wrote about digital
self-harm in a blog post in 2010 and speculated that it may reflect
a cry for help, a desire to look cool, or an effort to trigger com-
pliments as others defend against the harassment. A year later,
Englander [12] explored the phenomena among a sample of 617
college students and found that 9% had done so in high school
(13% of boys and 8% of girls). This study also found that while
depression did not differentiate between those who engaged in
digital self-harm, drug and alcohol use did [12]. Englander [12]
found that both males and females engaged in digital self-harm
mostly to gain the attention of peers. Interestingly, girls did it
to prove they could handle it, encourage others to worry, or get
attention from adults, while boys did it because they were mad at
someone and wanted to start a fight [12].
It has also been suggested that digital self-harm might relate
to empathy seeking, serve as a way to demonstrate a measure of
toughness and strength, help clarify whether certain negative
perceptions of them are universally shared by others, and make
their pain more visible and, consequently, more real [19]. That is,
pain may be not only something they feel, but something they
perform in order to elicit a desired response from others [19]. The
ubiquity of social media and the way in which youth present and
represent themselves in order to obtain attention, validation, and
feedback from an audience may enhance the likelihood they
choose online spaces as the preferred venue through which they
can affect and reach others.
The current study seeks to expand upon these early obser-
vations by systematically examining digital self-harm among
adolescents. We inquire both about participation in digital
self-harm and motivations for such behavior. In addition, we
examine if certain correlates identified in offline self-harm
research also apply to digital forms of self-harm. We discuss
their relevance before detailing how research on digital self-
harm might further develop to better inform our understand-
ing and response.
Methods
Data
Data for the current work came from a survey administered to
a nationally representative sample of English-speaking 12- to
17-year-old middle and high school students residing in the U.S.
A survey was distributed digitally between August and October
2016 that examined perceptions of, and experiences with,
bullying, cyberbullying, and related teen behaviors. Parental
consent and child assent were obtained for all participants, and
the survey took 23 minutes to complete on average. Three
separate research firms were contracted with to distribute the
instrument through four different sample sources via email.
Although this data collection practice is not well entrenched in
the history of survey research, such a cost-effective and
comparatively efficient approach has been utilized in recent
years by other researchers [20]. Furthermore, it seems especially
appropriate for exploratory inquiries into relatively new phe-
nomena among youthful populations.
With regard to the sampling design, nested age, sex, and re-
gion quotas were used to ensure a diverse sample of respondents
that was representative of students across U.S. After the data
were cleaned, the final sample size totaled to 5,593 adolescents.
The final response rate for this survey was approximately 15%.
Admittedly, this is lower than other methods of data collection
and not ideal [21,22] but still satisfactory for a preliminary in-
quiry to an understudied problem. It is worth mentioning that
findings from the current study on other measures (e.g., cyber-
bullying) were comparable to previous research we have con-
ducted using different methodologies [23]. We are therefore
more confident in the results obtained. Nevertheless, the rela-
tively low response rate, and limitations to the methodology
J.W. Patchin and S. Hinduja / Journal of Adolescent Health xxx (2017) 1e62

overall (e.g., email recruitment to participate), should be kept in
mind when interpreting the results [24,25]. The project meth-
odology was approved by the Institutional Review Board of
University of Wisconsin-Eau Claire (PATCHINJ51502016).
Measures
Digital Self-Harm. Two items were used to assess youth
involvement in digital self-harm: (1) “In my lifetime, I have
anonymously posted something online about myself that was
mean”and (2) “In my lifetime, I have anonymously cyberbullied
myself online.”The response set for these questions was “never,”
“once,”“a few times,”and “many times,”where “never”¼0 and
“many times”¼4. Responses were dichotomized with no
involvement coded as 0, while any involvement was coded as 1.
Respondents were also asked to describe why they engaged in
the behavior(s) via a single open-ended question.
Covariates. As an exploratory study, we first examined de-
mographic variables such as age, sex, and race. Age was included
as a continuous variable representing the respondent’s age in
years (range 12e17; mean ¼14.5). Generally, previous research
has found that self-harm is inversely related to age and occurs
(along with suicidal ideation) disproportionately among youth
and young adult populations [26].Sex was a dichotomous item
where 1 ¼male and 0 ¼female. The sample was evenly divided
across sex (49.9% female and 49.7% male). Recent research in-
dicates that traditional self-harm becomes more prevalent
among boys during the later teen years, while girls participate
more frequently than boys earlier in adolescence [27]. To note,
Englander [12] found that boys were more likely to engage in
digital self-harm. Race was a categorical variable where
respondents indicated if they were white/Caucasian, black/
African-American, Hispanic, Asian, American Indian/Native
American, multiracial, or another race. These groups were
collapsed into the following four categories: 1 ¼white,
2¼African-American, 3 ¼Hispanic, and 4 ¼other. Sixty-six
percent of the sample identified as white, 12% African-
American, 11.9% Hispanic, and 10% identified as multiracial or
some other race. Research on race and ethnicity largely shows
that self-harming occurs among people from all backgrounds,
although there may be regional variations to consider [28].
Next, we explored a series of other variables that could be
related to digital self-harm. Sexual orientation is a dichotomous
variable where students who identified as heterosexual were
coded as 0 and those who identified as lesbian, gay, bisexual,
questioning, or other were coded as 1. Previous research has
found that sexual minority youth are more likely to engage in
traditional self-harm [29].
Victim of school bullying and victim of cyberbullying were
collected as categorical variables with a response set of never (0),
once (1), a few times (2), and many times (3). Both were
dichotomized into single-item variables where students who
reported that they had been bullied at school (or online) at some
point in the 30 days preceding the survey (1 or higher) were
coded as 1, while those who were not were coded as 0. School
bullying victimization has been moderately to strongly linked
with self-harming behaviors in both cross-sectional and longi-
tudinal studies involving adolescents, and the limited research
on cyberbullying victimization indicates a similar trend [30e32].
Depressive symptoms was a dichotomous single-item variable
where students who responded yes to the following question
were coded as 1: “In the past year, did you feel so sad or hopeless
almost every day for two weeks or more in a row that you
stopped doing some of your usual activities?”Those who
responded no were coded as 0. Various indicators and manifes-
tations of depression have been consistently associated with
self-harm, particularly among youthful populations [33].Offline
self-harm was a dichotomous single-item variable where stu-
dents who responded yes to the following question were coded
as 1: “In the past year, have you ever hurt yourself on purpose in
any way (for example, by taking an overdose of pills or by cutting
yourself).”Those who responded no were coded as 0. No
previous research has explored the link between traditional
self-harm and digital self-harm, but we hypothesize that they are
related [7e11] .
Used drugs was a dichotomous variable where students who
said they had used (1) marijuana or (2) other illegal drugs in the
previous 30 days were coded as 1, while those who had not were
coded as 0 (Cronbach’s
a
¼.54). Some research has found that
alcohol and drug use are associated with self-harm among girls
[34], while other studies have found it a correlate among both
sexes [33].Deviance was a dichotomous variable where students
who said they had (1) stolen money or things worth $100 or less,
(2) stolen money or things worth more than $100, or (3) attacked
someone with the idea of seriously hurting them (all in the past
30 days) were coded as 1, while those who had not participated
in any of these activities were coded as 0 (Cronbach’s
a
¼.73).
Delinquency and aggression have been linked to self-harm
among populations of Korean [35] and Finnish youth [36]
based on parent evaluations of their child’s behavioral problems.
Analysis
We first present the prevalence rates of digital self-harm,
using both operationalizations of the behavior (“I have anony-
mously posted something online about myself that was mean”
and “I have anonymously cyberbullied myself”). We utilized
t-tests to determine if there were any statistically significant
differences across sex, race, and age with respect to respondent
involvement in digital self-harm. We then computed a series of
binary logistic regression models, testing the unique influence of
each of the covariates of interest while controlling for age, sex,
and race. Quantitative statistical analyses were performed using
SPSS 18, and p<.05 was considered statistically significant (two-
tailed). Finally, responses to the open-ended questions were
reviewed by both authors to identify recurring themes or general
patterns of motivations for participation in digital self-harm. We
did not develop categories ahead of time but instead relied on
the data to construct themes during our review [37].
Results
As shown in Table 1, 6.2% of students in our sample reported
that they had “anonymously posted something online about
myself that was mean.”Among those who had, about half (51.3%)
said they did it just once, about one-third (35.5%) said they did it
a few times, while 13.2% said they had done it many times.
Similarly, 5.3% said they had “anonymously cyberbullied myself.”
Again focusing on those who had, 44.4% had done it once, 37.2%
had done it a few times, and 18.4% had done it many times. When
looking at demographic factors related to digital self-harm, boys
were significantly more likely to report participating in the
behavior (in line with the findings by Englander [12] involving
J.W. Patchin and S. Hinduja / Journal of Adolescent Health xxx (2017) 1e63

college students), while neither race nor age was significantly
related to digital self-harm.
Table 2 presents results of the binary logistic regression an-
alyses. Even though the table lists all of the measures together,
each covariate of interest was entered separately in the models,
while controlling for age, race, and sex. Just over 7% of our sample
identified as nonheterosexual and those who did were three
times more likely to post something online that was mean about
themselves than heterosexual students and 2.75 times more
likely to say they cyberbullied themselves. Nearly 40% of students
had been bullied at school, and 16.5% had been bullied online.
Both groups were significantly more likely to have participated in
digital self-harm than those who were not bullied. Specifically,
victims of cyberbullying were nearly 12 times as likely to have
cyberbullied themselves compared to those who were not vic-
tims. Similarly, those who reported using drugs or participating
in deviance, had depressive symptoms, or had previously
engaged in self-harm behaviors offline were all significantly
more likely to have engaged in digital self-harm.
To better understand the nature and motivations for this
behavior, we included an open-ended question where we simply
asked respondents to tell us why they had engaged in digital self-
harm. Among the 347 students who reported that they had
posted something mean about themselves anonymously online,
160 provided comments about why they did it (see Table 3). Most
comments centered around certain themes: self-hate (32), “That
time was a time full of hate for myself;”attention seeking (13),
“So people could see that people bully me too and that I could
be mean to other people because ‘people’were mean to
me;”depressive symptoms (15), “I did it mainly out of depression
and a time that I was feeling suicidal; ”and, to be funny (24), “Ido
not like hurting others, but it’s easy to make fun of myself. I was
bored and did it to maybe make others laugh as a joke.”Others
were simply doing to see if anyone would react (20), “A couple
times to see how people I know would react so I would know if
they were talking about me behind my back.”
Discussion
Digital self-harm first gained public attention with the suicide
of 14-year-old Hannah Smith in 2013. In November 2016, a
15-year-old girl from Texas took her own life after apparently
posting anonymous comments toward herself saying she was
“ugly”and “should kill herself.”[38]. Despite these heartbreaking
examples, very little academic attention has been directed
toward this problem. The current work is the first comprehensive
empirical investigation of this behavior among middle and
high school students. According to our data, about one in twenty
12- to 17-year-olds have participated in the behavior. In addition,
students who reported being depressed or participating in off-
line self-harm were significantly more likely to be involved in
digital self-harm. Research has shown that self-harm and
depression are linked to increased risk for suicide and so, like
physical self-harm and depression, it is possible that digital self-
harm behaviors might precede suicide attempts [7e9]. More
research is necessary to better understand the temporal ordering
of these behaviors and experiences. For example, does depres-
sion lead to self-harm (online or offline) which then leads to
suicidal thoughts or attempts? Alternatively, do suicidal
thoughts manifest themselves as various forms of self-harm that
can surface offline and/or online?
The findings also illustrate a connection between digital self-
harm and experience with bullying. Those who were bullied
(either at school or online) were significantly more likely to
report that they had engaged in digital self-harm. This was
evidenced in the open-ended responses as well. A 16-year-old
white female wrote: “After this happened at school, and online,
I became very depressed. I didn’t like myself very much. I felt like
I deserved to be treated that way, so I thought I would get in on
the ‘fun’.”Research has shown that some who have self-harmed
have experienced interpersonal conflict or relationship break-
down [6,16]. As such, it is logical that relational conflict, drama,
Table 1
Experience with digital self-harm
Sample
size (%)
I have anonymously
posted something
online about myself
that was mean (%)
I have anonymously
cyberbullied
myself (%)
Total 5,593 6.2 5.3
Male 2,777 (49.7) 7.1
a
6.3
a;**
Female 2,792 (49.9) 5.3 4.2
White
b
3,691 (66.0) 6.4 5.4
African-American 637 (12.0) 5.8 4.8
Hispanic 667 (11.9) 4.8 4.1
Other 561 (10.0) 7.3 6.0
12 850 (15.2) 6.1 4.4
13 1,011 (18.1) 6.9 5.9
14
b
917 (16.4) 5.7 5.0
15 1,018 (18.2) 7.4 7.2
16 946 (16.9) 5.6 4.2
17 851 (15.2) 5.5 4.6
a
p<.01, t-test.
b
represents reference group.
Table 2
Logistic regression examining predictors of digital self-harm
% I have anonymously posted something online about myself that was mean I have anonymously cyberbullied myself
B (S.E.) Exp(B) 95% CI B (S.E.) Exp(B) 95% CI
Nonheterosexual 7.2 1.09 (.16) 3.00
***
2.19e4.04 1.01 (.21) 2.75
***
1.82e4.15
Victim of school bullying 38.6 1.34 (.13) 3.82
***
2.99e4.89 1.71 (.16) 5.53
***
4.01e7.64
Victim of cyberbullying 16.5 2.02 (.12) 7.51
***
5.99e9.41 2.48 (.15) 11.88
***
8.87e15.92
Deviance 6.3 2.21 (.19) 9.14
***
6.35e13.16 2.57 (.20) 13.07
***
8.85e19.31
Used drugs 9.0 1.60 (.19) 4.95
***
3.43e7.16 1.84 (.21) 6.28
***
4.20e9.39
Depressive symptoms 15.4 1.58 (.16) 4.86
***
3.57e6.62 1.64 (.18) 5.17
***
3.63e7.36
Offline self-harm 7.2 .87 (.08) 2.38
***
2.03e2.79 .98 (.09) 2.67
***
2.26e3.16
***p<.001.
All analyses include individual indicator while controlling for age, sex, and race.
CI ¼confidence interval; SE ¼standard error of the mean.
J.W. Patchin and S. Hinduja / Journal of Adolescent Health xxx (2017) 1e64

and strifedmanifested in school based or online bullyingd
might trigger self-harming behaviors because of the dysphoria it
produces.
It was also evident from the qualitative data that many who
had participated in digital self-harm were looking for a response.
Of the 160 responses to the question of why the youth engaged in
digital self-harm, nearly half (73) included some reference to
others. For example, a 14-year-old white male from Wisconsin
said that he “wanted other people’s pity”and “wanted to be
validated that someone did actually care about me.”Some
thought it would be a way to get help, like a 14-year-old male
from Virginia: “Everyone is going to have moments in their lives
hating themselves, sometimes it helps posting about it online.
People try to help you out and make you feel better. The internet
might be a terrible place, but there [are] tons of people around
the world who [are] willing to help you.”As such, these incidents
are often outwardly visible and therefore subject to our obser-
vation and intervention. Parents, youth-serving professionals,
and teens themselves should be trained to identifydand
empowered to intervenedin all instances of online abuse, irre-
spective of who is responsible. A first step would be to
acknowledge the hurtful content and offer support to the target.
Later, an investigation can be performed to determine whether
the cyberbullying was self-inflicted (and, if so, the motivations
for such behavior).
Even though the current study was able to shed some addi-
tional light on the understudied problem of digital self-harm, it is
not without limitations. We sought to obtain a nationally
representative sample of middle and high school students across
the U.S. but can never be certain of the generalizability of the
sample of youth who ultimately completed surveys. Even though
the demographic characteristics of the sample closely match to
those of the U.S. as a whole, there could be uncontrolled for
differences between those who ultimately agreed to complete
our survey and those who did not. Moreover, the low response
rate (about 15%) suggests that the findings should be interpreted
with caution. Another limitation is that the data were collected at
one point in time. As a result, we are unable to ensure proper
temporal ordering of key variables and therefore do not know
whether experience with bullying at school caused students to
engage in digital self-harm or if these behaviors occurred
concurrently. In fact, it is possible that many of the experiences
examined in this study co-occurdthat is, that digital self-harm is
another manifestation of depression [39]. Finally, some have
argued that data stemming from individuals’recollection about
the past are inherently unreliable because of the tendency
for them to misrepresent or distort facts from a previous time
period [40].
Considerations for future research
One notable concern that bears mention has to do with the
perceived prevalence and acceptability of digital self-harm
among youth. Research on traditional self-harm has identified
a clustering and contagion effect among young people and that
knowledge of self-harming among one’s immediate peer group is
a noteworthy risk factor for similar engagement [41,42]. More-
over, messages on social media sites like Facebook, YouTube,
Tumblr, Instagram, and Twitter which condone or even
encourage this behavior might contribute todor exacerbated
the problem [43,44], even though the Terms of Service of most
sites specifically ban representations of self-harm. If a critical
mass of adolescents comes to believe that self-cyberbullying is a
normative and justifiable behavior, or if disclosure or help
seeking is discouraged in certain online channels of communi-
cation, it stands to reason that others may be more inclined to
participate.
It is also unclear whether those who self-harmed online did
so because they were genuinely but maladaptively coping with
serious pain or stressors in their lives or if they intentionally lied
to provide themselves some sort of misguided pleasure in
deceiving others. Over the last 20 years, the latter explanation
has been explored by journalists [45,46] and researchers [47,48]
who have examined how some individuals have “virtual facti-
tious disorder”and gravitate online to fake pain and suffering in
various Internet-based support groups (now termed Munchau-
sen by Internet or “MBI”). Future inquiries should flesh out dif-
ferences in participants’motivations and rationalizations in
order to determine whether medicine, cognitive behavior ther-
apy, or other psychiatric approaches are best suited to help these
self-harmers. It has also been suggested that MBI be formally
acknowledged as a disorder in a revised version of the Diagnostic
and Statistical Manual (DSM-5) to help identify and minimize its
growth [47]. Perhaps, subsequent research will strengthen the
case for such a call.
Given that “human beings are highly responsive to cultural
and social norms, and this aspect of the prevention of suicide and
self-harm has been neglected”[6], educators, coaches, mentors,
celebrities, athletes, and other adults who have a platform and
voice into the lives of youth should continue to speak out against
any form of self-injurious behavior. This has been done with the
help of new technology and social media by various organiza-
tions (such as To Write Love On Her Arms [twloha.org], which
caters to millennials and the It Gets Better project [itgetsbetter.
com], which focuses on LGBT youth). We believe these efforts
should be redoubled by other far-reaching entities, especially
given the powerful and unparalleled influence that digital con-
tent and communications have on this population.
Table 3
Motivations for digital self-harm
Motivation Number Example
Self-hate 32 “Self-hate is a strong thing.”“Because I
already felt bad and just wanted myself
to feel worse.”
To be funny 24 “I don’t like hurting others, but it’s easy to
make fun of myself. I was bored and did
it to maybe make others laugh as a
joke.”
Looking for reaction 20 “I did it to see what others were saying
and to see how others saw me.”“I
wanted to see if someone was really
my friend.”
Depressive symptoms 15 “Because I was very sad and upset and
nobody would listen or talk to me so I
posted how I really felt about myself
online.”
Attention seeking 13 “Because I feel sad and needed attention
from others.”
Other 61 “At the time, I had very low self-esteem
and didn’t rely on myself for happiness,
I expected others to make me happy.
This resulted in my own belief that
everyone hated me, which was of
course completely false.”
J.W. Patchin and S. Hinduja / Journal of Adolescent Health xxx (2017) 1e65

To be sure, much more work needs to be done to understand
digital self-harm. As boyd aptly points out, irrespective of who
the perpetrator is, targets of cyberbullying need help. “Teens who
are the victims of bullyingdwhether by a stranger, a peer, or
themselvesdare often in need of support, love, validation, and,
most of all, healthy attention”[13]. Researchers should continue
to shed light on the epidemiological precursors and enduring
associated outcomes of digital self-harm. Their efforts can then
inform the work of youth professionals, who must consider the
gravity of this phenomenon and collectively work to develop
therapies and programming to provide struggling teens with the
help they need well before they decide to hurt themselves.
Funding Sources
The data utilized in this study were collected through a grant
from the Digital Trust Foundation (#31-3).
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