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Nonsuicidal Self-Injury on Instagram: Examining Hashtag Trends

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Amanda L. Giordano
Amanda L. Giordano
Amanda L. Giordano
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Lindsay A. Lundeen
Lindsay A. Lundeen
Lindsay A. Lundeen
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Kelly L Wester at University of North Carolina at Greensboro
Kelly L Wester
Jaewoo Lee
Jaewoo Lee
Jaewoo Lee
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Abstract and Figures

We sought to investigate how individuals who upload nonsuicidal self-injury (NSSI) content on Instagram conceptualize self-injury by examining associated hashtags. Additionally, we explored NSSI hashtag usage trends over time. Using a web-based crawler and data analysis system, we downloaded 1,217,208 Instagram posts containing one of five popular NSSI hashtags (#cutting, #selfharm, #selfharmmm, #hatemyself, and #selfharmawareness) and categorized them based on psychological constructs (suicide, depression, anxiety/panic, eating disorders, addiction, general mental distress, other specific mental illnesses, and self-injury). Results show that NSSI hashtags were most associated with suicide, depression, general mental distress, anxiety/panic, and eating disorders, and, to a lesser extent, other specific mental illnesses, borderline personality disorder, and addiction. We determined that three of the five hashtags demonstrated an increase in usage over time, one remained relatively stable, and one decreased in usage. We discuss implications for mental health professionals regarding how to discuss social media use with clients who self-injure and consider clients’ technology use in treatment plans.
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Vol.:(0123456789)
https://doi.org/10.1007/s10447-021-09451-z
1 3
ORIGINAL ARTICLE
Nonsuicidal Self‑Injury onInstagram: Examining Hashtag
Trends
AmandaL.Giordano1 · LindsayA.Lundeen1· KellyL.Wester2· JaewooLee1·
SamuelVickers1· MichaelK.Schmit3· InKeeKim1
Accepted: 16 August 2021 / Published online: 29 September 2021
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature
2021
Abstract
We sought to investigate how individuals who upload nonsuicidal self-injury (NSSI)
content on Instagram conceptualize self-injury by examining associated hashtags.
Additionally, we explored NSSI hashtag usage trends over time. Using a web-based
crawler and data analysis system, we downloaded 1,217,208 Instagram posts con-
taining one of five popular NSSI hashtags (#cutting, #selfharm, #selfharmmm,
#hatemyself, and #selfharmawareness) and categorized them based on psychologi-
cal constructs (suicide, depression, anxiety/panic, eating disorders, addiction, gen-
eral mental distress, other specific mental illnesses, and self-injury). Results show
that NSSI hashtags were most associated with suicide, depression, general mental
distress, anxiety/panic, and eating disorders, and, to a lesser extent, other specific
mental illnesses, borderline personality disorder, and addiction. We determined that
three of the five hashtags demonstrated an increase in usage over time, one remained
relatively stable, and one decreased in usage. We discuss implications for mental
health professionals regarding how to discuss social media use with clients who self-
injure and consider clients’ technology use in treatment plans.
Keywords Instagram· Nonsuicidal self-injury· Self-harm· Social networking
sites· Hashtags· Suicide· Depression
* Amanda L. Giordano
amanda.giordano@uga.edu
1 Department ofCounseling andHuman Development Services, University ofGeorgia, Aderhold
Hall, 110 Carlton Street, 30602Athens, Georgia
2 Counseling andEducational Development Department, University ofNorth Carolina
atGreensboro, Greensboro, NC, USA
3 Hazelden Betty Ford Graduate School ofAddiction Studies, CenterCity, MN, USA
International Journal for the Advancement of Counselling (2022) 44:1–16
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... Over the past two decades, social media platforms have rapidly evolved, with young people often being the earliest adopters and most frequent users (Yonker et al. 2015). Alongside the rise in social media, there has also been an increased awareness that these platforms are contributing to the deterioration in mental health of some users, including: anxiety and depression (Giordano et al. 2021;Manske & Schmidt 2019); development and maintenance of eating disorders (Tanner 2015); cyberbullying (Lamblin et al. 2017;O'Dea & Campbell 2011;Richards et al. 2015) and increased engagement in deliberate self-harm and suicide attempts (Edwards et al. 2016;Jarvi et al. 2013;Marchant et al. 2019;Picardo et al. 2020). ...
... Instagram is a social media platform largely used by the adolescent population. It allows them to construct their viral identity, self-express their personality, seek affiliation and create online friendships, whilst also maintaining contact with friends they have in physical life (Cataldo et al. 2021;Oberst et al. 2017 (Brown et al. 2018(Brown et al. , 2020Cataldo et al. 2021;Giordano et al. 2021;Memon et al. 2018;Record et al., 2020;Shafi et al. 2020;Picardo et al. 2020;Urbanek-Matusiak et al. 2020 (2017), who found when speaking to students that they were able to recognize that Instagram posts may not be a true reflection of the user's thoughts, feelings or lifestyle, thus they knew not to compare to themselves or imitate behaviours shown. Students also acknowledged that if they were regularly being negatively impacted by certain accounts, that they had the option to 'unfollow' the authors of the accounts to avoid contagion or further deterioration in mood (Weinstein 2017). ...
... In 2012, Instagram acknowledged and implemented preventative measures, including changing their policies to zero tolerance on DSH, and disallowing posts to be uploaded if DSH hashtags are used in attempt to combat the DSH culture on their platform (Brown et al. 2020;Record et al. 2020;Smith & Cipolli 2021). Initially considered as a move forward towards preventing the glorification of DSH, hashtags are a compelling tool (Cataldo et al. 2021) and users easily got around these guidelines by disguising DSH posts with the use of variated and ambiguous hashtags (Giordano et al. 2021;Moreno et al. 2016;Tiggeman & Zaccardo 2018). With previous interventions failing, Instagram attempted to remove DSH from their platform again in 2016, implementing further restrictions by adding a new feature which allowed users to anonymously report any posts which violated Instagram's policies (Cataldo et al. 2021;Record et al. 2020). ...
Assessing the impact of Instagram use and deliberate self‐harm in adolescents: A scoping review
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The use of Instagram by adolescents to access deliberate self‐harm content is a growing concern among scholars, mental health professionals and families, with many adolescents (10–19‐year‐olds) imitating offline what they have seen online. This scoping review aims to investigate the extent to which Instagram use impacts the mental health of its adolescent users, identifying whether there is a relationship between time spent on Instagram and engagement in deliberate self‐harm. The databases, PubMed, Web of Science, Google scholar, APA PsycInfo, CINAHL and child development and adolescent studies were explored, and after applying the inclusion/exclusion criteria, 15 papers were included in this review. Thematic analysis indicated that there was a relationship between time spent on Instagram and deliberate self‐harm; desensitization of deliberate self‐harm resulting in normalization; social contagion and that Instagram provided a sense of belonging to its users who engaged in deliberate self‐harm. Implications of this research is that it is quickly outdated as new social media platforms are developed and that the reliance on self‐reports does not have high validity or reliability.
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... Online representations of these behaviors have been growing (e.g., Biernesser et al., 2020;Duggan et al., 2012;Dyson et al., 2016;Lee et al., 2022;Lewis et al., 2012;Marchant et al., 2017), and there are several possible online activities connected with DSH (i.e., viewing, creating, and sharing content related to DSH; talking online about these behaviors with online or offline peers). These activities can occur on different platforms, such as social media (e.g., Instagram), messaging applications (e.g., WhatsApp), video platforms (e.g., TikTok), and discussion forums (e.g., Reddit) (Adler & Adler, 2008;Baker & Fortune, 2008;Brown et al., 2018Brown et al., , 2020Giordano et al., 2022;Lavis & Winter, 2020;Lewis & Seko, 2016;Logrieco et al., 2021;Nesi et al., 2021;Rodham et al., 2007;Whitlock et al., 2006). Worldwide, research has only recently started to highlight online DSH activities on contemporary and adolescents' popular social media (e.g., Instagram) (Arendt et al., 2019;Brown et al., 2018Brown et al., , 2020Giordano et al., 2022;Nesi et al., 2021), and we found no national studies that focused on DSH-related internet use. ...
... These activities can occur on different platforms, such as social media (e.g., Instagram), messaging applications (e.g., WhatsApp), video platforms (e.g., TikTok), and discussion forums (e.g., Reddit) (Adler & Adler, 2008;Baker & Fortune, 2008;Brown et al., 2018Brown et al., , 2020Giordano et al., 2022;Lavis & Winter, 2020;Lewis & Seko, 2016;Logrieco et al., 2021;Nesi et al., 2021;Rodham et al., 2007;Whitlock et al., 2006). Worldwide, research has only recently started to highlight online DSH activities on contemporary and adolescents' popular social media (e.g., Instagram) (Arendt et al., 2019;Brown et al., 2018Brown et al., , 2020Giordano et al., 2022;Nesi et al., 2021), and we found no national studies that focused on DSH-related internet use. ...
From Family Conflicts to Suicide Risk Through Deliberate Self-Harm Online Content in Adolescents and Young Adults
Article
  • Nov 2024
Introduction: Family conflicts are considered a risk factor for deliberate self-harm (DSH) and even suicidal thoughts and behaviors. Research also shows that adolescents are increasingly engaging in online DSH activities. However, studies on this topic are scarce. Aims: This study’s first goal is to replicate the effect of family conflicts on suicidal ideation (SI) and, according to the gateway theory, include DSH diversity as a step preceding SI. Second, we aim to consider online activities in understanding suicidal risk. We start by describing online DSH activities, and propose a sequential mediation model in which family conflicts predict DSH and SI through online DSH activities. Methods: The convenience sample of this cross-sectional study consisted of 357 adolescents and young adults between 12 and 22 years old who completed a self-report questionnaire measuring family conflicts, online DSH activities, identification with DSH-related content creators, DSH, and suicidal ideation. Results: The results showed that 85.3% of our community sample used the internet for DSH-related purposes. Results also revealed an independent mediation effect of DSH diversity on the relationship between family conflicts and SI, and a sequential mediation effect of online DSH activities, identification, and DSH diversity. Conclusions: Engaging in online DSH activities is only predictive of DSH or SI if adolescents perceive a shared identity with this community of creators. The findings might yield implications regarding the design of prevention strategies that include a further supervision of online platforms and psychological interventions that incorporate the family system and peers.
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... In investigations of NSSI online content, associations with suicidality have been reported. Giordano et al. (2022) investigated NSSI hashtag trends on Instagram and found that the two categories of hashtags most commonly associated with popular NSSI hashtags were suicide and depression. In addition, Lee et al. (2022) surveyed women in South Korea who had engaged in NSSI in the previous year and categorized them as those who posted about NSSI online (27%) and those who did not (73%). ...
Exploring Nonsuicidal Self-Injury Online Activity: A Content Analysis of Reddit Posts
Article
Full-text available
  • Aug 2024
  • Int J Adv Counsell
Online NSSI activity is a growing phenomenon among many internet-based forums, including Reddit. We sought to explore both the purpose of posting in a subreddit specific to NSSI and characteristics of these posts. We employed deductive content analysis to examine eight a priori categories among a sample of 400 original Reddit posts. Results indicated that the most common purpose for posting was to share a negative event followed by seeking the answer to an NSSI-related question, then a medical question. Cutting was the most commonly mentioned NSSI method in the posts (44.2%) and 42.3% of posts indicated that the poster was currently engaging in NSSI. Addiction language was present in 25.3% of posts and suicidality language in 8.5%. More posters described NSSI as a problem than as a solution, yet the percentage of posts expressing the intention to stop engaging in NSSI was about the same as those expressing no intention to stop. Among posts that disclosed the motive for NSSI, emotion regulation was the most prevalent. Significant positive correlations were found between conceptualizing NSSI as a problem and intention to stop. Additionally, engaging in NSSI for the purpose of emotion regulation was significantly, positively correlated with the use of addiction language in posts. Implications for counselors are discussed.
View
... The impact of social media in the context of peer contagion has received more attention recently. The posting and sharing of graphic images of self-harm [73,74] and content promoting anorexia [75] illustrate emerging digital dimensions of dynamic influencing processes. A growing body of research-largely based on correlational evidence [76]-points to the risks of excessive social media use, particularly among adolescent natal girls [77][78][79][80]. ...
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The sharp rise in the number of predominantly natal female adolescents experiencing gender dysphoria and seeking treatment in specialized clinics has sparked a contentious and polarized debate among both the scientific community and the public sphere. Few explanations have been offered for these recent developments. One proposal that has generated considerable attention is the notion of “rapid-onset” gender dysphoria, which is assumed to apply to a subset of adolescents and young adults. First introduced by Lisa Littman in a 2018 study of parental reports, it describes a subset of youth, primarily natal females, with no childhood indicators of gender dysphoria but with a sudden emergence of gender dysphoria symptoms during puberty or after its completion. For them, identifying as transgender is assumed to serve as a maladaptive coping mechanism for underlying mental health issues and is linked to social influences from peer groups and through social media. The purpose of this article is to analyze this theory and its associated hypotheses against the existing evidence base and to discuss its potential implications for future research and the advancement of treatment paradigms.
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... [13][14][15][16][17]62 Although more research is needed, sex-and gender-specific stressors may be associated with the pandemic such as a differential or gendered response to less in-person contact with peers and social networks, 63 cessation of in-person mental health support services, 60 opportunity for social comparison 66-68 -and access to online communities that perpetuate self-harm contagion. [68][69][70][71] Findings from this study should be interpreted in the context of well-established sex differences in psychiatric epidemiology among youth, including the preponderance of depression, [72][73][74] higher reported prevalence of self-harm 75,76 and more suicide attempts and mental health service use among adolescent females, 77,78 all of which were trending upward before the pandemic. [79][80][81][82][83][84][85] Indeed, younger females were the largest group of new users of acute mental health services in this study, which speaks to their baseline vulnerability. ...
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  • Sep 2023
  • CAN MED ASSOC J
Background: Youth have reported worsening mental health during the COVID-19 pandemic. We sought to evaluate rates of pediatric acute care visits for self-harm during the pandemic according to age, sex and mental health service use. Methods: We conducted a population-based, repeated cross-sectional study using linked health administrative data sets to measure monthly rates of emergency department visits and hospital admissions for self-harm among youth aged 10-17 years between Jan. 1, 2017, and June 30, 2022, in Ontario, Canada. We modelled expected rates of acute care visits for self-harm after the pandemic onset based on prepandemic rates. We reported relative differences between observed and expected monthly rates overall and by age group (10-13 yr and 14-17 yr), sex and mental health service use (new and continuing). Results: In this population of about 1.3 million children and adolescents, rates of acute care visits for self-harm during the pandemic were higher than expected for emergency department visits (0.27/1000 population v. 0.21/1000 population; adjusted rate ratio [RR] 1.29, 95% confidence interval [CI] 1.19-1.39) and hospital admissions (0.74/10 000 population v. 0.43/10 000 population, adjusted RR 1.72, 95% CI 1.46-2.03). This increase was primarily observed among females. Rates of emergency department visits and hospital admissions for self-harm were higher than expected for both those aged 10-13 years and those aged 14-17 years, as well as for both those new to the mental health system and those already engaged in care. Interpretation: Rates of acute care visits for self-harm among children and adolescents were higher than expected during the first 2 and a half years of the COVID-19 pandemic, particularly among females. These findings support the need for accessible and intensive prevention efforts and mental health supports in this population.
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... The Internet has changed the way people access health-related information and how they search for support and interaction with peers in similar situations. Studies of stress-and mental health-related content on Twitter (Doan et al., 2017;Kolliakou et al., 2020;McClellan et al., 2017), Instagram (Arendt, 2019;Bogolyubova et al., 2018;Budenz et al., 2020;Giordano et al., 2022), Tumblr (Choudhury, 2015;Griffith & Stein, 2021;Seko & Lewis, 2018), Facebook (Zhang, 2017;Rothschild & Aharony, 2021), and YouTube (Devendorf et al, 2020;Ziavras & Diamantaki, 2022) confirm that the popular social networking platforms are increasingly being used for informal mental health information and support seeking and communication by afflicted individuals, experts, professionals, and amateurs alike. ...
“We Should Be Talking About This More”: An Empirical Examination of Stress-related Content on TikTok
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Full-text available
  • Dec 2022
Recent research has revealed that popular social media platforms are emerging as crucial digital health sources for individuals across demographics, but more so for adolescents and young adults (Lupton, 2021; McCashin & Murphy, 2022; Montag et al., 2021). ΤikTok is the latest social networking tool said to be functioning as a source of informal mental health communication and is increasingly being utilized for giving and seeking advice, sharing information and personal stories about the symptoms, effects, challenges, and coping strategies related to stress and anxiety, among other mental health issues (McCashin & Murphy, 2022). Despite the rapid growth of TikTok-based research, investigations of mental health-relevant content on this platform are still very few. The current study aims to contribute to this body of research through a content analysis of the most popular TikTok videos labelled with pertinent hashtags, namely #anxiety, #stress, and #stressrelief. The aim is to map the practices through which TikTok content creators appropriate the platform’s affordances in order to create content and generate interactions around a focal object of common concern. The analysis focuses on diverse aspects of the platform’s use as a medium for creating stress- and anxiety-related content, including the content creator identity and presentation, video format, type and purpose, audience engagement levels, as well as reported sources, symptoms, consequences, and coping techniques of stress and anxiety. The examination of TikTok user practices offers insights into the evolving patterns of consumption and production of digital content, and cultural production in a social media context.
View
... Non-suicidal self injury (NSSI) is defined as "the direct, deliberate destruction of one's own body tissue in the absence of suicidal intent" [1]. Over the past 30 years, the field of NSSI research has focused primarily on Caucasian Western samples under specific cultural backgrounds [2][3][4]. The prevalence, characteristics, risk factors, and mechanism of NSSI among have been exclusively studied in countries where a majority of the population is Caucasian [5,6]. ...
Risky or protective? Online social support’s impact on NSSI amongst Chinese youth experiencing stressful life events
Article
Full-text available
  • Dec 2022
  • BMC PSYCHIATRY
Background This study was designed to investigate potential gender differences in the interrelations between different types of stressful life events and non-suicidal self injury (NSSI) among Chinese youth, as well as to test the direct and moderating impacts of online social support on Chinese students’ NSSI engagement under the pressure of different types of stressful life events. Methods Based on the data of 2200 students from middle - highschools and universities in Northwestern China, gender difference (male/female binary) in stressful life events, online social support, NSSI and their correlations were analyzed in the study. Results Among different types of stressful life events, male students were reported to experience a significantly higher impact of punishment and interpersonal relationship than females. Female students only experienced significantly higher learning pressure than males; Gender difference was not indentified in NSSI among youth; Stressful life events related to punishment could significantly predict NSSI engagement among males. Stressful life events related to learning pressures, interpersonal relationships, and adaption were significantly correlated to NSSI engagement among females; Online social support didn’t had a significant direct effect on youth’s NSSI, although it did significantly moderate the relationship between specific types of stressful life events (i.e., loss, interpersonal relationships, adaption among males and all types among females) and their NSSI. Conclusion The present study has provided evidence of specified types of stressful life events being risk factors in affecting youth’s NSSI: For male students, the higher impacts of stressful life events related to punishment they experienced, the more likely they were about to engage in NSSI. For female students, stressful life events related to learning pressure, interpersonal relationships and adaption were all proved as significant predictors and risky factors of female youth’s NSSI; Online social support did not impact on individual’s NSSI engagement directly, but moderated it significantly as a protective factor.
View
Beyond the Filter: Examining the Psychosocial Effects of Instagram Addiction
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  • Oct 2024
How has Instagram’s appeal shifted from a simple social media platform to a potent driver of addictive behaviors? What are the hidden psychological and social effects of endlessly scrolling through its curated content? The current study investigates these questions, highlighting how the line between routine use and addiction is becoming increasingly blurred as Instagram captivates millions in a perpetual scrolling cycle. The implications of this phenomenon raise significant concerns about the platform's impact on mental health and social dynamics. This study aims to systematically explore the main components of the Instagram addiction literature, addressing the psychosocial effects of Instagram addiction, the factors contributing to addictive behavior, and proposed strategies for reducing this addiction. Utilizing a systematic review methodology, the study analyzes 20 original research articles from the WoS database. The findings indicate that Instagram addiction has considerable psychosocial effects on mental health, body image, and self-esteem. Key factors contributing to addictive behavior include the platform’s notification features and the prevalence of appearance comparisons. Suggested interventions to mitigate Instagram addiction involve behavioral approaches (such as mindfulness techniques, meditation, and self-regulation training), as well as educational and technological strategies. These findings are discussed in the context of current literature, providing a comprehensive overview of Instagram’s psychosocial impact.
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Social Media and Screen Time in the Clinical Interview: What to Ask and What It Means?
Chapter
  • Mar 2023
As technology expands, children and teenagers are actively using their smartphones at unprecedented rates to access their social media accounts. Purposes behind social media application include connection to peers, entertainment, education, and creative expression. Popular social media sites among children and teens that serve these purposes include Tiktok, Snapchat, and Instagram. While positive aspects of social media are well documented, detrimental effects of increased screen time and social media use are also present. Additionally, dangerous behaviors, such as cyberbullying, sexual exploitation, and self-harm, are prevalent when children and teens access social media. This chapter aims to educate clinicians on what children and teenagers are accessing on social media, how to screen for problematic behavior and experiences in the psychiatric interview regarding screen time and social media, and how confidentiality relates to disclosure of dangerous behavior in the virtual world.KeywordsSocial mediaTeensChildrenSmartphoneTiktokSnapchatInstagramSextingCyberbullyingConfidentialityScreen timePsychiatryPsychologyInterview
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We should be talking about this more": an empirical examination of stress-related content on Tik Tok
Presentation
Full-text available
  • Oct 2022
Stress has often been described as the health epidemic of the 21st century, being nowadays one of the leading causes of illness, mortality, and the compromise of human and economic development. Recent studies from Europe, the USA, and other parts of the world, have documented both the high prevalence of stress and anxiety, as well the growing trend of individuals seeking for advice and stress coping methods, through either professional or informal channels. With the well-evidenced rise of chronic-led stress and anxiety, it is important to examine mediated expressions of stress in social media platforms. Studies of stress- and mental health related content on Twitter, Instagram, Tumblr, and YouTube show that the popular social networking platforms are increasingly being used in informal mental health communication by laypeople, afflicted individuals, and experts alike. ΤikTok is the latest social networking tool said to be functioning as a source of informal mental health communication, and is increasingly being utilized for giving and taking advice, and sharing information and personal stories about the symptoms, effects, challenges and coping strategies related to stress and anxiety, among other mental health issues. While TikTok-based research has been expanding rapidly over the past few years, studies of mental health–related issues on this platform are still very few. The present study seeks to add to this scholarship through a content analysis of the most popular TikTok microvideos tagged with relevant hashtags, such as #anxiety, #stressrelief and #stressmanagement. As a form of metadata, hashtags are essential for categorizing information, organizing discussions around specific topics or events, and creating virtual communities of interest on most social media platforms, including TikTok. Using a dataset of 200 user-generated videos, created for personal, social, promotional, or other purposes, we employed content analysis to ask how expressions of stress and stress coping strategies manifest on the popular video-sharing platform of TikTok. All video posts were analyzed by three independent coders according to a codebook designed to reveal the common patterns of expressions of stress on the platform. More specifically, our research addressed diverse aspects of the use of TikTok as a medium of expression of stress by users, such as: the identity and online self-presentation of content creators; the purpose, type, and format of each posted video; levels of audience engagement with different types of content, as well as the sources, symptoms, outcomes, and coping strategies related to stress and anxiety.
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Online Self-Injury Activities among Psychiatrically Hospitalized Adolescents: Prevalence, Functions, and Perceived Consequences
Article
Full-text available
  • Jan 2021
The majority of adolescents with psychiatric disorders use social media, engaging in a range of online activities that may confer both risks and benefits. Very little work, however, has examined engagement in online activities related to self-injury among these youth, such as posting about self-injury, viewing self-injury related content, or messaging about self-injury with online or offline friends. This study examined the frequency and types of online self-injury activities in which adolescents engage, perceived functions that these activities serve, and associated risk for self-injurious thoughts and behaviors (SITBs). Participants were 589 psychiatrically-hospitalized adolescents (Mage = 14.88), who completed self-report measures assessing online self-injury activities, perceived functions and consequences of these activities, and SITBs. Results indicated that 43.3% of the sample had engaged in online self-injury activities, that the majority (74.8%) used social networking sites (e.g., Snapchat, Instagram) to do so, and that these activities were significantly more common among sexual and gender minority youth. Adolescents who talked about self-injury with friends met online were more likely to report a history of suicide attempt(s). A latent profile analysis revealed three distinct subgroups of youth based on their perceived functions of engaging in online self-injury activities. Subgroups reporting higher levels of engagement for purposes of identity exploration, self-expression, and aiding recovery were at heightened risk for negative perceived consequences of these activities and reported greater suicidal ideation severity. Findings offer new insights for identifying youth who may be at heightened risk for SITBs in the context of social media use.
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Examining the Time to Transition From Nonsuicidal Self-Injury to Suicide Attempt: A Brief Report
Article
Full-text available
  • Aug 2020
Background: Nonsuicidal self-injury (NSSI) is a strong predictor of suicide attempts (SA). Characteristics of NSSI have been shown to influence the NSSI–SA relationship; however, the temporal nature of this association is understudied. Aims: This study aimed to elucidate the NSSI-SA relationship by examining the association between NSSI characteristics and time lapsed from NSSI onset to first SA. Method: Participants were 111 individuals with a history of NSSI that preceded their first SA who completed a series of self-report measures. Results: NSSI methods of cutting and burning, and the anti-dissociation function, were associated with a shorter transition time from NSSI to SA. Earlier age of NSSI onset and the interpersonal boundaries function were related to a longer time to transition. Limitations: This sample size was limited, and data were collected cross-sectionally. Conclusion: Findings provide foundational knowledge regarding NSSI characteristics to inform theoretical models of the NSSI–SA association. This information can inform suicide risk assessments among those with a history of NSSI.
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Nonsuicidal Self-Injury Among Adolescents In South Eastern Serbia
Article
Full-text available
  • Jul 2019
Background: Nonsuicidal self-injury (NSSI) refers to the deliberate, self-inflicted destruction of body tissue without suicidal intent and for purposes not socially sanctioned. The aim of this study was to explore the variety of self-injury behaviors as well as the function of NSSI among adolescents in South-East Serbia. Methods: The study included 50 adolescents of both sexes, aged 13-18 years, who had deliberately engaged in self-injury at least once. A general socio-demographic questionnaire and the Inventory of Statements About Self-Injury (ISAS) were used in the study. Results: The average age of the respondents was 15 (1.17); the most common NSSI methods were cutting (60%), followed by biting and severe scratching (14%); the average age of onset was 14.12 (0.77); the majority confirmed experiencing pain during self-injury (42%); the respondents more commonly performed NSSI when they were alone (68,0%); in 90% of the cases, the time elapsed between sensing the urge to self-injury and acting on it was less than 1 h; the majority of the respondents stated that they did not want to stop self-injuring (56%). In terms of the NSSI function, the obtained scores were the highest for affect regulation 3.36 (1.47), self-punishment 1.90 (1.39) and marking distress 1.72 (1.26). In terms of gender, there was a statistically significant difference for the antidissociation (P = .043), interpersonal influence (P = .004) and revenge (P = .019). Conclusion: The results may have practical implications when it comes to taking preventive and therapeutic measures in the vulnerable adolescent population.
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Effects of exposure to self-harm on social media: Evidence from a two-wave panel study among young adults
Article
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  • May 2019
  • NEW MEDIA SOC
Suicide is a leading cause of death among youth, and media depictions of suicidal behavior can be a contributing risk factor. Of interest, Instagram recently received more scholarly attention due to its large number of publicly available, explicit, and graphic depictions of self-harm. Importantly, researchers have hypothesized that exposure to this content could be a risk for self-harm and suicide in vulnerable audiences. We tested this hypothesis using a two-wave US panel survey among young adults (N = 729). Analyses indicated that exposure to self-harm on Instagram was associated with suicidal ideation, self-harm, and emotional disturbance even controlling for exposure to other sources with similar content. As hypothesized, exposure to self-harm on Instagram at the first wave prospectively predicted self-harm and suicidality-related outcomes at the second wave 1 month later. These findings provide evidence that such exposure can lead to contagion in vulnerable users. Implications are discussed.
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Motives for Nonsuicidal Self-Injury in Individuals with Lifetime Depressive Disorders and Posttraumatic Stress Disorder
Article
Full-text available
  • Dec 2019
  • J PSYCHOPATHOL BEHAV
Although researchers have identified a number of factors that may motivate individuals to engage in nonsuicidal self-injury (NSSI), few studies have examined whether motives for NSSI differ as a function of psychiatric diagnosis. Therefore, the goal of the present study was to examine motives for lifetime NSSI among individuals with a history of psychiatric disorders associated with elevated rates of NSSI: depressive disorders and posttraumatic stress disorder (PTSD). Young adults (N = 139) with a history of NSSI completed several diagnostic interviews and questionnaires, including a measure of lifetime NSSI motives. Results demonstrated that participants with (vs. without) a lifetime depressive disorder reported significantly lower levels of interpersonal influence motives for NSSI, and participants with (vs. without) lifetime PTSD reported significantly higher levels of emotional relief and feeling generation motives. Further, results revealed a significant interaction between lifetime depressive disorders and PTSD for interpersonal communication motives; specifically, whereas participants with lifetime diagnoses of both a depressive disorder and PTSD did not differ significantly in reported interpersonal communication motives from participants with neither diagnosis, those with lifetime PTSD but without a lifetime depressive disorder reported significantly higher levels of interpersonal communication motives than those without either diagnosis. Results suggest that a history of depression and PTSD (alone and in combination) may be associated with different motives for NSSI.
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Investigating Psychometric Properties of Social Media Addiction Measures Among Adolescents
Article
  • Oct 2020
Assessment has a long history in counseling, with scholars noting multiple benefits to using assessment instruments in determining client strengths and needs as well as establishing relevant treatment goals. However, when counselors use unreliable or invalid instruments, they gather results that are ill equipped to inform clinical decision‐making. Consequently, we evaluated and compared the psychometric properties of three scales of social media addiction—the Social Media Disorder Scale (van den Eijnden et al., 2016), the Bergen Social Media Addiction Scale (Andreassen et al., 2012, 2016), and the Social Media Addiction Scale (Al‐Menayes, 2015)—to inform clinical use. Adolescents (N = 440) between the ages of 13 and 19 completed the scales. Results indicated that each scale provides a reliable and valid measurement of problematic social media use or addiction among adolescents. We provide recommendations for choosing a social media assessment and for future research.
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Needs of Youth Posting About Nonsuicidal Self-Injury: A Time Sensitive Analysis
Article
  • Aug 2020
  • J ADOLESCENT HEALTH
Purpose Many youth who engage in nonsuicidal self-injury (NSSI) go online for information, resources, and support. Although research has noted the potential benefits and risks of online NSSI activity, little is known about the NSSI-related needs that youth express on social media, and, importantly, when these posts occur. This study elucidates the nature of these NSSI-related needs and how they may vary temporally, by time of day or day of week. Methods A total of 3,500 posts made by 2,799 users of an international mental health–focused social network app were analyzed for the presence of NSSI-related needs. Posts were coded using a rubric that was developed using existing knowledge about youth's online NSSI activity. Furthermore, prominently expressed needs were tested for associations with specific times of the day and days of the week. Results Users' frequently posted about suicidal ideation and behaviors, and difficult emotions; documented NSSI urges and interpersonal difficulties; and expressed feeling misunderstood and isolated. Furthermore, specific needs occurred more frequently during different times of the day (e.g., users were more likely to express suicidal ideation and behaviors just before midnight). Conclusions These findings have important implications for mental health professionals and policy makers. Youth who post about NSSI could benefit from the provision of tailored, evidence-based resources during times of need. Furthermore, clinicians may need to assess youth's online activity to inform intervention strategies and meet their NSSI-related needs.
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Adlerian Counseling and Psychotherapy: A Practitioner’s Wellness Approach
Book
  • Apr 2019
Adlerian Counseling and Psychotherapy, now in its sixth edition, places a fresh emphasis on wellness both in concept and in practice. Written with the practitioner in mind, this text provides a definitive overview of the theory and practice of individual psychology based on the work of both Alfred Adler and Rudolf Dreikurs. The sixth edition retains the clarity, focus, and practicality of the previous editions and incorporates research, methods, and techniques to illustrate the usefulness of the Adlerian approach with children, adolescents, and adults of all ages in settings with individuals, groups, and couples. Parent education, career counseling, lifestyle assessment and counseling, and clinical diagnosis and psychotherapy are all discussed, as are applications for working with clients of different cultural and ethnic backgrounds and gender orientations. Neuroscience concepts and methods are described in case examples that illustrate their effectiveness across the lifespan. Readers will also find clinical examples from lifestyle assessment and family counseling meetings, as well as tables and figures that augment the activities and review questions included with each chapter.
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