March 21, 2023

expert reaction to systematic review of studies which look at viewing self harm material online and associated psychological impacts

A systematic review published in Journal of Child Psychology and Psychiatry looks at the impact of viewing self-harm images on the internet and social media platforms, and associated psychological mechanisms.

Dr Rachel Moseley, Principal Academic in Psychology at Bournemouth University, said:

“It is inarguable that caution must be exercised in the way we talk about and portray suicide and NSSI (Nonsuicidal self-injury) online. Recent findings that highlight the danger of viewing self-harm images online are extremely important – but we need to be doing much more than blocking hashtags to protect young people and other vulnerable individuals from starting to self-harm. 

“Susi and colleagues highlight numerous impacts, both positive and negative, which have been linked to people engaging online around images related to self-injury. Their review appears to have been rigorous, their findings clearly outlined in relation to policy and clinical practice. However, I would say a political response such as around online regulations must be nuanced, and should be recognised as a late-stage response to the wider challenge of preventing self-injury and suicidality. I particularly note two aspects of the paper, both acknowledged by the authors. 

“First, nearly all of the studies reviewed in this paper were cross-sectional, meaning that it’s impossible to say that one thing (viewing NSSI images online) caused or preceded another (engaging in NSSI or suicidal acts).  Secondly, in many of these studies, it was unknown whether those viewing these images already engaged in self-harm, or struggled with their mental health.

“Research around NSSI has pointed out that it fulfils a functional purpose, or has some ‘benefit’, in the lives of those who engage in it (Hooley & Franklin, 2018). For instance, NSSI is most frequently a means of regulating emotions. At the same time, these authors point out that certain ‘barriers’ protect most people from ever engaging in NSSI. These barriers include not being aware of it; feeling that NSSI is socially frowned on; having an innate evolutionary aversion to pain and the sight of blood and wounds; having a positive sense of self-worth, such that you don’t believe you deserve to be hurt.

“It’s clear how viewing images online could act on three of these barriers. NSSI might become salient as a potential option to people who are struggling; one which, at least within these online communities, is not stigmatised, even accepted; and as the authors point out, viewing images of self-harm online may desensitise individuals to pain and injury. However, the study really couldn’t tell us if these points had already been passed at the point at which people search for online images. Most notably, are people who look for self-injury images online already desensitised to them? Are they already struggling with social relationships and disconnection in the real world, which research suggests is indeed the case? Are they already experiencing low self-worth and believing that they deserve to be hurt? 

“It is the point around the social difficulties and loneliness typically associated with self-injury that the paper causes me greatest concern, in case it provokes a political response which prevents people finding community with others struggling with the same things. While online regulations are inarguably important and should be explored, the point at which people search for images online is late in the day. What we really need to prevent is people wanting to self-harm and wanting to search for these things in the first place. This would require much more extensive and costly investments addressing the risk factors associated with NSSI: for instance, teaching emotional literacy and emotion regulation skills from early childhood, or focusing on disadvantaged communities most vulnerable to self-harm and suicidality, like people with neurodevelopmental conditions.” 

Dr Amy Orben, Programme Leader Track Scientist, MRC Cognition and Brain Sciences Unit, University of Cambridge, said:

“This review is both timely and important. It is extensive, solidly executed and clearly communicated, and summarises the best quality evidence we currently have available on this topic. 

“It reviews 15 studies, the vast majority cross-sectional, that examined the link between viewing self-harm images and self-harm behaviours. All studies found potentially harmful links, while 60% of the studies also showed potentially protective links. Interestingly, the author note that there can often be a dynamic relationship: the viewing of self-harm images can either be harmful or protective depending on the individual’s mood and the time of viewing. This shows how important further study in this area is. 

“The authors also note that the studies were limited, and no causal conclusions can be drawn from them. This could be misunderstood from the headline of the press release, but is clarified both later in the press release and in the paper.” 

‘Research Review: Viewing self-harm images on the internet and social media platforms: systematic review of the impact and associated psychological mechanisms’ by Karima Susi et al. was published in Journal of Child Psychology and Psychiatry at 00:01 UK time on Tuesday 21 March.

DOI: 10.1111/jcpp.13754

Declared interests

Dr Amy Orben: “I have no COI to declare.”

For all other experts, no reply to our request for DOIs was received.