Why digital self-harm is hidden in plain sight

With her latest work, Jessica Pater, MS, PhD candidate, research scientist, Parkview Research Center, is raising awareness about the lesser known hazards of digital self-harm. Here, she shares more about her work and how the findings could impact the dialogue between clinicians and their patients. 

It’s interesting, we only ever hear about how we use technology and online content to get healthier. We don’t hear about how it’s actually used to support certain diseases. There was research that looked at blogs and other websites, but we wanted to explore user activity on any type of online content.

The research

For our pilot study, we examined a range of platforms, and included both images and text-only content. Our motivation was, we really wanted to characterize what self-harm – things likes cutting and eating disorders – looked like online. There’s been previous research focused on digital self-harm, but mostly concerning cyber bullying. We extended the definition to be more encompassing of any online behavior that had a direct impact on an individual’s mental or physical health, and really tried to ground the concept in clinical construct.

We completed a limited pilot study, working with Parkview and area clinicians using a combination of validated screening tools, interviews and analysis of participants’ social media activity leading up to their recovery journey. What we found was that social and online media played a part in all of their disease pathology. They aren’t producing negative content, but they are avid consumers.

There’s a whole litany of people using “thinspiration” or unhealthy online content to amplify their disease thoughts or behaviors. And it’s not just young people, though they are more prone to the behavior. Through my work at Parkview, we’ve seen people in their 50s and 60s using technology to inflict this digital self-harm. The risks aren’t limited to a specific platform, age, gender or ethnicity. Technology as a means to amplify disease cuts across all of those different divisions. One participant, who suffered from an eating disorder, shared that engaging with a calorie tracking app was like “putting kerosene on fire,” because of the data visualization and daily accountability it provided.

Risks

As we live more of our lives online, if we’re sick or there’s certain things we have going on, it only makes sense that those issues will somehow filter into our online lives as well. They’re platforms we’re already on, which makes it convenient and easy to access. It’s already integrated into our lives.

One of the unique risks with digital self-harm, is that it’s hidden in plain sight. You can go on almost any popular social media site or socially connected website or online community and find groups using the platform to negatively impact their health. The individual doesn’t have to be creating the content, board or image. They can search for things and favorite things without anyone knowing. Additionally, many who practice this method of self-harm know the “tricks’ to navigating the space. Someone with anorexia, for example, will search for terms that others aren’t familiar with to stay under the radar. These lexical variations might include “anamia”, “proana”, pro-bulimia” or “proanorexia”. Searching this way allows the user to pull content that amplifies the disease state, but if the device owner or parent had a filter set for “anorexia” these terms wouldn’t be captured, allowing the user’s search activity to go undetected. Knowing and seeking out these terms could be a sign of seeking support for the disease state, rather than seeking help.  

Another risk is how easy it is to hide. If I’m cutting myself at home, there’s paraphernalia. If I’m binging or purging, someone might hear me. I would hope that in the physical world, I would have some sort of support system or someone to identify my self-harming behavior. But by consuming this information online, there aren’t many clues that I’m looking at content that’s making me fixate on my lack of progress in weight loss or the fact that I want to cut myself.

Another issue is the accessibility and invasive nature of social content. You access it mainly through your phone or mobile device, which is with you all the time. If I have a friend who’s bulimic, and I’m bulimic, and we get together, our disease is amplified and it exacerbates my thinking and behavior when we’re together. But we’ll likely part ways at some point. But technology is with us all day, every day. We get alerts and vibrations and things that pull us back in, making it harder to extract ourselves from it.

Warning signs

Pertaining to, not just digital self-harm, but really any unhealthy use of technology, parents and loved ones should look for the following:

  • A change in mood or behavior, particularly after the use of technology
  • A change in the frequency of the technology use
  • A dramatic increase in secrecy around technology use

These can all be signs that something is going on.  

Addressing the issue

Some platforms are creating interventions. For example, if a user searches certain terms or attempts to post certain terms, a pop-up might appear asking if they are OK. Some even reference health concerns. But these just address the person and their action in that moment. They don’t get to the root behavior and why they’re using technology in that way.

Through this research, I hope to start conversations between clinicians and patients. In some of our unpublished work, we interviewed clinicians who work with eating disorder patients. We discovered that they are asking the patient about their technology use and then typically moving on. We want to help clinicians engage with patients in a validated way about the impact of their technology use. We plan to do more work and exploration in the clinical setting.

If nothing else, it’s important just to raise awareness about these issues and start a dialogue, whether that’s about self-harm or cyber bullying. We have to ask others about how they’re using technology. Just because they aren’t creating it, don’t assume they aren’t consuming it. We can’t just focus on what they’re doing and putting out there. It’s also what they’re reading, looking at and searching for.

 

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