digital self-harm

Risk factors

Some risk factors that increase an adolescent's risk for digital self-harm include the following:

• sexual orientation;
• previous experience with online bullying and/or school bullying;
• drug use;
• previous experience with physical self-harm; and
• mental health problems, such as depressive symptoms, suicidal thoughts and/or eating disorders.

Why do teens engage in digital self-harm?

There is no single explanation for why teens engage in digital self-harm. Experts cite reports that provide several common immediate reasons, including the following:

• to get attention from parents or peers;
• to test their peers' friendship;
• to see if low self-opinion is shared by peers;
• to prove their toughness;
• to beat bullies to the punch by self-deprecating first;
• to feel validated by seeing low self-opinion reflected in the external world;
• to regulate emotion;
• to punish oneself;
• to gain a sense of control;
• to combat dissociation -- feeling numb or disconnected from one's body or identity;
• to stave off boredom; and
• to be funny.

A 2012 study also found an interesting gender divide in reported reasons for digital self-harm. Girls frequently claimed they did it to prove they could handle aggression, whereas boys often reported being mad at someone else and wishing to start a fight. Digital self-harm was also found to be more common in boys than girls.

The 2017 study also found that many digital self-harmers were looking to elicit a response from others. It's often to create the appearance of being abused to receive the attention a victim gets. Examples from the study include the following:

• garnering the pity of others to validate that others do care about them; and
• hoping a peer will stand up for the target of the self-inflicted harmful statement.

While these lists contain several external motivations, they stem back to negative internal feelings. Young people surveyed in the 2017 research study reported digitally self-harming in response to feelings of:

• emptiness
• self-hatred
• abandonment
• guilt
• depression
• desperation
• isolation
• tension
• stress

Digital self-harm is a relatively new concept, so there aren't decades of research or established standards surrounding it. As a result, physical self-harm is used as a reference point to understand digital-self harm. Those who physically harm themselves commonly suffer from a broader mental illness, so experts have a reason to suspect that the same might be true of digital self-harm. Mental illnesses common among physical self-harmers include the following:

• borderline personality disorder (BPD)
• schizotypal personality disorder (STPD)
• dependent personality disorder (DPD)
• avoidant personality disorder (AVPD)

Additionally, physical self-harmers report experiencing increased depression and anxiety, a greater difficulty regulating emotions and a decreased ability to cope with negative feelings in a prosocial -- or positive -- way. This too may become evident in digital self-harmers with new research.

Untreated self-harm can become a habit. One way this can happen is by self-harming in response to feeling shame caused by previous acts of self-harm. Because they feel they have no one to confide in, self-harmers turn to the coping strategy they know, even if it has a negative long-term effect.

Self-harmers may also be drawn to toxic online communities that validate and perpetuate negative behaviors. While the initial connection with others who share their experience may initially feel validating and supportive to self-harmers, it ends up normalizing the destructive beliefs and behaviors. Examples include Tumblr pages that are devoted to anorexia or cutting and Reddit pages with self-deprecating rants and suicide jokes. These forums are often filter bubbles that offer no outside guidance for improving low self-esteem or changing distorted, damaging beliefs about oneself or the world.

It's important to understand that, no matter how trivial or manipulative -- i.e., boredom, attention seeking -- the external reason for this behavior may seem, it stems from legitimate, overpowering negative feelings. They are seeking attention for a legitimate reason but doing so in a destructive way.

How can parents help prevent digital self-harm?

Parents can work to help digital self-harmers understand root causes for the behavior and create a positive support network. This is essentially the same approach that therapists take, but parents can do it, too.

To do this, parents should:

• maintain open communication;
• check in on children and their social profiles;
• avoid judgment and listen with an open mind;
• help build a positive support system; and
• consult a professional, if necessary.

Experts note that parents may want to blame technology for their child's behavior. However, technology is merely a tool for expressing the behavior.

Sameer Hinduja, co-author of the 2017 Journal of Adolescent Health digital self-harm study, warned that cutting teens off from social media may be a temporary solution but does not get to the heart of the problem.

He advised that parents' number one priority should be to practice open, nonjudgmental communication with their children. "Validating a teen's experience can encourage them to confide in adults about their distressing experiences," he said.

Instead of investigating their child's phone nightly, parents should talk to their children about what's happening. If parents notice a red flag, such as a negative comment on their kid's social media account, they should rationally address it with their kid and listen to their feelings about it with an open mind.

Experts note that it can be difficult to get teens to admit -- or even talk about -- digital self-harm because of the shame associated with deliberate self-harm. Teens may find it difficult to articulate their reasons for acting this way and may not have an answer because they are still developing and figuring themselves out. An ongoing pattern of honest and open communication can help them learn to articulate their feelings as they grow and provide the groundwork for when things do get serious.

Social media also introduces an entire, always-on social environment for kids that parents can only monitor to a certain extent. Parents should ask kids about their close friends, coaches and teachers, ensuring that they have an external support network.

Treatment

Still, it may not be possible for the parent and child to solve this behavior together by themselves. If they've tried and the situation does not improve, it's perfectly reasonable to consult a mental health professional.

A mental health professional can use several therapeutic approaches to develop certain skills in teens who struggle with self-harm, such as the following:

• identifying underlying issues;
• regulating complex emotions;
• problem solving;
• boosting self-esteem in uncomfortable situations;
• managing stress levels; and
• building healthy relationship skills.

The therapeutic methods for building these skills are the following:

• Cognitive behavioral therapy (CBT). This method pushes patients to identify and challenge unhelpful beliefs, thoughts and behaviors.
• Dialectical behavior therapy (DBT). This method identifies the need that a negative behavior fulfills in a patient and then replaces it with a positive behavior.
• Psychodynamic therapy. This method explores the patient's current emotions, past experiences and interpersonal dynamics. This includes analyzing the dynamics between the patient and therapist, also called transference.

These methods have proven effective in physical self-harmers, and experts have confidence that it will have similar effects on digital self-harmers.

Coping strategies

In some cases, those struggling with digital self-harm may not have access to a medical professional or a positive support network. Experts lay out several coping strategies and skills that individuals can utilize on their own. These include the following:

• Being able to recognize the situations that might trigger the behavior or make one feel out of control. This enables one to plan and prepare for these situations and avoid them if possible.
• Avoiding substance use to self-medicate when stressed.
• Being able to identify complex feelings surrounding a stressful situation. Intense feelings are often made up of many conflicting feelings occurring at once.
• Being able to ask for help. Even if an individual doesn't have concrete medical or community support, telling anyone about negative feelings can potentially help. Mental health carries various levels of stigma in different communities, but individuals should still reach out if necessary.
• Being able to express pain or manage emotions through certain activities, such as deep breathing, writing or exercising.

Where to get advice and help

Although digital self-harm is not immediately dangerous, some cases can eventually spiral into more serious behaviors if left untreated, including physical self-harm and suicidal ideation. There are services to help users in a crisis. These include the following:

• National Suicide Prevention Lifeline. Call 1-800-273-8255 for free, confidential, 24/7 support in a crisis. Here is its website.
• Crisis Text Line. Text "HOME" to the number 741741 for free, 24/7 support in a crisis. Click here for its website. Texting this number will connect users with a trained crisis counselor, who will listen and help the user move from a "hot" moment to a "cool," calm moment. The Crisis Text Line serves anyone in the United States, United Kingdom and Canada. The number listed above is for the U.S. United Kingdom users should text "HOME" to 85258. Canadian users should text "HOME" to 686868.

People in less dire circumstances should reach out to their primary care physician, who can refer patients to a local mental health professional. Any nearby medical institution is also a source of information. Students can reach out to their school nurse or the university health center if they are in college.

Parents can also search the web for therapy organizations that offer treatment on a wider scale. According to patient reviews, these large-scale organizations can sometimes be unsatisfactory in their ability to meet patient healthcare and cost needs.

Finding effective treatment requires an individual to persist and advocate for oneself, which is easier with the help of a friend, mentor or family member.