Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 16 nº 1 - Jan/Mar - 2019

Original Article Imprimir 

Páginas 7 a 12


Posts on non-suicidal self-injury on the internet

Post sobre autolesión no suicida en internet

Postagens sobre autolesão não suicida na internet

Autores: Juliana dos Santos Costa1; Aline Conceição Silva2; Kelly Graziani Giacchero Vedana3

1. Graduating in Nursing by the Nursing School of Ribeirão Preto at the São Paulo University (EERP-USP). Ribeirão Preto, SP, Brazil
2. Master in Health Sciences by the Federal University of São João Del-Rei (UFSJ). São João del-Rei, MG, Brazil. Doctor student in Psychiatric Nursing by the Nursing School at the São Paulo University (EERP/USP). Ribeirão Preto, São Paulo, Brazil
3. Postdoctoral by the Superior School of Nursing of Coimbra (ESEnfC) - Portugal. Doctor by the Postgraduate Program in Psychiatric Nursing at the São Paulo University (EERP/USP). Teacher Doctoral, by the EERP/USP. Ribeirão Preto, SP, Brazil

Aline Conceição Silva
Escola de Enfermagem da Universidade de São Paulo
Avenida dos Bandeirantes, nº 3.900 - Campus Universitário -, Bairro Monte Alegre
Ribeirão Preto, São Paulo, Brasil. CEP: 14040-902
csilvaaline@hotmail.com

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Keywords: Self-Mutilation; Self-Injurious Behavior; Internet; Adolescent Health.
Palabra Clave: Automutilación; Comportamiento Autodestructivo; Internet; Salud del Adolescente.
Descritores: Automutilação; Comportamento Autodestrutivo; Internet; Saúde do Adolescente.

Abstract:
OBJECTIVE: This study analyzed the themes related to non-suicidal self-harm in blog posts.
METHODS: Qualitative study performed on the Tumblr platform. Through the search for the term "self-mutilation" the first 250 Portuguese-language posts in text or citation format were selected and classified by Tumblr as the most popular. The collected data were transcribed and submitted to thematic analysis.
RESULTS: The categories of helplessness and continuous suffering were the main topics addressed in the posts. Pro-suicide behavior was cited as the only way to stop suffering considered permanent. The themes about prevention and offer of support were portrayed in the minority of posts and in some situations were related to criticism, depreciation, opposition and incomprehension.
CONCLUSION: Actions to promote and prevent self-injurious behavior should be implemented through direct contact as well as in virtual environments. These actions need to address coping strategies, recognition of requests for help, and offering support to people with self-harm or suicidal behavior. It is understood the importance of the conception of groups that support the coping of the vulnerabilities of people who practice self-mutilation and future studies on non-suicidal self-harm.

Resumen:
OBJETIVO: Este estudio analizó los temas relacionados a autolesión no suicida en post de blogs.
MÉTODOS: Estudio cualitativo realizado en la plataforma Tumblr. A través de la búsqueda por el término "automutilación" se seleccionaron los primeros 250 post en lengua portuguesa en formato de texto o citación y clasificados por Tumblr como los más populares. Los datos recolectados fueron transcritos y sometidos a análisis temático.
RESULTADOS: Las categorías desamparo y sufrimiento continuo fueron los principales temas abordados en los post. El comportamiento pro-suicida fue citado como única forma de cesar un sufrimiento considerado permanente. Los temas sobre prevención y oferta de apoyo fueron retratados en la minoría de los post y en algunas situaciones estaban relacionados a críticas, depreciación, oposición y incomprensión.
CONCLUSIÓN: Las acciones de promoción y prevención del comportamiento autolesivo deben ser implantadas tanto por medio de contacto directo, así como en ambientes virtuales. Esas acciones deben abordar estrategias de enfrentamiento, reconocimiento de pedidos de ayuda y oferta de apoyo para personas con comportamiento autolesivo o suicida. Se comprende la importancia de la concepción de grupos que ofrezcan soporte al enfrentamiento de las vulnerabilidades de personas que practican la automutilación y futuros estudios sobre autolesión no suicida.

Resumo:
OBJETIVO: Este estudo analisou os temas relacionados a autolesão não suicida em postagens de blogs.
MÉTODOS: Estudo qualitativo realizado na plataforma Tumblr. Através da busca pelo termo "automutilação" selecionou-se as primeiras 250 postagens em língua portuguesa em formato de texto ou citação e classificadas pelo Tumblr como as mais populares. Os dados coletados foram transcritos e submetidos à análise temática.
RESULTADOS: As categorias desamparo e sofrimento contínuo foram os principais temas abordados nas postagens. O comportamento pró-suicida foi citado como única forma de cessar um sofrimento considerado permanente. Os temas sobre prevenção e oferta de apoio foram retratados na minoria das postagens e em algumas situações estavam relacionados a críticas, depreciação, oposição e incompreensão.
CONCLUSÃO: As ações de promoção e prevenção do comportamento autolesivo devem ser implantadas tanto por meio de contato direto, bem como em ambientes virtuais. Essas ações precisam abordar estratégias de enfrentamento, reconhecimento de pedidos de ajuda e oferta de apoio para pessoas com comportamento autolesivo ou suicida. Compreende-se a importância da concepção de grupos que ofereçam suporte ao enfrentamento das vulnerabilidades de pessoas que praticam a automutilação e futuros estudos sobre autolesão não suicida.

INTRODUCTION

Over the last decade, Internet usage has increased globally by 566.4% between December 2000 and June 20121. In this way it has become increasingly accessible allowing individuals to access information on a wide variety of subjects in addition to communicate with several people around the world, often unknown. These resources have attracted concerns about how this can impact vulnerable individuals2.

By accessing the Internet, users can view various topics and information, and allow them to be able to express information, feelings that they often could not express in the offline environment2. The freedom provided by discussion and online activity can increase the potential of the Internet to exert positive or negative effects on the psychological health of users. These are commonly vulnerable adolescents, susceptible to intimidation, victimization and social exclusion1.

At present, the number of web pages on non-suicidal self-harm has increased concomitantly with increasing accessibility and development of Internet communication, that is, information about self-injurious behavior is more available than before3. Researchers4 point out that contact with harmful information about non-suicidal self-harm can result in damage such as normalization of behavior, trigger or source of contagion effect among users of the online environment. However, the online environment also has the potential to operate as a supportive environment, and to reduce social isolation.

Non-suicidal self-harm (ALNS), popularly known as self-mutilation, is an intentional behavior of self-harm to reduce intense emotional pain, induce a positive feeling state or solve an interpersonal difficulty. It is important to understand that non-suicidal self-harm does not have a suicidal intentionality, that is, self-harm is not intended to end life. However, exposure to non-suicidal self-harm acts as a predictor of suicide in the future5.

Non-suicidal self-harm has serious repercussions on individuals' personal and social life, social and affective dullness, stigma; bullying and clinical repercussions such as infections are some examples5. However, little is known about the repercussions that access to information about non-suicidal self-harm in the virtual environment has on the social and emotional life of users. Efforts have been made to understand the dynamics of information and interactions on non-suicidal self-harm in the virtual environment2.

Considering the impact of suicide and non-suicidal self-harm on the world stage, especially among young people, it is important to emphasize the importance of effective preventive actions and the need for greater understanding of this phenomenon. In this way the following question was formulated: what are the topics related to non-suicidal self-harm published in personal blogs? Thus, this study aimed to analyze the themes related to non-suicidal self-harm in posts of personal blogs.


METHOD

It is a study with a qualitative approach given its humanistic, inter-relational and empathic character. The qualitative approach aims to "understand the meaning or the internal logic that subjects attribute to their actions, representations, feelings, opinions and beliefs" 6. As a source of data collection, we opted for the blogging platform Tumblr, founded in February 2007, based in New York City, United States. According to information on the site, Tumblr is a platform composed of 289 million blogs. Tumblr's Privacy Policy does not govern what users do on their blogs, and the platform offers flexibility in blogging and the option of anonymizing users' account settings.

For the search strategy the term "self-mutilation" was used, since it is the most commonly used term to refer to non-suicidal self-harm. Then the posts were organized by the "most popular" tool that ranks posts and sorts them in descending order of popularity, which allowed you to select the top 250 posts rated as most popular, such as "text" or "citation" that met to the selection criteria of the present study.

The first 250 entries in the Portuguese language classified as "most popular", of the type "text" or "citation", which were identified through the word " self-mutilation " through the search tool, were eligible for the study. Posts related to videos, links, audios, chats or images were excluded.

The postings that met the inclusion criteria were saved by screen capture and identified by P (post) and the number corresponding to the order in which they were found. Each was transcribed in an editable document and the transcripts underwent a revision process to correct possible errors.

Inductive thematic analysis of data7 was used in this study to identify common themes or patterns and meanings contained in the data. The data analysis stages were performed by two researchers and then compared, discussed, judged and checked. Finally, discussions were held to establish consensus among the researchers.

Tumblr's posts are open access, blogs anonymity was supported in the study and the study fulfilled all research recommendations involving humans.


RESULTS

The categories that represent the main topics addressed in the post included in the study were: 1-Understanding non-suicidal self-harm; 2-Feelings related to self-injurious behavior; 3- Dynamics of the help relationship. It is important to note that for the present study we chose not to correct spelling of the selected posts, since it was noticed that the way users communicate is important for understanding the phenomenon of non-suicidal self-harm in the virtual environment.

Understanding non-suicidal self-harm

The category deals with the perception of the authors of the posts about the non-suicidal self-injurious behavior. In the most popular postings the ALNS practice was considered as a flow to alleviate emotional pain. For users, non-suicidal self-harm would be a way of resizing and controlling emotional pain through physical pain.


"Then she closed her eyes and found relief in a knife. The blood flows as it cries "(P173)

"I cut off the wrists, the arms and the legs in the hope that with the blood I would finish the pain" (P37)


Postings have also been identified by repulsing other people's interpretation of behavior so as to minimize it, for example by placing it as a way of "drawing attention." In this way the authors of the posts demonstrate to understand and to legitimize the pain veiled by the act of the ALNS.


"(...) Do you choose to be sick!? No, no, no, do not tell me that I just want to call attention, honestly, I do not really care, I do not care what you think, I'm fucking little for you, just do not come talk shit to me, words can hurt much more than even a shot ... "(P204)


Three out of four youths find it difficult to talk about and talk to someone else about ALNS, resorting to the virtual environment for help, information, and coping strategies8. The behavior of ALNS was expressed in postings as a method of materializing pain, often as a way of alleviating pain and psychic suffering through physical pain. During the ALNS act, the brain establishes a link between bad feelings with a sense of relief or false relief, and during another episode of strong emotion, the brain will yearn for this relief and thus, self-injurious behavior can become compulsive behavior, something that escapes the control of the individual itself9.

Feelings related to self-injurious behavior

This category includes postings that portray feelings, perceptions and reactions related to self-injurious behavior, such as hopelessness, perception of continuous suffering, self-deprecation, helplessness and suicidal behavior, subtopics listed as subcategories.

The posts about hopelessness portrayed a negative view of life, where users express feelings of pessimism and believe there is no chance of "life being better." The negative view about life is associated with the suffering experienced, difficulty dealing with difficult times and can be expressed by the following postings.


"They said I was going to hell, but how could I go to a place I already am?" (P68)

"Nothing makes sense in this world so lost" (P209)

"I woke up ... and that's where the nightmare began" (P69)


Hopelessness has been an important theme that intensifies and makes pain visible. Feeling of hopelessness, lack of perspective, desire for death and lack of meaning arise in the posts. The scientific literature points out that hopelessness is closely related to self-injurious behavior10.

The rigidity of thought and the intensity of feelings and reactions were identified in the posts. The authors of the posts seemed convinced that the suffering they experienced would be continuous, immeasurable, and endless suffering. In these posts, there were no glimpses of possibilities or alternatives for coping with the sufferings or positive resignification of the feelings experienced.


"Everything hurts. I do not know how to stop it. It hurts when I breathe, it hurts when I think ... I feel sinking, and it's my fault, and I do not know how to be well. I do not know if I can be well. "(P35)

"The pain is strong and insists on increasing ..." (P97)

"You do not understand I feel terrible every day!" (P12)


In the subcategory auto-depreciation were collected posts indicating a feeling of inadequacy, personal dissatisfaction, devaluation of oneself. Social maladjustment, sense of worthlessness and insignificance. The postings also related self-injurious behavior to body image disorders and as a form of punishment for feeling self-hatred and self-image.


"Pleasure, I am the disappointment of a family. I'm the daughter who does everything wrong. I'm the stranger that no boy will ever love. I'm the dumbest in the classroom. I'm the girl who gets hurt so she does not hurt others .... "(P176)

I do not feel good enough for anyone, you know, and that hurts. "(P169)

"The day I turned 16, I discovered that I had hatred of myself and could barely stand my image in the mirror. I stopped eating. (...) One day I found an old razor blade in the trash and got into the habit of cutting myself in my hands and arms. To punish me. "(P118)


Self-deprecation translates into feeling inadequate, feeling dissatisfied with you, feeling of worthlessness and low self-esteem. The posts with self-deprecating content were present in posts that favored the isolation of users and consequently intensified the user's own devaluation. The close relationship between posts with derogatory content and the use of self-injurious behavior as a form of self-punishment is perceived. Self-injuring individuals may present difficulties during the interpretation of behaviors and situations, interpreting them as critical of themselves and using self-injurious practices as a form of self-punishment11.

In the subcategory of helplessness, the posts refer to the perception of the users about the social context in which they are inserted. In most posts, users portray the feeling of being accustomed to living alone, not being heard or perceived in society. The postings also present the contradictory exposition of the real feelings.


My heart is already hoarse from screaming and no one is listening "(P71)

"A cut here, cut there, no one will notice, no one will mind" (P162)

"Relax, I am accustomed to being abandoned, I only had hoped that this time would be different, idiocy of mine" (P47)


The feeling of abandonment and repressed feelings intensifies as there is the expectation that other people will identify and legitimize feelings not expressed or carefully concealed. In the contemporary world there is an attempt to deny pain, on the one hand there is no other person to "perceive" the message of pain and suffering expressed by the individual, and on the other, there is a certain difficulty of the individual himself to admit that he is suffering12. This ambiguity makes it difficult to ask for help and express feelings outside the virtual environment, thus intensifying the isolation of individuals.

The suicidal behavior was expressed through the postings as an alternative to escape situations of suffering. In some cases non-suicidal self-injury was cited as a method to avoid suicide. Posts also presented the continuum of suicidal behavior as suicidal ideation.


"I'm dying, but it's taking so long and I just wanted to know how to accelerate this end- myself" (P88)

"Suicide is only good when it ceases to be a trial!" (P111)

"Every night a greater void, every night a deception, every night a dose of courage to commit suicide." (P117)


Suicide has often been expressed as a definitive way to cease ongoing suffering and ALNS as a temporary means of relieving suffering or as a form of avoidance or preparedness for suicide. People who self-injure have not necessarily attempted suicide at all, often self-injurious behavior is seen as a way to avoid death13.

Help relationship dynamics

The postings listed in this category address the dynamics of the aid relationship that operate in a demand day and support supply. The demand for support is expressed by posts that consist of requests for help or support. Preventive/aid content was a minority among other posts.


"(...) I want to die, but at the same time I can take a chance, show that I'm not wrong. I have to lie every day not to increase my medicine, my parents think I'm fine, I can´t stop smiling, laughing, but I'm so sad. Help me. "(P100)


The postings that approached the offer of support included, mainly, motivational phrases and involved hope, religiosity and valorization of life to face non-suicidal self-harm. The offer of support also occurred through more structured strategies, such as the "butterfly project", which aims at support and coping for practitioners of non-suicidal self-harm. It proposes the design of a butterfly in the body as a way of representing someone who gives support or love for the purpose of avoiding hurting oneself and the person represented in the butterfly.


"You can listen to people and let them destroy you, or you can listen to God and let Him heal you." (P106)

"Hi people. You suffer from depression, suicidal thoughts, self-mutilation, and favorite here. I want to give you a word of hope for your life. God bless you. "(P33)


The themes on prevention and the offer of support were portrayed in the minority of posts. However, a support relationship was observed mainly through religiosity, coping strategies such as butterfly design and mutual support among users. Online interaction reduces adolescents' social isolation and helps them connect with others by making the virtual environment a place of support in which they can vent and express their feelings10.


FINAL CONSIDERATIONS

The results of this study show the main topics covered in popular posts about non-suicidal self-harm on the Tumblr platform. It is noticed the need to implement preventive actions to the virtual self-injurious behavior and, at the same time, actions of prevention and evaluation in the clinical practice about the behavior in virtual environment. The themes revealed reveal the need to work with emotional abilities and the recognition of triggers. It is also important to disseminate reliable information in order to demystify behavior and reduce stigma by collaborating to identify cases and a sense of confidence for early aid demand. As a limitation of the study it is evident the analysis of the postings in an isolated way and not the interaction or analysis of the posts according to each user.


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