INTRODUCTION

Over the past decade, Internet use has increased globally by 566.4% between December 2000 and June 2012 ¹ . As such, it has become increasingly accessible, allowing individuals to access information on a wide variety of topics and communicate with many people around the world, often strangers. These resources have raised concerns about how they may impact vulnerable individuals ² .

By accessing the Internet, users can view a variety of topics and information, and it also allows them to express information and feelings that they would often be unable to express offline 2 ^. The freedom afforded by online discussion and activity may increase the potential for the Internet to have positive or negative effects on the psychological health of users. These are often vulnerable adolescents, susceptible to bullying, victimization, and social exclusion ¹ .

Currently, the number of web pages about non-suicidal self-harm has increased concomitantly with the increase in accessibility and development of communication on the Internet , that is, information about self-harm behavior is more available than before ³ . Researchers ⁴ point out that contact with harmful information about non-suicidal self-harm can result in harm such as normalization of behavior, trigger or source of contagion among users of the online environment . However, the online environment also has the potential to operate as a supportive environment and reduce social isolation.

Non-suicidal self-harm (NSS), popularly known as self-mutilation, is configured as intentional self-harm behavior to reduce intense emotional pain, induce a positive feeling state or resolve an interpersonal difficulty. It is important to understand that non-suicidal self-harm does not have suicidal intent, that is, the self-harm performed does not have the intention of ending one’s life. However, exposure to non-suicidal self-harm operates as a predictor of suicide in the future ⁵ .

Non-suicidal self-harm has serious repercussions on the personal and social lives of individuals, including social and emotional dulling, stigma, bullying and clinical repercussions such as infections ⁵. 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 lives of users. Efforts have been made to understand the dynamics of information and interactions about non-suicidal self-harm in the virtual environment ² .

Considering the impact of suicide and non-suicidal self-harm on the global scene, especially among young people, the importance of effective preventive actions and the need for greater understanding of the phenomenon that has been addressed on the Internet are highlighted . Thus, the following question was formulated: what are the themes related to non-suicidal self-harm published on personal blogs ? Thus, this study aimed to analyze the themes related to non-suicidal self-harm in personal blog posts .

METHOD

This is a study with a qualitative approach given its humanistic, inter-relational and empathetic character. The qualitative approach aims to “understand the meaning or internal logic that subjects attribute to their actions, representations, feelings, opinions and beliefs” ⁶ . The blogging platform Tumblr , founded in February 2007 and headquartered in New York City, United States, was chosen as the data collection source . According to information on the website, 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 creating blogs and the option of anonymity when configuring users’ accounts.

The term “self-harm” was used for the search strategy, as it is the term most commonly used to refer to non-suicidal self-harm. The posts were then organized using the “most popular” tool, which classifies the posts and orders them in descending order of popularity, which allowed the selection of the first 250 posts classified as most popular, of the “text” or “quote” type, that met the selection criteria for this study.

The first 250 posts in Portuguese classified as “most popular”, of the “text” or “quote” type, identifiable by the word “Self-harm” through the search tool, were eligible for the study. Posts related to videos, links, audios, chats or images were excluded. Posts

that met the inclusion criteria were saved by means of a screenshot and identified by P (post) and the number corresponding to the order in which they were found.Each one was transcribed into an editable document and the transcripts went through a review process to correct any possible errors.

Inductive thematic analysis of data ⁷ was used in this study to identify frequent themes or patterns and meanings contained in the data. The data analysis steps were performed by two researchers and subsequently compared, discussed, judged and checked. Finally, discussions were held to establish consensus among the researchers. Tumblr

posts are freely accessible, bloggers ‘ anonymity was supported in the study and the study complied with all recommendations on research involving human beings. RESULTS The categories that represent the main themes addressed in the posts included in the study were: 1-Understanding non-suicidal self-harm; 2-Feelings related to self-harm behavior; 3-Dynamics of the helping relationship. It is important to emphasize that for the present study it was decided not to correct the spelling of the selected posts, as it was perceived 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 This category deals with the perception of the authors of the posts about non-suicidal self-harm behavior. In the most popular posts, the practice of ALNS was considered as an outlet to alleviate emotional pain. For users, non-suicidal self-harm would be a way to resize and control emotional pain through physical pain.

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

“I cut my wrists, arms and legs in the hope that along with the blood the pain would drain away” (P37)

Posts were also identified that rejected other people’s interpretations of the behavior in order to minimize it, for example by presenting it as a way of “drawing attention”. In this way, the authors of the posts demonstrate that they understand and legitimize the hidden pain caused by the act of ALNS.

“(…) You choose to be sick!? No, right, so don’t tell me that I just want attention, honestly, I really don’t care, I don’t care what you think, I don’t give a shit about you, just don’t come talking shit to me, words can hurt a lot more than even a gunshot…” (P204)

Three out of four young people have difficulty talking about and talking to others about NSSI, resorting to the virtual environment in search of help, information and coping strategies ⁸ . NSSI behavior was expressed in the posts as a method of materializing pain, often as a way of alleviating pain and psychological suffering through physical pain. During the act of NSSI, the brain establishes a connection between bad feelings with the sensation 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 is beyond the individual’s control ⁹ .

Feelings related to self-injurious behavior

This category includes posts that portray feelings, perceptions and reactions related to self-injurious behavior, among which the following stood out: hopelessness, perception of continuous suffering, self-deprecation, helplessness and suicidal behavior, subthemes listed as subcategories.

Posts about hopelessness portrayed a negative outlook on life, in which users expressed feelings of pessimism and believed that there is no chance that “life will get better”. A negative outlook on life is associated with the suffering experienced, difficulty in dealing with difficult times, and can be expressed by the following posts.

“They said I was going to hell, but how can I go to a place I’m already in?” (P68)

“Nothing makes sense in this lost world” (P209)

“I woke up . . . And that’s when the nightmare began” (P69)

Hopelessness was an important theme that intensifies and makes pain visible. Feelings of hopelessness, lack of perspective, desire for death and lack of meaning appear in the posts . Scientific literature indicates that hopelessness is closely related to self-harming behavior ¹⁰ .

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. In these posts, no possibilities or alternatives for coping with the suffering or positive resignification of the feelings experienced were glimpsed.

“Everything hurts. I don’t know how to make it stop. It hurts when I breathe, it hurts when I think. I feel like I’m sinking, and it’s my fault, and I don’t know how to get better. I don’t know if I can get better.” (P35)

“The pain is strong and keeps getting worse…” (P97)

“You don’t understand. I feel terrible every day!” (P12)

The self-deprecation subcategory included posts that indicated feelings of inadequacy, personal dissatisfaction, and self-devaluation, as well as social maladjustment and feelings of uselessness and insignificance. The posts also related self-harm behavior to body image disorders and as a form of punishment for feeling hatred for oneself and one’s own image.

“Nice to meet you, I’m the disappointment of a family. I’m the daughter who does everything wrong. I’m the weird one that no boy will ever love. I’m the dumbest one in the class. I’m the girl who hurts herself so she doesn’t hurt others….” (P176)

I don’t feel good enough for anyone, you know, and that hurts.” (P169)

“The day I turned 16, I discovered that I hated myself and could barely stand my reflection in the mirror. I stopped eating. (…) One day, I found an old razor blade in the trash and got into the habit of cutting my hands and arms. To punish myself.” (P118)

Self-deprecation translates into the feeling of being inadequate, dissatisfied with oneself, a sense of uselessness, and low self-esteem. Posts with self-deprecating content were present in posts that favored the isolation of users and consequently intensified the user’s own devaluation. There is a close relationship between posts with deprecating content and the use of self-harming behavior as a form of self-punishment. People who self-harm may have difficulty interpreting behaviors and situations, interpreting them as criticism of themselves and using self-harming practices as a form of self-punishment ¹¹ .

In the helplessness subcategory, the posts refer to the users’ perception of the social context in which they are inserted. In most posts, users portray the feeling of being used to living alone, of not being heard or noticed in society. The posts also present the contradictory exposure of real feelings.

My heart is already hoarse from screaming so much and no one hearing it” (P71)

“A cut here, a cut there, no one will notice, no one will care” (P162)

“Relax, I’m used to being abandoned, I just had hope that this time it would be different, how stupid of me” (P47)

The feeling of abandonment and repressed feelings intensify as there is an expectation that other people will identify and legitimize unexpressed or carefully hidden feelings. In the contemporary world, there is an attempt to deny pain. On the one hand, there is no one else to “perceive” the message of pain and suffering expressed by the individual, and on the other, there is some difficulty for the individual to admit that he or she is suffering . ¹² This ambiguity makes it difficult to ask for help and express feelings outside of the virtual environment, thus intensifying the isolation of individuals.

Pro-suicidal behavior was expressed through posts as an alternative to escape situations of suffering. In some posts, non-suicidal self-harm was cited as a method to avoid suicide. Posts also presented the continuum of suicidal behavior such as suicidal ideation.

“I’m dying, but it’s taking a long time and I just want to know how to speed up this end – myself” (P88)

“Suicide is only good when it stops being an attempt!” (P111)

“Every night a greater emptiness, every night a disappointment, every night a dose of courage to commit suicide.” (P117)

Suicide was often expressed as a definitive way to end ongoing suffering and NSSI as a temporary means of alleviating suffering or as a way of avoiding or preparing for suicide. People who self-harm have not necessarily attempted suicide at some point; self-harm is often seen as a way of avoiding death ¹³ .

Dynamics of the helping relationship

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

“(…) I want to die, but at the same time I can have a chance, show me that I’m not wrong. I have to lie every day so they don’t increase my medication, my parents think I’m fine, I can’t stop smiling, laughing, but I’m so sad. Help me.” (P100)

The posts that addressed the offer of support mainly included motivational phrases and involved hope, religiosity and valuing life to cope with non-suicidal self-harm. The offer of support was also made through more structured strategies, such as the “butterfly project”, which aims to support and cope with non-suicidal self-harm. This proposes the drawing of a butterfly on the body as a way to represent someone who gives support or love with the purpose of avoiding harming oneself and the person represented by 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 everyone. If you suffer from depression, suicidal thoughts, self-harm, favorite this post. I want to give you a word of hope for your life. God bless you.” (P33)

The topics of prevention and support were portrayed in the minority of posts. However, a supportive relationship was observed mainly through religiosity, coping strategies such as the butterfly project and mutual support among users. Online interaction reduces social isolation among adolescents and helps them connect with other people, making the virtual environment a supportive place where they can vent and express their feelings ¹⁰ .

FINAL CONSIDERATIONS

The results of this study show the main topics addressed in popular posts about non-suicidal self-harm on the Tumblr platform . There is a need to implement preventive actions against virtual self-harm behavior and, concomitantly, prevention and evaluation actions in clinical practice regarding behavior in a virtual environment. The themes revealed point to the need to work on emotional skills and the recognition of triggers. It is also important to disseminate reliable information in order to demystify the behavior and reduce stigma, helping to identify cases and create a sense of confidence for early demand for help. As a limitation of the study, we highlight the analysis of the posts in isolation and not the interaction or analysis of the posts according to each user.