Non-suicidal self-injury (NSSI), like cutting or burning of the skin, is common among adolescents. In recent years, social media has become increasingly important, with Instagram being the second most popular social media platform for adolescents. Therefore, it is important to understand the way mental health issues are portrayed online.

Previous studies have shown pictures and videos of NSSI to be popular on social media, like YouTube or Flickr [1, 2]. While online NSSI activity can be beneficial to adolescents by reducing feelings of social exclusion and gaining motivation to end NSSI, it can also trigger NSSI urges and have socially reinforcing as well as contagion effects [3].

In the current study, we were interested in the scope of NSSI pictures on Instagram. In total, 32,000 pictures and corresponding comments posted in April 2016, tagged with popular German hashtags for NSSI were analysed. In terms of socially reinforcing effects, we found that pictures depicting wounds received significantly more comments and likes than did pictures that were related to NSSI content, but did not directly show wounds (e.g. a poem or a picture of a razor blade). We also found that pictures showing more severe wounds generated more attention than those depicting less severe wounds.

Generally, most comments were empathic, offering help, or expressing a wish for the other person to end NSSI, while some comments were abusive towards the person having posted the picture. Interestingly, the tone of comments did not change with increasing severity of wounds. In comparison to neutral pictures geotagged in Berlin, there was a much pronounced peak of NSSI related pictures to be posted in the evening and in the early morning on school days. This compares well to other studies showing that NSSI is engaged in most often in the evenings and might also reflect stress-related posting of NSSI pictures in the morning before going to school.

Overall, we showed that NSSI is popular on Instagram and that socially reinforcing effects might take place, while we were not able to show contagion effects. In response to NSSI on social media, some platforms (including Instagram and YouTube) have introduced an automated help pop-up window and content advisory warnings. However, social networks have the responsibility to take appropriate measures in order to prevent social reinforcement and contagion of NSSI via their platforms and to make use of preventative measures.

This blog post is based on the author’s Open Access article, #Cutting – the scope of non-suicidal self-injury (NSSI) on Instagram, published in Psychological Medicine.

View the press release for the article here.

1. Lewis, S. P., Heath, N. L., St Denis, J. M. and Noble, R. (2011). The scope of nonsuicidal self-injury on YouTube. Pediatrics, 127, e552-7.

2. Seko, Y. (2013). Picturesque Wounds: A Multimodal Analysis of Self-Injury Photographs on Flickr. Forum: Qualitative Social Research, 14 accessed at

3. Lewis, S. P. and Seko, Y. (2016). A Double-Edged Sword: A Review of Benefits and Risks of Online Nonsuicidal Self-Injury Activities. Journal of Clinical Psychology, 72, pp. 249-62.

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