A study conducted using YouTube's search option entering the keywords "self-injury" and "self-harm," found that the 100 most frequently-viewed videos received more than 2.3 million views -- and often contained graphic depictions of cutting, burning, and self-embedding, according to Stephen Lewis, PhD, of the University of Guelph in Ontario, and colleagues.
Most of the videos did not have warnings about the content or viewing restrictions, Lewis and co-authors reported online ahead of the March issue of Pediatrics.
Although the researchers did not evaluate the influence these videos may have on young viewers, they said that "the possible impact ... is worrisome."
In particular, they wrote, "The nature of nonsuicidal self-injury videos on YouTube may foster normalization of nonsuicidal self-injury and may reinforce the behavior through regular viewing of nonsuicidal self-injury-themed videos."
Previous studies have shown that self-injury in the absence of suicidal thoughts occurs at rates of 14% to 21% among children, teens, and young adults, and places them at risk for interpersonal difficulties, elevated psychiatric symptoms, and even suicide.
The proliferation of video-sharing Web sites featuring these self-harm videos, may serve to normalize such behavior, Lewis and colleagues warned.
To evaluate the accessibility and scope of self-injury videos on the Internet, the researchers identified the 100 most viewed videos involving self-injury on the largest video-sharing site, YouTube. Half of the videos involved a live person, and half did not.
The vast majority of the self-injury videos were uploaded by females (95%) with a mean age of 25. The researchers noted, however, that the actual average age of those who uploaded the videos was likely to be lower, because some YouTube viewers provide an older age to access restricted content.
But, in fact, Lewis and co-authors noted, most of the videos showing self-harm (80%) did not have any viewing restrictions at all.
Viewers clicked on the self-harm videos 2.3 million times -- and rated them favorably (an average of 4.61 out of 5).
Overall, 42% of the videos were neutral, neither encouraging nor discouraging self-injury. Another 26% of the videos were against such practices, 23% provided a mixed message, and 7% encouraged the acts.
Slightly more than half of the videos were factual or educational, or contained hopeless statements or depictions of sadness or crying.
Explicit images of self-injury were common. Overall, nearly two-thirds of the videos depicted self-injury, most commonly cutting (seen in 64% of videos).
Nine out of every 10 videos that did not include a live person had graphic pictures of self-injury. Of those videos that included a person, 28% had a live-action demonstration of cutting.
Unpublished research from Lewis' group indicates that images of self-injury cause some young people who practice self-injury to become upset -- and may even result in additional injury.
"This may therefore have triggering-like consequences for those who have enacted nonsuicidal self-injury repetitively and for youth who have just started to self-injure and who may come across these videos when searching for nonsuicidal self-injury material and information online," the researchers wrote.
But, even though the impact of online videos is concerning, the Internet may also provide solutions to the problem of self-injury, Lewis and colleagues noted.
"The Internet in general, and YouTube, in particular, offer novel ways to reach a greater number of youth who may otherwise not openly discuss their nonsuicidal self-injury with others," they wrote.
They acknowledged that the study was limited in that they did not examine every self-injury video or evaluate how viewers were influenced by or reacted to the videos.
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