YouTube provides easy access to videos of almost anything, but what is the impact on viewers, especially younger viewers, when "anything" includes hundreds of photos, video clips and montages of self-harming behaviors such as cutting and self-mutilation?
In a study that analyzed the videos, Canadian researchers found that the 100 most popular videos portraying self-harm on YouTube have been viewed more than 2 million times and selected as "favorite" more than 12,000 times, triggering concern over what kind of impact the sharing and viewing of these videos may be having on those at risk for self-injurious behavior.
"We found that very few videos actually encourage self-injury," says the lead author on the study, Stephen Lewis of the University of Guelph in Ontario. "Most were neutral or hopeful for overcoming this issue. But these findings also speak to the possibility of a few risks.
"Some videos may work to reinforce self-injury behavior or serve as a trigger for self-harm," Lewis adds. "It might foster communities where self-injury is more normal and [so is to] not always urge people to seek help."
In fact, concerned for the potential risks, YouTube contacted researchers and has since removed the videos they considered inappropriate content, Lewis says.
Self-injury behavior, which, in the videos, most often took the form of self-cutting, is known as non-suicidal self-injury (NSSI) because while it involves the deliberate destruction of one's own body tissue, it is not necessarily driven by a desire for suicide. Often, self-harmers report that cutting is a form of coping with emotional pain and that the act of inflicting pain on themselves provides powerful momentary relief from mental distress, says Kim Gratz, director of personality disorders research at the University of Mississippi Medical Center.
Though it's hard to gauge the prevalence of this behavior, Gratz says that studies find that between 17 and 40 percent of college students admit to committing self harm and between 15 and 30 percent of high school students do.
While research on self-harm and the influence of the Internet is fairly new, some are questioning whether the proliferation of self-harm videos, websites, and message boards -- even those which are somewhat neutral in their portrayal of self harm -- may be as dangerous as the many pro-anorexia and pro-bulimia internet forums that have been condemned by psychiatrists in recent years.
"It's hard to tell what role these videos and websites might play. Depending on the nature of the video it could be incredibly helpful ... [by] providing support and directing people to help, or they might glorify the practice and overlook the downsides. Honestly, I think that's the problem with the Internet [with things like this] -- it can be both."
Monday's research looked at highly viewed videos that either were character-based, meaning they featured a real person speaking, or non-character, which usually featured montages of photos and text set to music.
It found that, at the time of the study in December 2009, 90 percent of videos concerning self harm featured photographs of self injuries and 28 percent actually featured people inflicting injuries on themselves.
Less than half of these videos provided any warning concerning the graphic nature of the images or the risk of "triggering" self-harm behavior in those who had a tendency towards it.
But for the majority of the videos, promoting self-harm did not seem to be the intention. Often, the videos supplied educational information such as prevalence statistics or shared stories of beating self-harm behavior after many years struggling with it. Still others featured scars and warned viewers against the dangers of using self harm as a means of coping.
For many, posting or viewing the videos may be a means of battling feelings of isolation in those too afraid to admit their behavior to others.
Kevin Caruso, the executive director of Suicide.org says that "based on the countless communications I have had with people who self-injure, the vast majority of information and videos on the Internet helps and comforts self-injurers more than it puts them in danger."
"So many of them feel the Internet is the only place where they can get help," he adds.
While Caruso has spoken with some people who noted that they are easily triggered to self harm by images or talk of cutting, such people usually choose not to watch the videos.
A recent search of self-harm videos on YouTube brought up many in which posters explicitly mentioned that they created the videos in order to reach out so that other self harmers don't feel so alone.
One such video, posted by a user named SoLostInYou, stated in the comments that, "This is to raise awareness and to let others know, they're not alone."
Another, posted by MisunderstoodSoul, talked about the user overcoming cutting: "I've been self harming for over 5 years, but am at the moment on a break from it, and have noticed that ... I DON'T NEED It. Please just give living without self injury a chance ... there are so many things you can do instead. All the best to you my friends, we really can beat this!"
Lewis says that the main purpose of his study is to "get a sense of what exactly is portrayed and contained within these videos."
The study unfortunately cannot speak to why people post the videos or what impact they are having on those who view them, but Caruso and colleagues are doing further research to help elucidate such questions.
"There's been a lot of interest in the last five years concerning the idea of social contagion with these images, but my sense is that we just don't know what impact they are having. We need more research," Gratz says.
For now, the existing research may serve to raise awareness concerning the prevalence of self harm and the fact that many may be suffering in silence.
"All people who self-injure need immediate and professional help, but most do not get it," Caruso says. "They usually hide their cuts or scars below clothing and hide the pain that is causing them to self-injure."