An Inductive and Deductive Content Analysis of Images of Nonsuicidal Self-Injury: (Dis)Connecting through Social Media

Background and Purpose: Nonsuicidal self-injury (NSSI) refers to self-inflicted, deliberate destruction of body tissue without suicidal intent, and includes behaviors such as cutting, scratching, banging or hitting, and burning. Because NSSI presents in mood, anxiety, stress, and personality disorders, it is often considered from a functional versus diagnostic perspective. These functions include both intrapersonal and interpersonal processes (e.g., emotion regulation and peer bonding, respectively). Current research indicates social media and other online sources may reinforce, validate, or otherwise normalize NSSI. For example, an increasing number of self-injuring individuals post images of wounds, scars, or other NSSI-relates images to their social media accounts. Relatedly, some researchers suggest the incidence of NSSI has increased over time and cited the proliferation of social media as a possible explanation for the increased rates of NSSI. The present study sought to phenomenologically understand how individuals use images of NSSI on social media—more  especially, understand the possible functions of posting NSSI-related images, as well as consider what is being made possible through these images.

Methods: Selection criteria were created in order to obtain 200 #selfinjury images and captions from Instagram. Inductive and deductive content analysis procedures were employed to identify themes--an inductive approach was used to identify latent and emergent themes, and a deductive approach was used to create a codebook based on relevant theory and subsequently categorize the images and captions according to their functions. All images were coded independently by a minimum of three coders and then reviewed through a peer debriefing process. All data were analyzed using ATLAS.ti software.

Results: The deductive analysis procedures revealed the functions of posting NSSI-related images aligned with current interpersonal and intrapersonal models of NSSI, including automatic social reinforcement, communicating internal distress, and  self-punishment in the form of publicly expressing feelings of guilt and shame for having engaged in NSSI. The inductive analysis procedures revealed emergent themes that did not fit into existing models—for example, expressions of desire for community, acknowledging NSSI for the sake of accountability, and requests for help in overcoming self-destructive behaviors and suggestions for alternative coping methods.

Conclusions and Implications: These findings challenge the assumption that posting images of NSSI on social media is intended to reinforce or normalize NSSI in others or that such posts are inherently attention-seeking in nature. Rather, posting NSSI-related images to social media serves diverse and nuanced functions that could potentially be harnessed to address these self-destructive behaviors. Further research is needed to clarify when social media use needs to be targeted in NSSI interventions and to understand how social media can be utilized to increase help-seeking attitudes and adaptive coping.