Social Media Posts About Nonsuicidal Self-Harm Have Hallmarks of Addiction-Related Content

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Reddit posts from forums discussing self-harm were used to characterize and quantify the addiction language and to evaluate the extent to which individuals who engage in self-harm feel they are suffering from an addiction.

Social media posts related with nonsuicidal self-injury (NSSI) showed patterns in language and content similar to addiction-related content. These findings were published in the Journal of Behavioral Addictions.

Investigators at the National Institute on Drug Abuse Intramural Research Program extracted posts on Reddit from forums discussing self-harm. These posts were used to characterize and quantify the addiction language and to evaluate the extent to which individuals who engage in self-harm feel they are suffering from an addiction.

A total of 69,380 posts and 290,524 comments from 38,484 users between 2010 and 2019 were used. A summary of 2000 words from 500 random users were selected and compared with 11 Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) criteria for substance use disorder (SUD).

Across all DSM-5 SUD criteria, Fleiss’ k ranged from 0.16 to 0.62. The posts that were in slight agreement with SUDs were about spending time preparing to self-harm, engaging in self-harm, and recovering from self-harm. The posts which were most in line with SUDs were about the urge or craving to self-harm.

Posts with content about trauma or posttraumatic stress disorder were in moderate agreement with the disorders and posts about trauma were almost in perfect agreement with obsessive-compulsive disorder criteria.

Among 384 users, 76.8% had ≥2 NSSI-adapted DSM-5 SUD criteria and would be categorized as having mild (59.9%), moderate (34.9%), or severe (5.2%) addiction. The most common symptoms were craving (67.6%), escalation (47.8%), and NSSI that is physically hazardous (38.2%).

For addiction language, Fleiss’ k ranged from 0.25 to 0.96. The language in fair agreement with addiction content were “I’m an addict” or concepts similar to

“celebrating time without self-injury” and almost in perfect agreement were words like “relapse,” “clean,” and “recovery.”

Addiction symptoms were correlated with addiction language (r, 0.22; P <.001) and related with the number of psychiatric disorders (β, 0.12; P <.01) and number of methods of self-harm (β, 0.10; P =.02).

After removing NSSI events which were physically hazardous, addiction symptoms increased risk for positive endorsement of harm (odds ratio [OR], 1.37; 95% CI, 1.19-1.57; P <.001).

The data in this study may be limited as they could not be validated and only represent information that individuals chose to share on a public forum.

The study authors concluded, “This study analyzed the posts of a subset of users on the subreddit r/selfharm for symptoms of addiction adapted from the DSM-5 SUD diagnosis and found that a large majority of users met diagnostic criteria for addiction. […] Taken together, our findings lend support for the addictive nature of NSSI and the relationship between addictive features and indicators of clinical severity. Clinicians should monitor for symptoms of addiction to NSSI and may consider adapting strategies from SUD treatment to better support people who self-injure.”


Himelein-Wachowiak M, Giorgi S, Kwarteng A, et al. Getting “clean” from nonsuicidal self-injury: Experiences of addiction on the subreddit r/selfharm. J Behav Addict. 2022;11(1):128-139. doi:10.1556/2006.2022.00005

This article originally appeared on Psychiatry Advisor