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The Dual Value of the Web: Risks and Benefits of the Use of the Internet in Disorders with A Self-Destructive Component in Adolescents and Young Adults

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Abstract

Eating disorders (ED) and non-suicidal self-injury (NSSI) present common aspects and factors which contribute to their onset and development. The last decade has seen an increasing circulation of online materials and interactions connected to ED and NSSI. There is a general agreement among mental health clinicians and researchers that this kind of online content involves serious risks, such as normalization and reinforcement of unhealthy behaviors, alongside with some benefits, like receiving peer support and validation. The aim of this paper is to offer an overview of major research contributions on this topic. After describing common aspects between these disorders, we analyze data concerning the usage of harm-advocating websites on internet and the characteristics of users. Furthermore, we define and explore the contents of both pro-ED and NSSI websites, and we extensively inspect risks and benefits of the exposure to these online content. Finally, we present clinical guidelines for assessment, intervention and prevention, particularly focusing on family interventions. Due to the rapidity of changes when technology is involved, the research on this topic is far from being concluded; more in-depth studies are needed, not only to explore long term effects of the use of the websites described, but also to investigate new alarming tendencies such as the diffusion of websites challenging self-destructive behaviors.

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References

  • Adler, P. A., & Adler, P. (2008). The cyber worlds of self-injurers: Deviant communities, relationships, and selves. Symbolic Interaction, 31(1), 33–56.

    Article  Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (5th ed.). Arlington, VA: American Psychiatric Publishing.

    Book  Google Scholar 

  • Amoss, S., Lynch, M., & Bratley, M. (2016). Bringing forth stories of blame and shame in dialogues with families affected by adolescent self-harm. Journal of Family Therapy, 38, 189–205.

    Article  Google Scholar 

  • Bacigalupe, G. (2011). Families and emergent technologies and adolescence. The Family Psychologist, 27, 11–13.

    Google Scholar 

  • Baker, T. G., & Lewis, S. P. (2013). Responses to online photographs of non-suicidal self-injury: A thematic analysis. Archives of Suicide Research, 17, 223–235.

    Article  PubMed  Google Scholar 

  • Balázs, J., Miklosi, M., Kereszteny, A., Hoven, C. W., Carli, V., Wasserman, C., et al. (2013). Adolescent subthreshold-depression and anxiety: Psychopathology, functional impairment and increased suicide risk. Journal of Child Psychology and Psychiatry, 54(6), 670–677.

    Article  PubMed  Google Scholar 

  • Bardone-Cone, A. M., & Cass, K. M. (2006). Investigating the impact of pro-anorexia websites: A pilot study. European Eating Disorders Review, 14, 256–262.

    Article  Google Scholar 

  • Bardone-Cone, A. M., & Cass, K. M. (2007). What does viewing a pro-anorexia website do? An experimental examination of website exposure and moderating effects. International Journal of Eating Disorders, 40, 537–548.

    Article  PubMed  Google Scholar 

  • Borcsa, M., & Hille, J. (2016). Virtual relations and globalized families—the genogram 4.0 interview, In: M. Borcsa & P. Stratton (Eds.), Origins and originality in family therapy and systemic practice. (pp. 215–234). Cham: Springer.

    Chapter  Google Scholar 

  • Borzekowski, D. L. G., Schenk, S., Wilson, J. L., & Peebles, R. (2010). e-Ana and e-Mia: A content analysis of pro-eating disorder websites. American Journal of Public Health, 100, 1526–1534.

    Article  PubMed  PubMed Central  Google Scholar 

  • Boston, P., Eisler, I., & Cottrell, D. (2010). SHIFT—Systemic Family Therapy Manual for adolescent self-harm. Unpublished manuscript. University of Leeds. https://medhealth.leeds.ac.uk/info/414/mental_health/1743/shift.

  • Brenneisen, N. (2015). Ho Passato una settimana in un gruppo Whatsapp per anoressiche [online article] Retrieved from Jul 8, 2015 https://www.vice.com/it/article/exjyge/una-settimana-in-un-blog-proana-ana-divinita-479.

  • Brotsky, S. R., & Giles, D. (2007). Inside the “pro-ana” community: A covert online participant observation. Eating Disorders, 15, 93–109.

    Article  PubMed  Google Scholar 

  • Brown, T. B., & Kimball, T. (2013). Cutting to live: A phenomenology of self-harm. Journal of Marital and Family Therapy, 39(2), 195–208. doi:10.1111/j.1752-0606.2011.00270.x.

    Article  Google Scholar 

  • Carvalho, J., Francisco, R., & Relvas, A. P. (2017). ICTs and family functioning: A study with Portuguese families with adolescents and emerging adults. Contemporary Family Therapy. doi:10.1007/s10591-017-9436-8.

  • Chesley, E. B., Alberts, J. D., Klein, J. D., & Kreipe, R. E. (2003). Pro or con? Anorexia nervosa and the Internet. Journal of Adolescent Medicine, 32, 123–124. doi:10.1016/S1054-139X(02).006158.

    Google Scholar 

  • Chiara, G., & Cottone, P. (2015). The role of the opioid system in binge eating disorder. CNS Spectrums, 20(6), 537–545. doi:10.1017/S1092852915000668.

    Article  PubMed Central  Google Scholar 

  • Cspike, E., & Horne, O. (2007). Pro-eating disorder websites: Users’ opinions. European Eating Disorder Review, 15, 196–206.

    Article  Google Scholar 

  • Cucchi, A., Ryan, D., Konstantakopoulos, G., Stroumpa, S., Kaçar, A.Ş., Renshaw, S., et al. (2016). Lifetime prevalence of non-suicidal self-injury in patients with eating disorders: A systematic review and meta-analysis. Psychological Medicine, 46, 1345–1358. doi:10.1017/S0033291716000027.

    Article  PubMed  Google Scholar 

  • Custers, K. (2015). The urgent matter of online pro-eating disorder content and children: Clinical practice. European Journal of Pediatrics, 174, 429–433.

    Article  PubMed  Google Scholar 

  • Dalai, J. (2017). Web waves and positive resonance in the community in Milan. Contemporary Family Therapy. doi:10.1007/s10591-017-9433-y.

  • Dallos, R. (2004). Attachment narrative therapy: integrating ideas from narrative and attachment theory in systemic family therapy with eating disorders. Journal of Family Therapy, 26, 40–65.

    Article  Google Scholar 

  • Dyson, M. P., Hartling, L., Shulhan, J., Chisholm, A., Milne, A., Sundar, P., et al. (2016). A systematic review of social media use to discuss and view deliberate self-harm acts. PLoS ONE, 11(5), e0155813. doi:10.1371/journal.pone.0155813.

    Article  PubMed  PubMed Central  Google Scholar 

  • Eisler, I. (2005). The empirical and theoretical base of family therapy and multiple family day therapy for adolescent anorexia nervosa. Journal of Family Therapy, 27, 104–131.

    Article  Google Scholar 

  • Favaro, A., Ferrara, S., & Santonastaso, P. (2004). In: J. L. Levitt, R. A. Sansone & L. Cohn (Eds.), Self-harm behavior and eating disorders: Dynamics, assessment and treatment (pp. 31–44). New York: Routledge.

    Google Scholar 

  • Favaro, A., Ferrara, S., & Santonastaso, P. (2007). Self-injurious behavior in a community sample of young women: Relationship with childhood abuse and other types of self-damaging behaviors. Journal of Clinical Psychiatry, 68(1), 122–131.

    Article  PubMed  Google Scholar 

  • Favaro, A., & Santonastaso, P. (2000). Self-Injurious behavior in anorexia nervosa. Journal of Nervous & Mental Disease, 188(8), 537–542.

    Article  Google Scholar 

  • Fortune, S., Cottrell, D., & Fife, S. (2016). Family factors associated with adolescent self-harm: A narrative review. Journal of Family Therapy, 38, 226–256.

    Article  Google Scholar 

  • Fox, N., Ward, K., & O’Rourke, A. (2005). Pro-anorexia, weight-loss drugs and the internet: An ‘anti-recovery’ explanatory model of anorexia. Sociology of Health & Illness, 27, 944–971.

    Article  Google Scholar 

  • Gale, L., Channon, S., Larner, M., & James, D. (2016). Experiences of using pro-eating disorder websites: A qualitative study with service users in NHS eating disorder services. Eating and weight disorders: EWD, 21, 427–434.

    Article  PubMed  Google Scholar 

  • Gavin, J., Rodham, K., & Poyer, H. (2008). The presentation of “pro-anorexia” in online group interactions. Qualitative Health Research, 18, 325–333.

    Article  PubMed  Google Scholar 

  • Halstead, R. O., Pavkov, T. W., Hecker, L. L., & Seliner, M. M. (2014). Family dynamics and self-injury behaviors: A correlation analysis. Journal of Marital and Family Therapy, 40(2), 246–259.

    Article  PubMed  Google Scholar 

  • Jett, S., LaPorte, D. J., & Wanchisn, J. (2010). Impact of exposure to pro-eating disorder websites on eating behaviours in college women. European Eating Disorder Review, 18, 410–416.

    Article  Google Scholar 

  • Jones, R., Sharkey, S., Ford, T., Emmens, T., Hewis, E., Smithson, J., et al. (2011). Online discussion forums for young people who self-harm: User views. The Psychiatrist, 35(10), 364–368.

    Article  Google Scholar 

  • Juarascio, A. S., Shoaib, A., & Timko, C. A. (2010). Pro-eating disorder communities on social networking sites: A content analysis. Eating Disorders, 18(5), 393–407. doi:10.1080/10640266.2010.511918.

    Article  PubMed  Google Scholar 

  • Lavender, J. M., Wonderlich, S. A., Engel, S. G., Gordon, K. H., Kaye, W. H., & Mitchell, J. E. (2015). Dimensions of emotion dysregulation in anorexia nervosa and bulimia nervosa: A conceptual review of the empirical literature. Clinical Psychology Review, 40, 111–122.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lewis, S. P., & Arbuthnott, A. E. (2014). Non-suicidal self-injury, eating dis- orders, and the Internet. In L. Claes & J. J. Muehlenkamp (Eds.), Non- Suicidal Self-Injury in Eating Disorders (pp. 273–293). Berlin: Springer.

    Chapter  Google Scholar 

  • Lewis, S. P., & Baker, T. G. (2011). The possible risks of self-injury web sites: A content analysis. Archives of Suicide Research, 15(4), 390–396.

    Article  PubMed  Google Scholar 

  • Lewis, S. P., Heath, N. L., Michal, N. J., & Duggan, J. M. (2012). Non-suicidal self-injury, youth, and the Internet: What mental health professionals need to know. Child and Adolescent Psychiatry and Mental Health, 6(1), 13. doi: 10.1186/1753-2000-6-13.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lewis, S. P., Heath, N. L., Sornberger, M. J., & Arbuthnott, A. E. (2012). Helpful or harmful? An examination of viewer’s responses to nonsuicidal self-injury videos on YouTube. Journal of Adolescent Health, 51, 380–385.

    Article  PubMed  Google Scholar 

  • Lewis, S. P., & Knoll, A. K. (2015). Do it yourself: Examination of self-injury first aid tips on YouTube. Cyberpsychology, Behavior, and Social Networking, 18(5), 301–304.

    Article  Google Scholar 

  • Lewis, S. P., & Michal, N. J. (2014). Start, stop, and continue: Preliminary insight into the appeal of self-injury e-communities. Journal of Health Psychology, 21(2), 250–260. doi:10.1177/1359105314527140.

    Article  PubMed  Google Scholar 

  • Lewis, S. P., Rosenrot, S. A., & Messner, M. A. (2012). Seeking validation in unlikely places: The nature of online questions about non-suicidal self-injury. Archives of Suicide Research, 16(3), 263–272.

    Article  PubMed  Google Scholar 

  • Lewis, S. P., & Seko, Y. (2016). A double-edged sword: A review of benefits and risks of online nonsuicidal self-injury activities. Journal of Clinical Psychology, 72(3), 249–262.

    Article  PubMed  Google Scholar 

  • Livingstone, S., Haddon, L., Görzig, A., & Ólafsson, K. (2011). Risks and safety on the internet: The perspective of European children: Full findings and policy implications from the EU Kids Online survey of 9–16 year olds and their parents in 25 countries. EU Kids Online. LSE. London: EU Kids Online.

    Google Scholar 

  • Lock, J. (2010). Treatment of adolescent eating disorders: Progress and challenges. Minerva Psichiatrica, 51(3), 207–216.

    PubMed  PubMed Central  Google Scholar 

  • Mars, B., Heron, J., Biddle, L., Donovan, J. L., Holley, R., Piper, M., et al. (2015). Exposure to, and searching for, information about suicide and self-harm on the internet: Prevalence and predictors in a population based cohort of young adults. Journal of Affective Disorders, 185, 239–245.

    Article  PubMed  PubMed Central  Google Scholar 

  • Marzola, E., Abbate-Daga, G., Gramaglia, C., Amianto, F., & Fassino, S. (2015). A qualitative investigation into anorexia nervosa: The inner perspective. Cogent Psychology, 2, 1032493. doi:10.1080/23311908.2015.1032493.

    Article  Google Scholar 

  • Miller, W. R. (1983). Motivational interviewing with problem drinkers. Behavioural Psychotherapy, 11, 147–172.

    Article  Google Scholar 

  • Miller, W. R., & Rollnick, S. (2002). Motivational Interviewing (2nd ed.). New York: The Guilford Press.

    Google Scholar 

  • Mitchell, K. J., Wells, M., Priebe, G., & Ybarra, M. L. (2014). Exposure to websites that encourage self-harm and suicide: Prevalence rates and association with actual thoughts of self-harm and thoughts of suicide in the United States. Journal of Adolescence, 37, 1335–1344.

    Article  PubMed  Google Scholar 

  • Murray, C., & Fox, J. (2006). Do Internet self-harm discussion groups alleviate or exacerbate self-harming behaviours. Australian e-Journal for the Advancement of Mental Health, 5(3), 1–9.

    Article  Google Scholar 

  • Norris, M. L., Boydell, K. M., Pinhas, L., & Katzman, D. K. (2006). Ana and the internet: A review of pro-anorexia websites. International Journal of Eating Disorders, 39(6), 443–447.

    Article  PubMed  Google Scholar 

  • Oksanen, A., Näsi, M., Minkkinen, J., Keipi, T., Kaakinen, M., & Räsänen, P. (2016). Young people who access harm-advocating online content: A four-country survey. Cyberpsychology: Journal of Psychosocial Research on Cyberspace. doi: 10.5817/CP2016-2-6.

    Google Scholar 

  • Pebbles, R., Wilson, J. L., Litt, I. F., Hardy, K. K., Locks, J. D., Mann, J. R., et al. (2012). Disordered eating in a digital age: Eating behaviors, health, and quality of life in users of websites with pro-eating disorder content. Journal of Medical Internet Research, 14, e148.

    Article  Google Scholar 

  • Peterson, J., Freedenthal, S., Sheldon, C., & Andersen, R. (2008). Nonsuicidal self injury in adolescents. Psychiatry, 5(11), 20–26.

    PubMed  PubMed Central  Google Scholar 

  • Prochaska, J. O., & DiClemente, C. C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research and Practice, 19, 276–288.

    Article  Google Scholar 

  • Rodgers, R. F., Lowy, A. S., Halperin, D. M., & Franko, D. L. (2015). A meta-analysis examining the influence of pro-eating disorder websites on body image and eating pathology. European Eating Disorders Review, 24, 3–8.

    Article  PubMed  Google Scholar 

  • Rogers, A., & Schmidt, P. (2016). Emotion talk in the context of young people self-harming: Facing the feelings in family therapy. Journal of Family Therapy, 38(2), 206–225. doi: 10.1111/1467-6427.12115.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rouleau, C. R., & von Ranson, K. M. (2011). Potential risks of pro-eating disorder websites. Clinical Psychology Review, 31, 525–531.

    Article  PubMed  Google Scholar 

  • Sandman, C. A., & Hetrick, W. P. (1995). Opiate mechanisms in self-injury. Mental Retardation and Developmental Disabilities Research Reviews, 1(2), 130–136.

    Article  Google Scholar 

  • Sansone, R. A., & Levitt, J. L. (2002). Self-harm behaviors among those with eating disorders: An overview. Eating Disorders: The Journal of treatment and prevention, 10(3), 193–203.

    Article  Google Scholar 

  • Schutz, H. K., & Paxton, S. J. (2007). Friendship quality, body dissatisfac- tion, dieting and disordered eating in adolescent girls. British Journal of Clinical Psychology, 46(1), 67–83.

    Article  PubMed  Google Scholar 

  • Smink, F. R., van Hoeken, D., & Hoek, H. W. (2012). Epidemiology of eating disorders: Incidence, prevalence and mortality rates. Current Psychiatry Report, 14, 406–414.

    Article  Google Scholar 

  • Sternudd, H. T. (2012). Photographs of self-injury: Production and reception in a group of self-injurers. Journal of Youth Studies, 15(4), 421–436.

    Article  Google Scholar 

  • Svirko, E., & Hawton, K. (2007). Self-injurious behavior and eating disorders: The extent and nature of the association. Suicide Life Threat Behavior, 37(4), 409–421.

    Article  Google Scholar 

  • Swannell, S., Martin, G., Krysinska, K., Olsson, K., & Win, A. (2010). Cutting on-line: Self-injury and the internet. Advances in Mental Health, 9(2), 177–189. doi: 10.5172/jamh.9.2.177.

    Article  Google Scholar 

  • Swanson, S. A., Crow, S. J., Le Grange, D., Swendsen, J., & Merikangas, K. R. (2011). Prevalence and correlates of eating disorders in adolescents. Results from the national comorbidity survey replication adolescent supplement. Archives of General Psychiatry, 68(7), 714–723. doi: 10.1001/archgenpsychiatry.2011.22.

    Article  PubMed  PubMed Central  Google Scholar 

  • Tan, T., Kuek, A., Goh, S. E., Lee, E. L., & Kwok, V. (2016). Internet and smartphone application usage in eating disorders: A descriptive study in Singapore. Asian Journal of Psychiatry, 19, 50–55.

    Article  PubMed  Google Scholar 

  • Vajda, A., & Láng, A. (2014). Emotional abuse, neglect in eating disorders and their relationship with emotion regulation. Procedia—Social and Behavioral Sciences, 131, 386–390.

    Article  Google Scholar 

  • Vieira, A. I., Ramalho, S., Brandão, I., Saraiva, J., & Gonçalve, S. (2016). Adversity, emotion regulation, and non-suicidal self-injury in eating disorders. Eating Disorders, 24(5), 440–452.

    Article  PubMed  Google Scholar 

  • Whitlock, J. L., Powers, J. P., & Eckenrode, J. E. (2006). The virtual cutting edge: Adolescent self- injury and the Internet. Developmental Psychology, 42, 407–417.

    Article  PubMed  Google Scholar 

  • Wilson, J. L., Peebles, R., Hardy, K. K., & Litt, I. F. (2006). Surfing for thinness: A pilot study of pro-eating disorder web site usage in adolescents with eating disorders. Pediatrics, 118, 1635–1643.

    Article  Google Scholar 

  • Wright, B., Hooke, N., Neupert, S., Nyein, C., & Ker, S. (2013). Young people who cut themselves: can understanding the reasons guide the treatment? Advances in Psychiatric Treatment, 19, 446–456. doi: 10.1192/apt.bp.112.011049.

    Article  Google Scholar 

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Authors and Affiliations

  1. University of Padua, Via Venezia 12, 35100, Padua, Italy

    Giulia Campaioli

  2. Child-psychiatry, S.C. Infanzia, Adolescenza e Famiglia, Azienda U.L.S.S. 16, Padua, Italy

    Eleonora Sale

  3. University of Padua, Padua, Italy

    Alessandra Simonelli

  4. First Department of Psychiatry, National and Capodistrian University of Athens, Athens, Greece

    Valeria Pomini

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  1. Giulia Campaioli
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  2. Eleonora Sale
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  3. Alessandra Simonelli
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  4. Valeria Pomini
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Correspondence to Giulia Campaioli.

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Appendix

Appendix

The following list includes websites that have been recommended by several authors (Lewis et al. 2012; Lewis and Arbuthnott 2014); these websites provide information and resources upon mental health, NSSI, and ED issues. Mental health professionals may refer to these websites when they wish to establish a safe, pro-recovery oriented online activity with their patients, as well as for research purposes.

  • Teen central net https://www.teencentral.com/ This anonymous website is intended for youths and their parents; it provides support and information; content is protected being the site professionally driven.

  • Mayo clinic http://www.mayoclinic.com/ 
Online community designed to provide a wide range of health information, such as definitions, symptoms, risk factors, tests and diagnoses, treatment and drugs, coping and support, and prevention.

  • Teen mental health http://teenmentalhealth.org/
 Provides mental health information and resources for youths and their families, but also teachers and mental health professionals.

(Reported by Lewis et al. 2012).

Non-Suicidal Self-Injury

  • Self-injury outreach and support (SIOS) http://www.sioutreach.org This website focuses on NSSI information and support, and it holds NSSI experience-sharing and NSSI resource. It is designed for self-injurers, peers, family, teachers, mental health and medical professionals.

  • Cornell research program on self-injurious behavior http://www.selfinjury.bctr.cornell.edu/ Provides research findings and resources upon NSSI; designed for mental health professionals and researchers, physicians, school professionals.

  • Self abuse finally ends (SAFE) http://www.selfinjury.com This website is recommended for both self-injurers and people belonging to their social context; NSSI information is provided, with a focus on treatment intervention.

Eating Disorders

  • National eating disorders association (NEDA) http://nationaleatingdisorders.org Nonprofit organization with the aim of prevention and support for people who deal with ED issues, their family and friends, health and school professionals.

  • Academy for eating disorders http://www.aedweb.org. This professional association focuses on ED and it is specifically designed for health professionals and researchers.

(Reported by Lewis and Arbuthnott 2014).

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Campaioli, G., Sale, E., Simonelli, A. et al. The Dual Value of the Web: Risks and Benefits of the Use of the Internet in Disorders with A Self-Destructive Component in Adolescents and Young Adults. Contemp Fam Ther 39, 301–313 (2017). https://doi.org/10.1007/s10591-017-9443-9

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