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Self-injurious behaviors on the net: a survey of resources for school counselors.

Self-injurious behaviors (SIBs) are encountered almost daily by some school counselors, and although many resources are cited and referenced in textbooks and professional journals, few online resources have been explored in the literature. In this article, the authors give an overview of the most visited Web sites related to information about self-injurious behaviors, provide an analysis of the various online SIB resources, and offer school counselors strategies for evaluating all Web sites.


Over the past decade there has been a steady rise in the reports of self-injurious behavior (SIB) among adolescents (Conterio & Lader, 1998; Trepal, Wester, & MacDonald, 2006). SIB is defined as nonsuicidal behavior in which youth physically harm themselves using a variety of techniques to overtly or covertly mutilate parts of their bodies (Muehlenkamp, 2005). Current estimates of SIB patterns of youth in the United States reveal a significant number of adolescents may be involved in these types of self-harming behaviors (White Kress, Costin, & Drouhard, 2006; Whitlock, Powers, & Eckenrode, 2006). In fact, White-Kress et al. found nearly 13% of youth surveyed reported personally engaging in self-injurious behaviors. Clearly, school counselors will be faced with students who engage in SIB. Thus, the need exists for school counselors to have resources and information related to prevention, intervention, and education strategies regarding SIB.

With the rise in the prevalence of SIB, there has been an increase in information available to school counselors working with students who self-injure (Murray & Fox, 2006). For example, trade texts describe self-injurious behavior and outline different techniques to provide SIB support and counseling (Alderman, 1997; Conners, 2000; Conterio & Lader, 1998; Favazza, 1996; Strong, 1998; Walsh, 2006; Walsh & Rosen, 1988). Likewise, academic and news articles provide guidelines, research, and interventions for SIB (Crowe & Bunclark, 2000; Murray, Warm, & Fox, 2005; Nock & Prinstein, 2004; Ross & Heath, 2001; Selekman & King, 2001). However, SIB resources on the Internet have received far less attention and critical review (Whitlock et al., 2006). Considering that a majority of the population in the United States uses the Internet (U.S. Department of Commerce, n.d.), and adolescents seek out health and mental health resources online at a high rate (Rideout, 2001), it is imperative that school counselors have strategies to discern online information related to SIB. Therefore, the purpose of this article is to give an overview of various online resources, and to provide school counselors with a methodology to evaluate Internet-based SIB information.


The Internet has evolved into a medium that facilitates much of the social ecology of adolescents in the United States (Gross, Juvonen, & Gable, 2002). Given that 90% of 12- to 17-year-olds report using the Internet, and over half use the Internet daily (Lenhart, Madden, & Hitlin, 2005), the World Wide Web is a formidable social and educational medium. Further, schools actively support and encourage student Internet usage by infusing computer technology in classroom activities and on campuses (Gray, Klein, Noyce, Sesselberg, & Cantrill, 2005). As adolescents are encouraged to use technology as an educational endeavor, they also have turned to the Internet for social interactions and networking (Peter, Valkenburg, & Schouten, 2006).

Adolescents have been labeled as the "defining users of the Internet" (Peter et al., 2006, p. 526). Although Internet time may be spent on many different tasks (e.g., homework, downloading music, general surfing), the majority of adolescents spend their online time communicating with others, including friends and strangers (Gross, 2004). Social networking sites have become increasingly popular within the adolescent population (Peter et al.; Valkenburg, Peter, & Schouten, 2006). Gross et al. (2002) found that adolescents use the Internet to interact with school peers with whom they feel comfortable, and seek out relational connections with peers and others when they are troubled. As adolescents search for online social support they may encounter a variety of Web sites and individuals online, and these troubled teenagers may be vulnerable to online exploitation (Wolak, Mitchell, & Finkelhor, 2003). Adolescents who visit Web sites focusing on self-injury may be exposed to others who share SIB techniques, sell paraphernalia, and encourage SIB (Whitlock et al., 2006).

In addition to seeking and maintaining online relationships, adolescents often search for health information and medical advice online (Gray et al., 2005). A recent survey revealed that 75% of 15- to 24-year-olds visited health information Web sites, and nearly 40% of the respondents claimed to have changed a behavior as a result of reading online health information (Rideout, 2001). The participants in Rideout's study also reported feeling more comfortable seeking psycho-social information from friends or others with the same condition, rather than obtaining medical information from experts. Considering SIB has medical, psychological, and social implications, troubled adolescents considering or engaging in SIB may readily turn to the Internet as a source for information and connection with others.


The number of SIB discussion boards and Web sites grew considerably between 1998 and 2000, and participation has remained steady over the past years (Whitlock et al., 2006). Self-injurious behaviors usually begin in early to mid-adolescence (Alderman, 1997; Moyer & Nelson, 2007), which corresponds with the ages that teenagers use the Internet at high rates (Peter et al., 2006). As these youth seek online resources, they may be confronted with a wealth of information and opportunities for interaction. For example, online discussion boards and informational Web sites are available at any time of the day and can be easily accessed from private locations. Privacy may be especially inviting to those who self-injure because their coping behavior may be misunderstood by many family members, or even viewed as manipulative by some mental health professionals (Murray & Fox, 2006).

Although there has been some research conducted related to the content and interactions on SIB discussion boards (Whitlock et al., 2006), a clear gap exists in the literature focused on non-interactive online SIB resources. Thus, school counselors who are equipped with strategies for evaluating the helpfulness and accuracy of online SIB information can better serve their students and communities. Further, carefully analyzing and reviewing online SIB resources meets the American School Counselor Association's (2004) ethical standards for professional and technological competencies (E.1.C), enabling school counselors working with self-injurious students to keep abreast of pertinent online resources. As previously stated, the purpose of this article is twofold. First, we provide an analysis of various non-interactive SIB online resources. Second, we offer school counselors a methodology to evaluate Internet-based SIB information they may encounter online.


To analyze the lexicon of Web-based information related to SIB, we followed published protocols in the counseling and health-care literature for evaluating Internet resources. For example, Morahan-Martin and Anderson (2000) recommended assessing Web sites according to several different domains: source of sponsorship, authorship, coverage of stated topic, objectivity, use of inflammatory language, regularity of updates and site maintenance, site design, and user privacy. Dorman (2002) proposed similar principles for evaluating Web sites and urged users to evaluate Web sites based on their authority, complementarity, confidentiality, attribution, justifiability, transparency of authorship, transparency of sponsorship, and honesty in advertising. By following these online information appraisal strategies, we judged Web sites to be helpful SIB resources when they (a) were written by a credible or credentialed author, (b) were free of commercial and other biases, (c) logically followed the goals and purpose of the Web site, (d) were updated frequently, (e) provided references to resources, (e) were easy to navigate with information readily accessible, and (f) provided users confidentiality and privacy (Dorman; Morahan-Martin & Anderson).

Each Web site was evaluated based on the guidelines stated above and Web sites were grouped according to the type of content presented, the stated philosophy of SIB, and the accuracy of the information. As we conceptualized this project, we reviewed the literature and discussed the potential categorizations of online SIB information. After proposing potential categories, we categorized potential sites for review according to the following groups: (a) informational and factual, (b) supportive self-help, (c) pro-cutting--sites to be avoided, and (d) interactive sites (message-board forums, MySpace and other social networking accounts, and chat rooms).

After we considered the purpose and focus of this study, we excluded interactive sites from this study.

We saw these interactive sites as having the potential to deliver harmful and unpredictable messages about SIB. In addition, for the sites under study, we were careful to catalog Web sites that included triggering material. We defined a trigger as online material that causes viewers to experience emotions and perceptions that typically precede and trigger cutting behavior. Examples of triggering material include images and statements that glorify or discuss SIB as a preferred alternative to coping with emotional pain (LifeSIGNS Self-Injury Guidance & Network Support, n.d.). Finally, each author of the study independently visited and assigned the Web sites to our agreed-upon categories.

On March 3, 2007, we conducted two Google searches using the terms "self mutilation" and "self-injury." Google returned more than 789,000 and 931,000 sites, respectively. These results demonstrated the sheer number of sites available. As a result, we decided the best way to evaluate the most used and most available Web sites would be to investigate only the top 20 sites (N = 80) listed under each of the top search engines. Search engines studied included,,, and ( and are meta-searches that query several other search engines). In order to address all Web sites focusing on the identified topics, we also used several different search terms. We conducted a separate search with each of the aforementioned search engines for the following terms: (a) "cutting," (b) "self-mutilation," and (c) "self-injury." After we compiled lists from each search engine, and eliminated duplicate sites, we identified a total of 48 separate Web sites for further analysis.


Out of the total of 48 Web sites we visited, 37 met criteria for further in-depth analysis. We delineated the 37 sites by our defined groups, categorizing 10 as supportive or self-help, 5 as pro-cutting or anti-cutting but having triggering information, and the remaining 22 as informational and factual. Although most sites generally belonged to one particular category, we found that some had characteristics of more than one category. Web sites meeting multiple criteria are identified in Table 1 with an asterisk.

Health On the Net Foundation

After reviewing several Web sites, we observed that several (n = 6, 16%) were accredited by the Health On the Net Foundation (HON). HON offers certification based upon Dorman's (2002) principles for online health information. When Web sites display the HON seal, they have been evaluated by this foundation and have met standard requirements for online health information. We found the HON Web site to be a valuable starting point for searching about self-injury information; however, HON certification is not self-injury specific and does not alert users to potential triggering information or interactivity among users. In our analyses, we expanded upon the HON standards and evaluated potential triggering information, as well as evaluated non-HON-certified resources that school counselors may uncover when conducting online searches.

Informational and Factual Web Sites

Informational and factual Web sites (Table 1) typically offered definitions and discussion about the characteristics of SIB. They cited pertinent literature and often provided some references to the reader; however, the range of the number of scholarly citations varied considerably with some providing only 1 reference and others providing as many as 104. In addition, most reported when the last update or review of the information occurred (n = 12, 64%), and most had privacy policies listed (n = 12, 64%). A similar number of the sites also provided users with dear authorship (n = 12, 64%). One example of an informational and factual Web site that included dear authorship, recent citations and resources, and notice of updates was Self-Injury and Related Issues (SIARI; This Web site provided users with an enormous amount of valuable information including a working definition of SIB, communities and forums, a tremendous reference list, and research pertaining to SIB. All of SIARI's information was updated regularly and was provided by professional authors with experience working with SIB.

Supportive Self-Help Web Sites

Supportive self-help Web sites (Table 2) included users' stories of struggle and healing with themes stressing the importance of connecting with others and seeking help while attempting to understand and recover from SIB. For example, visitors were able to peruse users' written and visual material with anonymity. Finally, to be included in this category, we assessed that a majority of the information included narratives of connectedness, hope, catharsis, and discourse about recovering from SIB. These first-person narratives provided readers with honest portrayals of the emotional struggles associated with SIB, delivering messages of alternatives to SIB and giving users permission to seek help from support groups or professionals. For example, when visiting, users could read poetry, view pictures, and read personal stories of others struggling with this coping behavior and learn that they were not alone in this activity. Users also were able to view ways that others had found to be successful in putting aside their cutting behaviors. All of these options were available for visitors, which may have helped them in feeling as though they were a part of a healing community.

Pro-Cutting Web Sites--To Be Avoided

The information provided in pro-cutting Web sites (Table 3), like the others, was non-interactive. However, we observed varying levels of triggering content. The Web-site design and material seemed to glorify sell-injurious behaviors and used terminology to encourage SIB. Despite including some informational and factual components and supportive elements, these sites seemed biased toward encouraging SIB. Due to conflicting or clearly biased information, we included these sites under this category. For example, 43 Things ( seemed, at first glance, like a valuable and informative Web site and a place where those who self-injured were able to share their stories and gain support from others. However, upon closer examination, it was clear that the information available could be harmful and detrimental if viewed by those who were struggling with self-injury. The Web page allowed users to post their recent struggles with self-injury while at the same time some posters glorified how they injured themselves, and there was even some sharing of techniques and postings that asked the viewing audience for suggestions of how best to cut themselves. Along with the general content of the Web site there was a great deal of triggering material present--material that when read may have brought about thoughts and ideas of cutting for an individual who was trying to refrain from sell-injury.


The second purpose of this study was to provide school counselors with guidelines to evaluate online SIB information. We build upon the suggestions provided by Dorman (2002) and Morahan-Martin and Anderson (2000), expanding their recommendations to focus on online SIB information. The following steps serve as a template for school counselors to use when assessing the content of Internet-based SIB information. Due to the fluid nature of online information, these strategies may help school counselors critically evaluate ever-changing online SIB content. Each of the types of Web sites we identified could be used by school counselors as resources for students and families.

Do HON Searches

As we previously mentioned, the Health On the Net Foundation offers general certification for Web sites that provide the public with health information. In addition, the HON home page ( has an engine for conducting searches of certified sites. We would recommend starting searches about sell-injury from this resource and then applying the following principles specific to SIB resources.

Review the Web Site in Its Entirety

Be sure to review all aspects of any Web site before recommending it to any student or family. Reviewing the sites allows school counselors to have prior knowledge about the material available and thus be able to direct students and families to the most pertinent information for their needs. School counselors should not refer a Web site if upon review the site seems to provide insincere information. Some sites also may be more or less appropriate based on the ease in which material is accessible. Information is only useful if it can be accessed. A simple review of the site can provide an idea of whether the material is age-appropriate and provides the depth of information that will be useful to the user. Each Web site should have clearly stated goals and objectives and then meet those stated goals. Web sites also should provide additional references, links, or contact information that allows the user to search for more information if he or she wishes.

Review Web-Site Authors and Owners

Reviewing a site's authors and owner can be especially important when referring students and families to view Web material, for a number of reasons, including safety. School counselors can get a good idea of the credibility of the information provided by reviewing the authors, along with their credentials and motives for providing the material. Also, it is key to consider the regularity with which the material is revised. This is particularly important for Web sites focused on self-injurious behaviors because the literature and research are continually changing and being updated.

Look for General Themes

General themes of Web sites may be found throughout the material presented as well as by looking at the sponsors or financial supporters of the Web site. Sponsorship and financial backers are important to identify because they can influence the type and vantage point of the information that is presented. Also, look to determine whether the Web site is for profit or a nonprofit. All of these factors can point to the purpose and themes of the Web sites.

Look for Any Potential Triggering Material

Triggering information can be either hidden or blatant within the content of a Web site. Some site managers choose to post extensive warnings about the material included on their page and others make no mention of it and leave readers open to whatever information they find. When perusing a Web site before referring a student to it as a potential reference, it is important to search for and be knowledgeable about possible triggering content as to not refer a student who may be in a fragile state. Look for any mention of sharp objects, references to cutting or burning, or statements that may seem to glamorize or encourage the self-injurious act.


Given the ever-changing nature of Web sites and the voluminous amount of potential information available, we recognize that SIB Web sites may become outdated, change in focus, or disappear completely. Therefore, the sites reviewed in this article were only a sample of what was available at the time of our research. School counselors should seek information and consultation from knowledgeable professionals about SIB and online health information, and carefully review information for credibility and therapeutic value. Although we acknowledge that online material may be a useful resource, we recommend families and clients affected by SIB work closely with a counseling professional specifically trained in SIB treatment.


Clearly, self-injurious behaviors are a serious clinical concern. In this article, we sought to explore the kinds of information that families may encounter when searching for SIB information online, and we suggest that carefully reviewed online information could be used as a helpful adjunct in the treatment of SIB. Further, families may access the Internet to gain information to supplement their counseling services or learn more about SIB. School and community counselors can help families ascertain the accuracy and credibility of the online information the families may find. Counselors and families also may access several federal Web sites focused on mental health issues and behavior. Of note, the Substance Abuse and Mental Health Services Administration offers a mental health treatment locator at Furthermore, the National Institute of Mental Health ( provides information about serious issues (e.g., borderline personality disorder, bipolar disorder, suicide) that may co-occur with SIB. As a serious behavioral issue, school counselors and families should be sensitive to comorbidity of SIB with other major diagnoses.

The enormous amount of information available online to students, families, and school counselors can be both a great attribute and a dangerous entity depending on how it is used. Online authors have the freedom to publish materials without passing through traditional gatekeepers who safeguard readers and ensure quality information. Many times there is no editorial board or peer review; anyone who has the technical ability can produce material accessible to the entire World Wide Web (Morahan-Martin & Anderson, 2000). In the changing world of school counseling in which many of the best resources are available through Internet connections, it is important that school counselors be aware of and educated on material available online relating to self-injurious behaviors. School counseling professionals should be able to help their students and families find, evaluate, and use online health-care information (Morahan-Martin, 2004).

School counselors often may be the first professional a student or parent turns to when dealing with issues of self-injury and consequently may encounter the issue on a daffy basis (Froeschle & Moyer, 2004). Many school counselors are confused and even frustrated with how to best help these students with their self-injury and oftentimes turn to available resources for assistance (White Kress et al., 2006). It is the goal of this article to present school counselors with a new avenue and new strategies to search for and provide factual and current resources for their students and families. Self-injury is just one of many issues that are at the forefront of confusing and disturbing adolescent problems. With the help of online resources, school counselors can provide the best references for their students and families as well as use the most up-to-date information in all aspects of their guidance program.

The information organized in this project is only the tip of the iceberg in terms of what students can access. Sites are constantly being created and then again dropping off and becoming inaccessible. Even though we worked diligently to cover the largest and most easily accessible resources available online, there are still numerous areas that have not yet been investigated such as YouTube, MySpace, and many other personal Web sites in which individuals can post a vast array of different information including video, music, poetry, and pictures. With the understanding that online information changes and Web sites come and go quite frequently, it is crucial for school counselors to critically evaluate Web sites before recommending them as potential resources for students and their families.


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Michael Moyer, Ph.D., and Shane Haberstroh, Ed.D., are assistant professors, and Christina Marbach is a doctoral student, at the University of Texas-San Antonio. E-mail:
Table 1. Informational and Factual Web Sites

Web-Site Name and Address Num Privacy
 Refs Policy

SAFE Alternatives: 31 No

College of Education, Northern Illinois 5 No

Mental Health Matters: www.mental-health- 6 Yes

iVillage: 0 Yes

Self-Injury and Related Issues: 104 No *

American Academy of Child & Adolescent 1 Yes
for+Families 1 Yes
self_injury.htm 0 Yes
your mind/mental health/cutting.html

American Self-Harm Clearinghouse: 2 No *

Cool Nurse: Not found

On Your Mind (interactive): 0 Yes

By Parents for Parents: www.byparents- 0 No

Right 0 No

Wikipedia: 20 Yes

NPR: 1 Yes

The Prevention Researcher: www.tpronline. 0 Yes

National Center for PTSD: Not found
gov/facts/problems/fs self harm.html

American Association for Marriage and 5 Yes
Family Therapy:
Consumer-Updates/Adolescent Self Harm.asp

Lysamena Project (religious-based 26 No
information): www.concernedcounseling. 0 No
com/communities/Self Injury/Site/indea.htm

Mayo Clinic: 0 Yes

Musicians for Mental Health: www.mpower 2 Yes

Web-Site Name and Address Author Date

SAFE Alternatives: P No

College of Education, Northern Illinois P No

Mental Health Matters: www.mental-health- P No

iVillage: P Yes

Self-Injury and Related Issues: P Yes *

American Academy of Child & Adolescent P Yes
for+Families P Yes
self_injury.htm P Yes
your mind/mental health/cutting.html

American Self-Harm Clearinghouse: NP/Unk No *

Cool Nurse:

On Your Mind (interactive): Unk No

By Parents for Parents: www.byparents- Unk No

Right Unk No

Wikipedia: NA Yes

NPR: P Yes

The Prevention Researcher: www.tpronline. P Yes

National Center for PTSD:
gov/facts/problems/fs self harm.html

American Association for Marriage and P Yes
Family Therapy:
Consumer-Updates/Adolescent Self Harm.asp

Lysamena Project (religious-based Unk Yes
information): www.concernedcounseling. Unk No
com/communities/Self Injury/Site/indea.htm

Mayo Clinic: P Yes

Musicians for Mental Health: www.mpower Unk Yes

Note. Num Refs = the number of references to outside resources that
the Web site provides visitors. Privacy Policy = whether or not
the Web site has a stated privacy policy. Author = the type of
authorship on the Web site, whether professional (P),
nonprofessional (NP), unknown (Unk), or not applicable (NA). Date
Info = whether or not the Web site offers a date for when
information was updated. * = Web site meeting multiple criteria.

Table 2. Supportive Self-Help Web Sites

Web-Site Name and Address Num Privacy Author Date
 Refs Policy Info

Secret Shame: 81 No Unk Yes
LifeSigns: 0 No NP No
Bipolar World: bipolarworld. 25 No NP No
Crescent Life: Self Injury: 0 No NP No
Self-Injury Information and 0 No NP Yes
Men Who Self-Injure: 0 No NP No
Can't Scream, Can't Shout: 0 No NP No
Self-Injury: A Struggle: 20 Yes NP Yes
Self Injury: www.mirror- 0 No Unk No
About: Bipolar Disorder: 4 No P No

Note. Num Refs = the number of references to outside resources that
the Web site provides visitors. Privacy Policy = Web = whether or
not the Web site has a stated privacy policy. Author the type of
authorship on the site, whether professional (P),
nonprofessional (NP), or unknown (Unk). Date Info = whether or not
the Web site offers a date for when information was updated.

Table 3. Pro-Cutting Web Sites--To Be Avoided

Web-Site Name and Address Num Privacy
 Refs Policy

The Onion: 0 No
43 Things: 6 Yes

Watch Me as I Cut Myself Wide Open: 0 No]

Cutters (Zanne & Razor's personal Web site): 2 No

Self-Injury: What Makes You Cut: 0 Yes

Web-Site Name and Address Author Date

The Onion: NP No
43 Things: NP No

Watch Me as I Cut Myself Wide Open: NP No]

Cutters (Zanne & Razor's personal Web site): NP No

Self-Injury: What Makes You Cut: Unk No

Note. Num Refs = the number of references to outside resources that
the Web site provides visitors. Privacy Policy = whether or not the
Web site has a stated privacy policy. Author = the type of authorship
on the Web site, whether nonprofessional (NP) or unknown (Unk). Date
Info = whether or not the Web site otters a date for when information
was updated.
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No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2008 Gale, Cengage Learning. All rights reserved.

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Author:Moyer, Michael; Haberstroh, Shane; Marbach, Christina
Publication:Professional School Counseling
Article Type:Report
Geographic Code:1USA
Date:Jun 1, 2008
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