Elena Scotti/FUSION

It was over a decade ago that I sat alone in my college dorm room and cut myself for the first time. My life felt out of control. My father was dying a slow death from a terminal illness. The guy I was dating was seeing someone else. And the daily woes of having no money at an Ivy League school were piling up. So sitting on my twin bed, exhausted from crying alone, I grabbed a razor blade and sliced into my wrists. This is what people do when they're sad, right?

It was surprisingly hard to get my skin to bleed, but I kept cutting until marks lined my left forearm. I remember how alone I felt in my suffering. I felt like I had no other choice.

In the decade since what was the darkest and loneliest period of my life, teens' personal lives have arguably grown even more challenging, and tens of thousands are turning to self-injury—which usually entails cutting, scratching, burning, or disordered eating—to deal with emotional pain. According to the U.S. Centers for Disease Control and Prevention, self-harm is a major public health concern, with somewhere between 7% and 24% of teens engaging in some form of it.

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While I never told anyone about my cutting—I felt too alienated, too ashamed—that was before smartphones. Today, just as most young people live their outward-facing lives on social media, so, too, do they live their most intimate lives in public spaces. While self-harm is not new, what is relatively new is instant and visceral access to a community of like-minded people going through the same hell as you.

But when does finding others online with whom you can quite literally share your pain serve as a source of support, and when does it encourage self-destructive behavior?

Megan Moreno, a pediatrician specializing in adolescent medicine at Seattle Children's Hospital, works closely with teens who engage in self-harm and wondered the same thing. In a new study published in the Journal of Adolescent Health, she aimed to get a more in-depth understanding of the role social media plays for these patients. Moreno and her team focused specifically on Instagram, where a hidden-in-plain-sight subculture of depressed and self-harming young people is thriving. "If you're cutting, it can be stigmatizing,” said Moreno. “But teens in my clinic go on Instagram and use hashtags because it provides them a key to others just like them."

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After poring through Instagram posts, Moreno uncovered dozens of hashtags teens use to post about self-harm—sometimes encouraging others to injure themselves, sometimes crying out for help. The reason they required “uncovering” in the first place is because Instagram’s community guidelines explicitly prohibit “glorifying self-injury,” so users are forced to constantly change their tag language. "If you have these secretive hashtags you can unlock this community that understands what you're going through," explained Moreno, "and you can get a sense of belonging."

After Instagram actively shut down the hashtag #selfharm, making it unsearchable, users replaced it with #selfharmm. After the hashtag with two m's was shut down, users simply added yet another m, making it #selfharmmm. This constantly evolving language makes policing self-harm pages difficult.

After a month of searching, Moreno and her colleagues discovered nearly 20 ambiguous hashtags currently in use. The list included tags ranging from the obvious #selfinjury to more underground ones including #mysecretfamily, #blithe, #ehtilb ("blithe" spelled backwards), #cat, #deb (meaning depression), #annie (meaning anxiety), #olive (relating to obsessive compulsive disorder), and #secretsociety123. The teen users I spoke with for this piece said the words are almost interchangeable, serving as a means to reach a broad community.

In total, only six hashtags from the study resulted in warning labels from Instagram like the one below, which appears when you click on the tag #blithe, a word that teens use mainly when discussing depression, cutting, or eating disorders. That hashtag in particular was linked to more than one million posts, including illustrations of cut arms, emotional quotes, mirror selfies, and posts about binging and purging. More ambiguous hashtags such as #cat and #annie are harder to monitor. "It's really a public health problem," said Moreno. "Teens are looking for a way to get better.”

For some users, posting and commenting about self-harm on Instagram can indeed provide what feels like a social support network. In reporting this piece, I reached out to young people on the app who were actively using self-harm hashtags, many of whom reported that Instagram nearly saved their lives by connecting them with others when they had no one else to turn to.

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One Instagram user I contacted, Lily (not her real name per her request), said she is 15 years old and told me over email that she has struggled with depression for three years, but couldn’t ask her parents for help. Instagram, she wrote, gave her the positive, supportive community she needed. "I have found my best friend through Instagram who has helped me through a lot,” she said. “I possibly wouldn't be alive without him.”

Another frequent poster who goes by Shelby and said she was 24 years old told me that she has been diagnosed with bipolar disorder and uses Instagram as a form of therapy. "This is the only way how I keep in contact with the world sometime, and I think that is better than nothing," she wrote in an email. "Honestly, in the past, my Insta friends have kept me from doing some REALLY stupid things, like hurting myself or worse." Neither Shelby nor Lily reveals their true identity on the app, which is standard for many users.

And yet, Moreno worries that too many young people are turning to Instagram in lieu of seeking adult or professional help—and that the community can become toxic, its own type of addiction. After all, the sense of belonging users feel within the community can become a double-edged sword, since giving up their destructive habits can mean giving up their social family, too. If cutting was the key to getting in, without it, a teen becomes locked out.

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Then there’s the issue of triggering. Many teens go on Instagram for fun, said Moreno, but the impulse can backfire. "Adolescents go on social media when they’re bored, and when they’re down, and then they can stumble onto these maladaptive pages," she says. For example, "#cat" is used for cats—but it's also used for self-harm, which can send vulnerable users down a wormhole. Studies have shown that viewing content about self-harm, especially on social media, can be a trigger for offline behavior.

Looking at posts about self-harm can also impede recovery. "One thing we hear about in the recovery phase is that teens are really sensitive to triggers,” she says. “If they're goofing around on Instagram and then a picture flashes of someone self-harming, that can be a trigger for them to do that as well.”

An Instagram user I contacted who goes by Cari-Anne, who said she was 18 years old, told me that she has struggled with both depression and self-harm—and she knows the trigger risk first-hand. "Even though going online for help can be very useful and positive, it can also be triggering," she wrote in an email. For example, "Sometimes you may reach out to a user online you always talk to because they understand, but maybe they don't encourage trying to get better as well."

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Cari-Anne's Instagram is full of positive messages handwritten on notepads, such as "If today was not good, start fresh tomorrow." She uses the account to reach out to others who may need help, telling users to direct message her if they need someone to talk to.

For all of these reasons, knowing the secret language young adults use on Instagram can be beneficial to educators, mentors, friends, and parents. "Parents can really view coming across this content as a positive opportunity to have a really tough conversation with their kids," Moreno told me. This is especially important, she added, since self-harm is usually the symptom of a mental health issue such as depression, which parents should be addressing with their child.

Moreno also said that she would also like to see Instagram improve its content advisory warnings. While she recognizes that it's nearly impossible for the company to shut down every hashtag related to self-harm (case in point: #cat)—a move that might not even be helpful—the site can utilize other methods to help users who may be suffering from self-injury, such as directing them to professional support networks and resources. "It's more about what Instagram provides in return," she said. Like making an effort to recognize trends, then incorporating messaging that might help users get help.

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Today, when you search hashtags including #blithe, #ehtilb, and #mysecretfamily on Instagram, a warning page pops up explaining that you're about to view graphic content. At the bottom of the page is a "learn more" link that redirects users to a suicide prevention site—but that may not be helpful or inviting to some teens.

I know that the few times I cut myself, I was nowhere near suicidal—but I was struggling. And studies have shown that many self-harmers don’t necessarily have suicidal thoughts. Instead, Moreno suggests the labels should apply more directly to the specific hashtags. For instance, if #blithe typically deals with cutting and eating disorders, users should be pointed to resources specifically for those issues—not just suicide. "There are a lot of groups dedicated to self-harm and recovery," says Moreno, "Instagram could find appropriate resources and link to those sites specifically."

The road to recovery for anyone who self-injures can be hard. Since the behavior usually speaks to a larger mental health issue, it's important for those struggling to address the root of the problem and find a way to cope without injury.

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Eventually, I realized that cutting was not the way out of my emotional black hole. I didn't like how it made me feel, which was desperate and hopeless. Instead, I began to open up more to my friends and family about what I was going through, and they helped me move out of the darkness. I came to realize that there's no shame in just being sad.

For additional resources on self-harm, The Cornell Research Program on Self-Injury and Recovery offers a good starting point.

Taryn Hillin is Fusion's love and sex writer, with a large focus on the science of relationships. She also loves dogs, Bourbon barrel-aged beers and popcorn — not necessarily in that order.