Abstract
The social media platform Twitter provides a space for users to form niche communities that can help those suffering from eating disorders or self harm by promoting recovery, sharing beneficial mental health resources and providing individuals with a sense of belonging. Despite this, there is an overwhelming amount of negative content encouraging users in these communities to continue with practices surrounding eating disorders and self harm, seemingly overriding the benefits these communities bring. This paper looks at studies that investigate the benefits and drawbacks of these communities and discusses the potential positive impact these Twitter communities can have, and the areas of concern that need moderation to do so.
Introduction
The social media site Twitter (recently rebranded as ‘X’) is a microblogging platform that allows for rapid dissemination of information on a public forum and connects users with shared topics of interest. While most of these communities are thematically harmless, discussing topics surrounding fandoms, political issues, pop culture, and other similar content, the app allows mentally ill youths to encourage each other’s harmful behaviours by facilitating communities that enable eating disorders and self-harm. SHtwt (self-harm Twitter) and EDtwt (eating disorder Twitter) are communities that have been formed on Twitter by individuals suffering from the respective disorders to communicate about their struggles and experiences. While mentally ill youths can benefit from online friendships with those who have faced similar struggles, it is important to weigh the pros and cons and consider whether the inherent normalisation and even encouragement of harmful behaviour within these communities are detrimental enough to negate the benefit that can be gained from a sense of belonging.
Ramifications of Content on Self-Harm Twitter
Self-harm or non-suicidal self-injury (NSSI) is defined as “a person’s self-inflicted damage to body tissues, caused consciously and deliberately, to modify their mood and without suicidal intent” (Pérez-Elizondo, 2020, as cited in Atauri-Mezquida et al., 2025, p. 1). It is an increasingly significant health problem, particularly in girls aged 13-16 (Morgan et al., 2017, as cited in Lavis & Winter, 2020, p. 842). With almost twice as many self-harmers reporting a higher internet usage when compared to those who do not self harm (Mitchell & Ybarra, 2007, as cited in Hilton, 2017, p. 1692), it is likely that their internet use is a large contributor to their mental condition. SHtwt content consists of users publishing their acts of self-harm, typically through photos or videos. The majority of the media published shows open wounds and tools used to self-harm and this exposure can be detrimental to young people’s mental health (Atauri-Mezquida et al., 2025), more so if they are already struggling with mental health issues. Regular consumption of self-harm imagery can “encourage or even cause acts such as self-cutting through mechanisms of contagion” (Lavis & Winter, 2020, p. 842), and when paired with captions or comments describing acts of self-harm as an everyday task it becomes normalised and even romanticised to those viewing the content. Users on SHtwt will often provide positive reinforcement on posts with self-harming material through likes and comments, strengthening the sense of community in a harmful way as it encourages users to self-harm in order to post about it to receive social reinforcement in return (Atauri-Mezquida et al., 2025). The cycle of publishing and consuming self-harm content has a dangerous impact on the mental health of the users within these communities, promoting toxic echo chambers and normalising and promoting self-harming behaviours.
The Benefit of Community for Self-Harming Individuals
It is important to acknowledge that the SHtwt community can also positively impact these individuals. A prominent reason for self-harming individuals to join these online forums is to be validated by others as they may feel defined by their self-harm to their peers in real life (Adams et al., 2005, as cited in Hilton, 2017). The sense of community can help reduce feelings of isolation and create meaningful friendships between those who struggle to do so in real life. Due to its ability to allow anonymity, Twitter provides a space where users can express their emotions more honestly, creating trust between individuals and allowing users to feel more comfortable exchanging support or advice (Hilton, 2017). There is evidence that the internet can help to facilitate “wellness and empowerment and [reduce] social isolation for those with poor health” (Hilton, 2017, p. 1700), with SHtwt users often providing each other with messages of encouragement and alternatives to self-harming when others express the need for help (Hilton, 2017). The real-time nature of Twitter allows those going through a mental health episode to receive instantaneous support to alleviate their distress (Lavis & Winter, 2020). Users support each other and spread information within the community on how to seek professional help offline, giving tips on how to be taken seriously or move up waiting lists within the health industry. Harm reduction is also prominent within the self-harm community on Twitter, with threads being posted on how to self-harm safely, “such as how to sterilise a blade or what to put in a first aid kit” (Lavis & Winter, 2020, p. 848). Users will also respond to extremely graphic imagery with “comments such as ‘that’s too deep’ or ‘that needs stitches’” (Lavis & Winter, 2020, p. 848) and encourage users whose self-harm may be putting their lives at risk to go to the hospital. The sense of belonging and plethora of advice and support that SHtwt provides is a valuable way for youths to alleviate their struggles in a way that may be difficult for them offline. However, peer-to-peer support, while beneficial to those receiving help, can harm those providing it. Listening to other stories of distress can have an emotional impact on individuals and potentially trigger them to self-harm (Lavis & Winter, 2020). The usage of the hashtag “#shtwt,” a hashtag used to categorise tweets belonging to the community has increased by 500% between October 2021 and August 2022, reaching 20,000 tweets a month on average (Atauri-Mezquida et al., 2025; Goldenberg et al., 2022). This indicates that while Twitter has policies in place that do not tolerate content featuring self-harm, there appears to be a lack of actual content moderation. This lack of moderation is what causes the existence of the self-harm Twitter community to have a negative overall impact on its users. While the community provides a valuable space to seek help and a sense of belonging, the plethora of triggering content ultimately normalises and encourages acts of self-harm.
The Role of EDtwt in Encouraging Disordered Eating Behaviours
Eating disorders (EDs) are complex psychophysiological illnesses with serious health consequences and have the highest mortality rate of any psychiatric disorder (Arseniev-Koehler et al., 2016), claiming the lives of “3.3 million people globally every year, a number that has doubled over the last 10 years” (Sukunesan et al., 2021, p. 2). EDtwt, also known as pro-ana (pro-anorexia) Twitter, are communities that take normalising eating disorders to extremes, posting about the disorder as if it is a lifestyle choice rather than a mental illness. The nature of social media, particularly on Twitter, makes it easier for eating disorder content to spread, potentially having a negative effect “on vulnerable individuals ranging from healthy individuals who may be influenced to engage in ED behaviours, through to the ‘triggering’ of individuals who may already have an ED” (Branley & Covey, 2017, p. 2). Much of the content on eating disorder Twitter revolves around users’ desire to continue with their disordered behaviour and encourages users to do the same. Rather than being just a passive member on these forums, many users centre their whole account around disordered eating, indicating their current and goal weights in their account biographies. These users document their ‘weight loss journey’ by posting what they eat, tracking calories, posting exercise routines and images of their bodies to sustain motivation (Branley & Covey, 2017, p. 3). Exposure to this type of content is linked to negative body image (Rodgers et al., 2016, as cited in Branley & Covey, 2017), and the competitive nature of eating disorders can result in those consuming the content feeling obligated to follow this lifestyle. EDtwt, specifically pro-eating disorder or pro-ana communities, are centred around users posting ‘tips’ for others, such as how to prolong a fast, and ‘motivational’ materials, such as “‘thinspo’ images of extremely thin women displaying extremely protruding collarbones, hipbones and ribs, or thigh gaps” (Branley & Covey, 2017, p. 3). Starvation is seen as a sign that users are ‘successful’ in their behaviour, with sayings such as “the sound of a stomach rumbling is equivalent to the sound of applause” and “nothing tastes as good as skinny feels” being popular within the community. Encouraging other users to engage in disordered eating behaviours allows these individuals to feel as if their lifestyle is “acceptable, justifiable, and sometimes even desirable” (Schroeder, 2010, as cited in Branley & Covey, 2017, p. 2).
The Pro-Recovery Side of Eating Disorder Twitter
Similarly to SHtwt, the eating disorder communities have some users who are on the pro-recovery side, encouraging recovery in other users and sharing their own recovery process and struggles (Branley & Covey, 2017). Users in these communities are often in a vulnerable state of mind and are easily influenced by the content they are viewing; however, this has the potential to be used positively to direct those struggling towards support, advice and help. Health professionals can also use the content posted on eating disorder Twitter to identify issues that those with eating disorders struggle with and determine how to approach them correctly (Branley & Covey, 2017). While there are benefits to having support communities and insights into the struggles of individuals with eating disorders, careful moderation is required to reap the benefits without the consequences. Trigger warnings can alert users that the content could potentially trigger those with eating disorders, “however, it has been suggested that the use of trigger warnings may help users to purposefully search for pro-ana content (Borzekowski et al., 2010) and the use of hashtags is likely to facilitate this” (Branley & Covey, 2017, p. 5). Hashtags are the most prominent tool on Twitter used to find posts with specific content, with #proana being used to find content with users promoting eating disorders as a lifestyle rather than a psychophysiological illness. Unlike other social media platforms, Twitter currently lacks policies regarding blocking hashtags (Sukunesan et al., 2021). Complete censorship of eating disorder content is not a suitable option because although the majority of content is harmful towards individuals with this disorder, there are posts dedicated to support and recovery, which are particularly important due to ED sufferers rarely seeking professional help offline (Branley & Covey, 2017). Censorship may also “push these communities further into secrecy and stigmatise individuals already feeling alienated because of their ED symptoms” (Arseniev-Koehler, 2016, p. 664). Finding a middle ground where triggering content is monitored, but the sense of community and pro-recovery posts are still maintained, is something that needs to be done in order for users in these communities to be impacted in a positive rather than negative way.
Conclusion
Social media has the potential to detrimentally impact young people’s mental health (Lavis & Winter, 2020). Twitter, in particular, hosts a variety of online communities, including self-harm Twitter and eating disorder Twitter. While it is important to note that both of these communities have positive impacts on youths suffering from mental health issues, such as providing a safe space in which they can feel less isolated and have a sense of belonging, the negative impacts that consuming content surrounding these disorders are dangerous and potentially life-threatening. Both EDtwt and SHtwt are flooded with content that normalises, encourages and glamorises harmful behaviours and generally goes unmoderated. While Twitter has the potential to have a positive impact on these communities, in its current state, the consequences of young and impressionable users consuming content posted by those normalising self-inflicted and dangerous behaviours are too damaging to argue that the existence of EDtwt or SHtwt should be seen as having a positive impact on mentally ill youths.
References
Arseniev-Koehler, A., Lee, H., McCormick, T., & Moreno, M. A. (2016). Proana: Pro-Eating Disorder Socialization on Twitter. Journal of Adolescent Health, 58(6), 659–664. https://doi.org/10.1016/j.jadohealth.2016.02.012
Atauri-Mezquida, D., Nogales-González, C., & Martínez-Pastor, E. (2025). Exploring self-harm on Twitter (X): Content moderation and its psychological effects on adolescents. Online Journal of Communication and Media Technologies, 15(1), 1-12. https://doi.org/10.30935/ojcmt/15867
Branley, D. B., & Covey, J. (2017). Pro-ana versus pro-recovery: A content analytic comparison of social media users’ communication about eating disorders on Twitter and Tumblr. Frontiers in Psychology, 8(1), 1356–1356. https://doi.org/10.3389/fpsyg.2017.01356
Emma Hilton, C. (2017). Unveiling self‐harm behaviour: what can social media site Twitter tell us about self‐harm? A qualitative exploration. Journal of Clinical Nursing, 26(11–12), 1690–1704. https://doi.org/10.1111/jocn.13575
Lavis, A., & Winter, R. (2020). Online harms or benefits? An ethnographic analysis of the positives and negatives of peer‐support around self‐harm on social media. Journal of Child Psychology and Psychiatry, 61(8), 842–854. https://doi.org/10.1111/jcpp.13245
Sukunesan, S., Huynh, M., & Sharp, G. (2021). Examining the pro-eating disorders community on twitter via the hashtag #proana: Statistical modeling approach. JMIR Mental Health, 8(7), 1-9. https://doi.org/10.2196/24340
Hi Shannon Kate, You’re right to ask; it is incredibly difficult to police these issues today. Predatory behaviour isn’t exclusive…