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Despite efforts of social media sites to curb the amount of disturbing material their users post online, images of self-harm, like “cutting,” continue to surface on sites like Instagram and Tumblr.

“Over the last five years I’ve noticed the volume of the practice has been consistent – if not increasing,” says Jamison Monroe Jr., executive director of the Newport Academy, a teen and young adult treatment facility with locations on the East and West coasts.

The most popular social media sites have since 2012 outlined policies for images or posts about self-harm, whether glorifying cutting, suicide or eating disorders like anorexia and bulimia.

But a search of related terms still can yield pictures of cut wrists and more graphic images that could be triggering for people inclined to harm themselves.

“They are seeking a connection to normalize the behavior, to make them feel OK about the way they are coping,” Monroe says. “The fact that they are cutting means they need help.”

Teen posting images of disturbing behavior online is not new. Pictures of dangerously thin people, usually girls, appear as “thinspiration,” motivating people with bulimia or anorexia to avoid treatment. Other images involve dangerous trends: In April, teens posted pictures of themselves trying the “Kylie Jenner Challenge,” sucking their lips inside a glass to give them an inflated look like the reality star. The glass can break under the pressure, requiring stitches; the suction can create severe bruising and tissue damage. Teens have posted videos of the “Cinnamon Challenge,” where they swallow a spoonful of ground cinnamon in under 60 seconds without drinking anything – which can be dangerous to their lungs.

The concern experts have about these sites is that they can lead to others engaging in similar behavior. “They found out about [cutting] first through social media, or they heard about it somewhere else and seeing it on social media made it OK to them,” Monroe says.

Jamie Howard, a clinical psychologist at the Child Mind Institute in New York, says her patients tell her on some websites users can find instructions on how to hurt themselves themselves without killing themselves. Some even include messages that read, “Don’t do this!” while still explaining the process.

Facebook, Instagram, Twitter, YouTube, Tumblr and Pinterest have stated in their “community standards,” or terms of use, that self-harm posts are not allowed on their websites. Still, the sites act only after the images have been posted; employees actively police the site, but they also rely significantly on other users to report a post if it is disturbing.

Hashtags, used to filter content, don’t necessarily make it easier to monitor the sites. Many teens find ways to get around the most commonly used terms and make up their own. “They were born with the Internet and it’s intuitive to them and they work with it so quickly,” Howard says.

Prohibiting certain hashtags associated with self harm could prevent access to posts that allow people to get help, social media sites have explained in the past. A hashtag could also be used to provide information about phone numbers to call or facilities to visit when facing mental health challenges.

Instead, some social media sites offer help directly. For instance, when searching about “cutting” on Tumblr, a message appears asking, “Everything Okay?” and provides a hotline for people to call, along with other resources, such as links to S.A.F.E Alternatives, Imalive and 7 Cups of Tea, all crisis-intervention groups that help teens.

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Though there is no data on whether the Internet has exacerbated self-harm, Howard believes it has helped normalize the behavior. She tells her patients who self-harm – most of whom are female – to discuss these issues with a professional or guidance counselor but not to discuss self-harming with their friends. “It’s the kind of thing – even before the Internet – that can happen in groups,” she says. “It’s a logical extension that the internet would exacerbate the problem.”