Attentional bias and urge reactivity to self-injury-related social media content in adolescents with nonsuicidal self-injury

Background As nonsuicidal self-injury (NSSI) is a common clinical concern among adolescents, identifying factors that contribute to its maintenance is clinically important. Previous research suggests that adolescents who engage in NSSI, but not healthy adolescents, show attentional bias and urge reactivity when exposed to NSSI-related cues. However, little is known about whether these effects extend to social-media-like contexts. We investigated whether NSSI-related Instagram-style posts, viewed during eye-tracking, elicit sustained visual attention, subjective reactivity, and sympathetic arousal in adolescents with recurrent NSSI. Methods Forty-eight adolescents with recurrent NSSI in the past 12 months (14–18 years) completed an eye-tracking task with 30 mock Instagram-style posts presented across three conditions: neutral, negatively valenced, and NSSI-related. After each post, participants rated tension and NSSI urge, and skin conductance responses (SCRs) were quantified per trial. Results Participants viewed NSSI-related posts longer than negatively valenced and neutral posts. Images within NSSI-related posts received greater sustained attention, reflected in higher fixation counts and longer total and first fixation durations. Trial-wise ratings indicated higher tension and stronger NSSI urges following NSSI-related posts compared with negatively valenced and neutral posts. Exploratory SCR analyses indicated more responses during exposure to NSSI-related posts, consistent with increased sympathetic activation. Conclusions The findings indicate sustained attentional engagement with NSSI-related social media imagery alongside heightened subjective and autonomic reactivity. This supports the potential relevance of social media exposure as a proximal cue-reactivity context in adolescents with recurrent NSSI.