YouTube videos on cutting and other self-injury methods are an alarming new trend, attract millions of hits and could serve as a how-to for troubled viewers, a study warns.

Many videos show bloody live enactments or graphic photos of people cutting their arms or legs with razors or other sharp objects, the study found. Many also glamorize self-injury and few videos discourage it, the study authors said.

They also feature haunting music and rich imagery that may attract young self-injurers and trigger the behavior, especially in those who have just started to self-injure, the authors suggest.

Canadian psychologist Stephen Lewis, a study co-author, said he found more than 5,000 YouTube videos on self-injury. The study focused on 100 videos the authors found in December 2009. Their analysis was published online Monday in Pediatrics.

The 100 videos were viewed more than 2 million times and generated many online comments.

Parents and mental health professionals should be aware of the YouTube postings and that the videos might be perpetuating the problem, said Lewis, an assistant professor at the University of Guelph in Ontario.

The study's authors also recommended that YouTube provide helpful resources or links when people enter search terms for "self-injury." A company spokeswoman said YouTube is looking into the feasibility of the suggestion.

She said the site has policies against graphic content and content that encourages dangerous activities. It relies on viewers to flag questionable videos, and a YouTube team reviews and removes those in violation of those policies. Self-injury videos are among those that have been removed.

Self-injury is most common among young people. Between 14 percent and 24 percent of teens and young adults have engaged in self-injury at least once, Lewis said. Cutting is among the most common methods.

Psychologist Tracy Knight, an associate professor at Western Illinois University in Macomb, Illinois, is interviewed in a documentary-style YouTube video about cutting that has been viewed more than 14,000 times and generated more than 80 comments.

Knight said the video was done by a student and he didn't know it was on YouTube. The video's opening scenes include a young woman poking a sharp tool into her leg.

Knight said such videos may inadvertently trigger self-harm, but that YouTube also can serve a benefit by taking self-injury out of the closet and into the public realm.

"It makes it open for social discussion . . . in a way that was not possible when it was secret," he said.

Lewis said therapists who treat self-injurers should consider asking their patients if they watch these videos and counsel them about possible effects. Parents, too, should be aware that kids may be watching the videos and discuss the issue with them, he said.

Self-injurers typically are struggling with feelings of anger, sadness, depression or other emotional troubles, and usually don't cut deep enough to cause major harm, said Barent Walsh, a therapist and author of a book on self-injury treatment.

Self-injuring "is oddly effective in reducing emotional distress" in people who have poor coping skills, Walsh said.

He said it's well-known that photos and websites about self-injury can trigger the behavior in people who already self-injure or who are tempted to do it. But he said the study results are important and raise concerns that YouTube "may well be the most powerful influence of them all because of its nature."

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Online:

Pediatrics: http ://www.pediatrics.org