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Self-harm and social media: thematic analysis of images posted on three social media sites. OBJECTIVES: To explore the nature of images tagged as self-harm on popular social media sites and what this might tell us about how these sites are used. DESIGN: A visual content and thematic analysis of a sample of 602 images captured from Twitter, Instagram and Tumblr. RESULTS: Over half the images tagged as self-harm had no explicit representation of self-harm. Where there was explicit representation, self-injury was the most common; none of these portrayed images of graphic or shocking self-injury. None of the images we captured specifically encouraged self-harm or suicide and there was no image that could be construed as sensationalising self-harm.Four themes were found across the images: communicating distress, addiction and recovery, gender and the female body, identity and belonging. CONCLUSIONS: Findings suggest that clinicians should not be overly anxious about what is being posted on social media. Although we found a very few posts suggesting self-injury was attractive, there were no posts that could be viewed as actively encouraging others to self-harm. Rather, the sites were being used to express difficult emotions in a variety of creative ways, offering inspiration to others through the form of texts or shared messages about recovery.