'I've seen you at your worst, but I still want to be your friend': A qualitative study of peer support exchange from the perspective of participants in online communities centred around self-harming and suicidal behaviour.

OBJECTIVE: Research on online communities centred around self-harming and suicidal behaviour often focuses on harmful effects. The concept of peer support, which may help explain why individuals engage with such forums, remains under-explored. This study aimed to examine how peer support is experienced in these communities.

METHODS: Thirteen in-depth, semi-structured interviews were conducted with current and former participants in online communities focused on self-harming and suicidal behaviour (12 women and one non-binary person, mean age 28). A reflective thematic analysis was used to identify patterns in the data.

RESULTS: Four main themes emerged: (1) You are allowed to feel bad and express it on your own terms, (2) Anonymity and intimacy is not a paradox in the online world, (3) It is necessary to have friends in real life as well, and (4) When support, relations, and motivation change over time, one must ask: Should I stay or should I go? The findings not only illustrate the communities as emotionally supportive spaces that foster belonging and intimacy, but also point to challenges in maintaining boundaries and disengaging when support becomes unhelpful.

CONCLUSION: Online communities centred around self-harming and suicidal behaviour provide an alternative to traditional mental health services, often perceived as paternalistic and unsupportive of autonomy. Participants describe online peer support as a way to share emotional burdens and form meaningful relationships. However, the informal nature of support may complicate recovery, especially when individuals become entrenched in the community. These dynamics warrant further research and consideration in mental health practice.