Understanding the new link between social media and mental health

 I have been following the general public's reactions to this news about social media and its impact on eating disorders and mental health. And what I am seeing is that the real point is not truly being understood. For example, read the comments on the KSL article posted 12/9 on the topic.

Yes, it's well known that social media of any type has a questionable impact on mental health. Some research shows that social media can have a positive impact. Examples that I see of this in my practice is patients reporting interactions on pages designed to be support groups, or promote positive body image, or sharing podcasts that support therapy goals. These are clearly all positive places on social media. And, research backs this up. The study that I focused on, which looked at a number of studies (what is called a meta-analysis) showed that those who actively engage in social media, defined as talking to others on Messenger, for instance generally have a positive experience with social media. But those who "passively" use social media tend to have a negative experience. Examples of this are simply looking at others' content, perhaps hitting "like," or maybe commenting, but not directly communicating with others, tend to have more negative experiences. So, that covers what we have known for a while about social media; it can be positive, or it can be negative, BASED ON CHOICES THE USER MAKES.

The reason that was in bold, even though that makes it seem like I'm yelling, is the need to make this very, very important point:

What we now know is that the social media platforms use algorithms that push upon young users content which is harmful. Meaning, what the teen is exposed to goes beyond what they are choosing to view. An algorithm is deciding what they should see, and the suggestions that are presented have the potential to be very damaging.

But, what does that mean? Truly the best example is the stories coming from various congressional members. They are going in and creating fake profiles of 13 year old girls, and then watching what happens on that profile. I believe the first to do it was Senator Richard Blumenthal, and now Utahan Mike Lee is reporting having done the same thing. 

And what are they finding? See this quote from yesterday's KSL article: "Why did following Instagram's top recommended account for a 13-year-old girl cause our Explore page to go from showing relatively innocuous things like hairstyling videos to content promoting body dysmorphia, the sexualization of women and content otherwise unsuitable for a 13 year old girl?" Lee asked Mosseri. "What happened?" https://www.ksl.com/article/50308196/sen-mike-lee-to-instagram-youre-the-new-tobacco-whether-you-like-it-or-not

But then you read KSL comments, and people get hung up on each government official's overall political leaning and the generic understanding of social media. This means people are missing the point!

And the longer parents go missing the point, the more kids might well be exposed to the content that is pushed upon their children by an artificial intelligence algorithm. 

Now, anyone can go to my Facebook page and see that I "got off" (as defined by having I believe 9 FB friends) Facebook (the only social media I have ever had) weeks ago, after months, likely years, of knowing it was toxic to me. I have no problem with others knowing I have social anxiety. And, for me, social media worsened social anxiety. Did it also provide a form of communication/connection? Sure. But more so it worsened my social anxiety, and let's be honest, social anxiety is not that much fun. So, I finally...finally...decided to stop my exposure to it; not an easy task in our society. I now really only see what horse-related companies are having sales, and for me, that is the perfect use. ;)

Is social media all bad? Absolutely not. But do we all need to better understand how it works and how it might impact us? I would argue the answer to that is a resounding yes! I fear all the news coming out is simply not sinking in, and for social media to eventually improve, it needs to sink in. 

Pardon me while I leap off my soapbox. 

More on Social Media

Given the last post, the next logical question is "What can I do, as a parent?"

This is, of course, a very tricky question, as we knowing parenting teenagers is tricky in general. But, I have found that teenagers do best when things are simply explained to them in straightforward terms. Especially once a teenager has developed an eating disorder, it is common to walk on eggshells around them, never knowing when the next explosion might occur...whether that is an explosion of anger, or tears. 

But, as a professional, I never tiptoe. I just don't. And I have found that all clients, teens included, appreciate this the vast majority of the time. Teens are looking for direction. Sure, they want to believe they know all the things, but in the end, they also seek guidance from trusted adults. So, my suggestion is this:

First, explain what you have learned about social media and what they might have been exposed to. The response to this will vary, I'm sure, based on the stage of recovery from the eating disorder. Those later in recovery might easily volunteer what they have been exposed to, while those more protective of the eating disorder might deny. They might want the continued exposure, so they can learn ways to improve their eating disorder behaviors. 

I'm guessing I don't need to say a lot about what to do if your teen is open about what they have experienced. Listen to what they have to say, and then ask them how they want to respond, rather than telling them what they should do. We all know that works better with teenagers, and humans in general.

If they are resistant, that probably is answer in and of itself; it likely means they are guarding the information on their social media. At that point, you have a couple options: 1) keep trying to talk to them, or 2) notify their treatment team. Reality is, sometimes teenagers are more willing to talk calmly to their treatment team than their parents, unfortunately.

As I stated previously, right now, we don't know well enough what teens have been exposed to via social media, but it is likely that more and more of that information will become clear over the coming months. Remember, the majority of clinicians are not aware of this new information about social media exposure. Your child's providers will be better able to help as they are made aware of your child's specific exposures. 

 

Parents: What You MUST Know About Social Media

As most of us know, a whistleblower, Frances Haugen, recently testified in front of Congress regarding her knowledge of some of the dangerous actions taken by Facebook, Instagram and WhatsApp. Whereas her testimony covered a number of topics, most relevant to my work is the fact that it appears these companies use artificial intelligence (AI) to push diet and eating disorder content to young girls and young women. The extent of this is likely to continue to unfold over the coming months, but for now, what we know is that, in spite of this testimony and news coverage, it continues to happen.

For years, eating disorder providers have known that social media is risky for those with eating disorders. Studies have repeatedly shown that involvement with social media correlates to worsened body image, which is a precipitating factor for the development of eating disorders. As a result, providers have worked with adolescents and young adult to try to alter their usage patterns. We have recommended parents monitor for concerning content, and we have worked directly with patients to choose to change the accounts they follow, with an emphasis on following more positive messaging.

But, what we have not known is that, regardless of how we encourage our patients to use a different approach in their intentional use of social media, the AI algorithms have forced upon these same individuals content that is not within their control. THIS is what is so important for parents, and providers, to understand at this time. In short, simply being a certain age and gender is the trigger for being bombarded with pro-diet and pro-ED content, and there is nothing the user can do to change this.

Since this news came out, I have spoken to a few providers, including some at the top of the field, regarding their understanding of social media and its impact on those with EDs. And what surprised me was that NONE of them knew about this new finding, the impact of this algorithm. And we all agreed, this changes things in a massive way. No longer can we focus solely on encouraging patients to change their choices online, as simply doing that will not stop the barrage of eating disorder and diet content. So, what do we do now? There's not an answer to that question, but I pose some ideas below.

I have dug into the research on social media and eating disorders, knowing none of it has yet to address this new information. But here are some key takeaways:

1. In 2021, the overall social media (SM) usage rate in the US was 74%. In the EU, 88% aged 16-24 use SM. Globally, the SM platforms with the highest number of user are Facebook (2.449m), WhatsApp (2B), Instagram (1B) and TikTok 800M (Statista, 2020)
2. From 2014-2017, Facebook usage in adolescents 12-18 increased from 47% to 75.1% of users. A 2018 study showed highest use for adolescents was Instagram. (Clinical experience says that use of TikTok is also very high.)
3. In one study, 61.3% of females sought body image related products on SM. Engagement with health, beauty and physical health accounts have been shown to correlate with an increased drive for thinness.  Finally, increased time on SM was associated with lower self-esteem about appearance, which was related to increase dietary restriction. 
4. SM usage was positively correlated with body image dissatisfaction, and also with restricting, bingeing, purging, laxative and diuretic use, and drive for muscularity. 
5. Social media use increased pathology in those with lower self-esteem and higher social comparisons. Passive FB use, defined as viewing others' content, without posting one's own, and intensity of use, were linked to social comparison and poor self-esteem. Both of these were then linked to depressive and anxiety symptoms, which often underlie eating disorder behaviors. 
6. Longitudinal research has shown: Greater social media usage predicted greater body dissatisfaction and increased appearance-related discussions with peers 18 most later. Body dissatisfaction did NOT predict SM usage, meaning that SM, instead, negatively impacts BI. 

An important detail in reviewing this research is the differentiation between correlation and causation. Many of the studies have shown correlation between SM usage and ED pathology. But, correlation is NOT causation. So, to clarify, the correlations above show that those who use social media more, also have higher levels of body image dissatisfaction and Ed pathology, but it cannot say that the SM uses CAUSES ED pathology. However, this is where we can bring in clinical experience, and clinical experience backs this research; many clients report that their social media use played a major role in their eating disorder development and maintenance. As a result, most, if not all, ED treatment centers terminate the usage of social media while in their treatment centers, and recommend limited to no use upon discharge. 

Fortunately, there is some data that is able to look at causative factors. The few experimental studies have shown that young adult men and women who were exposed to images of same-sex "attractive" strangers in mock SM profiles reported poorer body image than those exposed to "unattractive" strangers, and exposure to “fitspiration” images taken from IG led to a more negative mood and body dissatisfaction than did exposure to appearance neutral control images. These data reinforce the reality that exposure to problematic images on SM significantly contribute to ED pathology.

This is all research conducted at the time before we were truly aware of the impact of these AI algorithms. So, all of this data that has been based on the content that users voluntarily seek is only exacerbated by the new reality, which is that increasing amounts of this content is actively pushed upon teens and young adults, AND the SM companies know that and, to this day, have not changed it. 

Yes, to this day, users report that this content is still pushed upon this age group. 

This changes the landscape for parents and providers. No longer is it as simple as encouraging our children and patients to choose wisely what they follow on social media. No, now we have to explain the reality that, simply due to their demographics (age and gender) this content is forced upon them each time they use SM. 

Fortunately, as I have started to explain this to the girls and women I work with, the main response is anger. Nobody with an ED wishes it upon anyone else, so the women I work with are enraged about this reality. (I will add, some have indicated that TikTok is the worst offender, so I'd recommend to all of those with EDs...well, and probably everyone in general, but that's another post...to get off of TikTok.) And, I believe, that rage in the mind of the highly intelligent and powerful girls and women with eating disorders can then result in change. But we must get the word out. Talk to everyone you know about this situation...from parents, to teachers, to providers, to teens and young adults. Everyone needs to unite in the fight against this attack from SM companies; an attack based in increasing income to advertisers, seemingly without worry about the impact on these girls and women. Moving forward, providers will start to get a sense of how much this newly recognized exposure has impacted those with eating disorders, but for now, it is important that those working with individuals with eating disorders know that this is something to look at. 

And yes, men are exposed to it also, just not at the same rates, it seems.