Social Media Is Impacting Teens’ Health — What Can We Do About It?

Just two weeks ago, a Wall Street Journal report showed that Facebook knows its image-sharing app Instagram is toxic for teenage girls, but it has publicly downplayed the harmful effects. As Facebook’s head of safety testifies on social media’s impact on mental health, we’re asking: what can parents do about it?

Check out Katie’s discussion with child and adolescent psychiatrist Dr. Patrice Harris about some of the dangers to watch out for — from eating disorders, to anxiety, to online bullying — and what to do about them. 

Social anxiety on the rise

Katie: Social anxiety during this re-entry period is up. I saw something like 10% of teenagers are experiencing social anxiety, kind of acclimating to the new social activities. Can you explain what social anxiety is exactly, and how it manifests itself?

Dr. Harris: In general, social anxiety really was the definition of anxiety in social situations, right? And again, that existed pre-Covid. But we went into this period of just being with our immediate family. Maybe some very limited socializing with friends, and now suddenly, it’s all or nothing. It’s back to the full-on, going back to school for some. Some young folks here in Georgia went to school for two weeks and back home for two weeks. And so it’s been very disruptive. People are wondering, how do I interact with friends? Adults too, they don’t know whether we shake hands! I’m worried about getting infected, I’m worried about infecting others. And so all of these pressures are brought to bear as our kids are going back to school and activities, and we just don’t know what to do.

Katie: I think it’s so disruptive Dr. Harris. One of the many reasons I miss having my kids around is because it brought a certain kind of cadence to my life and to my days. Everything is so up in the air, so topsy turvy, this lack of a regular schedule. Does that contribute to things feeling off?

Dr. Harris: It does. And that’s one of the reasons that I suggested to parents and guardians and families that even though we were certainly not experiencing our usual routines, they should develop new schedules. Children, young adults, adolescents thrive with consistency and schedules. I think we all do, it’s very anxiety-provoking when you don’t know what’s coming next. And so one of the many ways that families can cope – and we are certainly not out of the woods yet – is developing new schedules together.

The disturbing impact of social media

Katie: Certainly our use of social media has gone up a great deal during the pandemic. It was probably too much before that, but now everybody is even more addicted to their devices. And of course, the Wall Street Journal did a whole investigative report about Instagram (this is sort of like Captain Obvious!) and it was really disturbing to know that the people at Instagram were well aware of the negative impact Instagram is having, particularly on young girls. And I know that a lot of the parents out there really need help with this. It’s really, really tricky. Before we talk about solutions, why are teenage girls particularly susceptible to the damaging effects of Instagram? And, and in what ways are they being damaged?

Dr. Harris: Well, I think there are several reasons. When I was growing up, when I made a mistake, maybe only a few people knew that I made a mistake. Or when my boyfriend broke up with me, maybe only a few people knew that. But today, teens are living in this world where their tiniest mistakes are amplified. Everyone at school knows about it. And I think that is leading to anxiety.

And then you have all of the curated images we see on social media, right. And we already know that girls mostly, but we can not forget that some boys have body image issues, right. And everyone on social media, again, these are curated, but you and I might know that, but our younger folks might not know that. And so there’s the perfect outfit, the perfect shoes, the perfect parents, uh, you know, no one’s spats with their parents.

Farewell, FOMO

Dr. Harris: And so that is just not real life, but it’s difficult to know what’s normal and what’s abnormal. And Katie, I think we should coin a new phrase. I know all of us (and I’m guilty as well!) talk about FOMO. But I think we need to start thinking about the value of missing out. We do not have to be connected, and we don’t have to have the perfect anything, because no one does. I think there’s just a lot of pressure, again, particularly on girls, more than boys, but boys are impacted as well.

Catch the signs before it gets more serious

Katie: Certainly with the body image thing. People are Photoshopping themselves, filtering themselves, perfecting their image on social media. It’s not necessarily real life, but there’s still so much pressure with girls and bikinis and all that jazz. Emerson says comparison is the thief of joy, and and it really is true. And I’m sure this is having such a negative impact on the way girls feel about themselves, the way they view their bodies. And I have to imagine that it’s increasing the number of eating disorders that are popping up among teenage girls. Some boys too, I don’t mean to leave them out, but the vast majority, I think of eating disorders involve young women.

Dr. Harris: Again, pre pandemic in my practice, I saw increased anxiety disorders. And we can’t forget about bullying. I think that’s all sort of part and parcel of what happens on social media. It’s just easier to say nasty things and to be unkind when you are behind your screen and in the privacy of your home. And it’s less likely that our young folks even see the consequences of those things. They are not totally unaware of the consequences in the moment, of course, but when you are behind your screen, it certainly is easier. And so I saw bullying, or issues around curating and Photoshopping, and the perfect boyfriend. And so we did see increases in eating disorders, but not only symptoms and signs that might meet the level of a diagnosis; also restricting and doing other things to try to get that “perfect” body.

Katie: Obsessing over food. I mean, I have disordered eating and I had an eating disorder when I was younger. So I think having kind of having the food play an outsize role in your life and just, you know, thinking about it too much is a form of disordered eating. And we could do a whole segment on that. It’s such a serious and dangerous problem, but what can parents do? Because it’s really hard to police kids and social media. I remember when my girls were teenagers, Ellie had a thing that turned off social media while she was doing her homework.

Keeping your head in the game

I’ve done a lot of reporting on this – there’s no such thing as multitasking. Your brain can not really focus on two things at the same time. And deep thinking takes like 20 to 30 minutes. So with you’re constantly interrupted, you have to spend time again to get, get your brain acclimated to deep thinking. So I guess the question is, what can parents do? I guess it’s so hard because if you try to keep your kids off social media, they feel like social outcasts and they feel different, and kids hate to feel different. On the other hand, it’s such a time suck and they spend too much of their lives on looking at a screen. So what are some basic guidelines for people?

Dr. Harris: So first of all, I’m glad you said this is hard because a lot of times, as some old patients would say, I would make recommendations, then they would say, Dr. Harris it’s easier said than done. And I do want to recognize that the best way to address these issues is through prevention. So for the parents who have really young children who are not using their devices as much, they can really be mindful. They should think about limiting and starting good habits early. So, so that’s one thing. And also getting everyone involved, rather than a parent just sort of saying, these are the rules. So you have the adolescents and young children sort of come together and say, look, here’s what we want to do as a family.

Set a good example as parents

The parents have to set parents or guardians have to set good examples. So I had a family who just said, all right, when we come in, or at least from X time to X time, all the phones go into a basket. If it rang, people would have to get up and walk over. And so, you have to be intentional about it. This particular family said, you know, what? Unless there was someone calling, it really wasn’t that important. And they were enjoying that time.

I do think it’s good to set these rules on our own devices, but not everyone has the privilege of doing this. Internet provider companies can sometimes turn off the internet from X time to X time overnight. Also, maybe put a computer in a common area and not having individual computers. I realize this is all very difficult, and if you’re already in those habits, it’s hard to break. And so parents should just give themselves the grace and the space to try to gradually change these behaviors, engage the entire family and make these decisions.

I even think during Covid, even our young folks have appreciated or gained an appreciation of being with families. We’ve seen folks do board games who didn’t know what board games existed before the pandemic. So I think it’s about being gradual, engaging everyone and new rules, but also substituting. If you’re not going to watch TV, we’re not going to be on our phones, what are we going to do? Substitute some of those toxic behaviors with pro-social, pro wellness ones.

Get together with like-minded friends

Katie: And going for a hike on a Saturday and saying, we’re going to leave our phones at home. And, or one person brings it to take pictures, but, and maybe that’s even a bad idea. But I was wondering too – my kids are older – but if schools could get together and parents could get together, I think if they’re all singing from the same hymnal, it’s much easier. Maybe that’s too much like imposing standards on families, but it seems to me, at least in a friend group with concerned parents, they could say, “Hey, we’re trying to limit our kids and maybe there’s power in numbers?” And the peer pressure would feel less. I don’t know.

Dr. Harris: I think that’s a great idea. I hadn’t heard that one before. As you know, it’s always the worry about being different when, everybody else gets to do it. And so if you have this, this small friend group where everyone has agreed to work on this, and again, it’s a journey, right? It’s not necessarily a destination, but it’s a journey.

Katie: You know, it’s interesting. I remember interviewing Susan Sarandon and Tim Robbins a long time ago when they were married. And they said, and I’ll never forget: “We don’t answer the phone between 5pm and 8pm. That’s the time we’re having dinner with our kids. We’re really focused on our kids.” This was before iPhones, because I’m that old. But when you think about it, they haven’t been around for that long, I think like 2008. I’m very addicted to my phone. And I’d like to work on it for myself as well. I know that you talk a lot about doom scrolling. I think many people know what that is. I don’t doom scroll, I just scroll. And then I leave, go from one article to another, and I’m kind of, oh, I should read that. I should read that. And I feel like I’m not wasting time because I’m actually reading articles from the Atlantic or the New Yorker, legitimate publications. But then I think, wow, I’ve been on my phone for so long and it is easy to get sucked in! What is doom scrolling? What’s your definition, and what is the psychological impact?

Dr. Harris: So doom scrolling is spending an excessive amount of time with that negative media feed. I’m guilty too. And we might wake up in the morning, especially during Covid, and see it’s not a happy story. Right. Vaccines were a positive move, but especially early on, we were unable to go to work, and unfortunately, people were dying in the hospital. And so you click on that first story, because like, you want to be informed, you want to get up into the news of the day.

And before, you know, it’s been 30 minutes. Right? And so certainly if you are reading things that are not doom scrolling, it might have less of a negative impact. But if you start your day with 30 minutes of full-on negativity, that can certainly negatively impact your mental health. So you’re right. But I think scrolling media is also critical. We have to be mindful of that. It’s easy to do. Um, and so that’s why putting these alerts on our own devices like your daughter did, or making sure that we limit our intake when we get up in the morning. And I say, before you even go on your phone, take a moment and be present and people do different things, meditate, pray, stretch, whatever you want to do, but just take a moment and be present at the moment, waking up and then get to your day and then pick up your phone. All of us, again, are on our journey.

Assume we are on Zoom all day, many of us, either for work or for school. And before you know it, you’ve been seated in your chair for hours without a break. So we have to be intentional about getting up in between meetings. I know there are some issues about turning off your video and the rest of your colleagues might think you’re not present, but here’s where you need to say: “I’m here. I’m going to step away for a moment and stand and stretch. So I’ll be off-camera for five minutes.” I think we have to build those breaks in, even when we are at doing things for work and not just sort of doom scrolls.

Katie: And eating and exercise are so important, I think, for your mental wellbeing (says the person who just ate two chocolate chip cookies!). But the thing I wanted to not let you go without asking is, how can you tell if your teen is struggling? What are some of the warning signs? Because it’s terrible and heartbreaking, teenage suicide has gone up dramatically. So it’s not it’s anxiety and depression and even worse, suicidal ideation and thinking about it. It’s heartbreaking. So I guess the question is, how can parents make sure that they’re aware of some of the signs so that there can be some kind of intervention?

Dr. Harris: Well, I would say a couple of things watch for are any changes in sleep, maybe you don’t sleep so well, cause are worried about something no longer having a good appetite or as you and I chatted earlier, having these different patterns of eating or restrictive eating, only eating certain foods and only eating at certain times, but mainly the ability to function. Has there been a change in ability to function? Now, everyone will say yes. And so I would say, a significant and sustained change. And so not able to engage in pro-social activities that they used to engage in. Not connecting with friends, even via video. Parents should also ask, “how are things going? I want what’s happening with you, I’m here for you. I want to you to know that you can share with me when things aren’t going well.” Because parents know their kids pretty well, but sometimes the kids can hide things. And that’s why it’s important to ask if kids are okay, I noticed you’re no longer eating, that you’re getting up in the middle of the night and you aren’t sleeping very well. Let talk about it.

How about ‘kids’ in their twenties?

Katie: And what about older kids in their twenties? People have asked me about that because a lot of kids in their twenties miss their graduation, certain rites of passage, they’re not out socializing. Like these are supposed to be some of the best periods of their lives. They’re supposed to be having fun and getting out and doing all kinds of activities. And I think it’s really a very difficult time. Also, you know, a lot of them are beginning their careers and they’re stuck at home. They’re not making those social connections you often make when you embark on your professional life. And what about those, those young people? Because I know your frontal lobe isn’t fully formed, which you often and reasoning and kind of your emotional maturity when you’re twenty-five years old. What advice would you give to kids and their concerned parents who want to make sure that they’re as healthy and happy as possible under these really tough times?

Dr. Harris: Well, I think first of all, acknowledging the grief and the loss. Some people feel like, oh, I didn’t lose anyone to death during Covid. So it’s not so bad, I think. No, absolutely. It’s okay to grieve those rites of passage and the things that were lost, the graduations. And then I hope people do things likeat my Alma mater West Virginia University, when they were able to have graduation and another couple of other universities that did this as, that I know of. And I’m sure many other students made sure that they included the class of 2020 and the class of 2021. And so I think it’s important again, as a community or friend group. “So you missed a birthday last year or that important milestone let’s do that.” Now of course, now we are in the midst of a Delta barrier, but at some point, we will be able to go back and, and do some of those things.

And in Katie, I, I said this, I, I think words do matter. And there’s no question, um, that there were losses and we miss those rites of passage and certain things, but it is not all is not lost. And so I even am careful about saying the last year of Covid it was a different year, uh, but let’s be careful about using terms such as lost, unless it’s figuring out how to transform that into, uh, something now that we can celebrate. We can acknowledge, we can recognize, but we have to be intentional about that. And most importantly, don’t forget, don’t forget those milestones that were lost. They, we grieved them and then we figure out how we are going to celebrate those rites of passage and the milestones that we were not able to celebrate that

Katie: Well, it’s certainly something they’re going to be able to tell their grandchildren about. I have one last question, Dr. Harris. A lot of people would like to have therapy, but they can’t afford it or there aren’t enough therapists in their community. What, what do you tell patients who feel like their kids, or they could really benefit from some kind of therapy, but their insurance doesn’t cover it or they don’t want to have to put in for it because it’s still stigmatized in certain circles or there aren’t enough therapists, what do you tell people? Because I know there’s more telemedicine, there’s a lot of therapy that’s can, you can do online there. I know meditation apps and things like that. Um, there’s also pastoral counseling, by the way. I just want to give a plug to that because a lot of churches and synagogues and mosques and even schools sometimes have it, they often get cut when their budget cuts, unfortunately. I’m asking you the longest question. I’m in search of a question, mark, Dr. Harris!

And finally… how do you actually get help?

Dr. Harris: You know, I wish I had an answer or solution. I have an answer. I think the, again, another silver lining is people are recognizing the importance. Of course, I have to say our young folks have less stigma associated with asking for help. So the one thing I would say is there is no shame in asking for help. Now we are on our journey to get there because for some people – I still hear this – if you have a mental disorder or substance use disorder – and we’ve seen some increases in substances, substance use during this pandemic, Katie – that it means you have a weakness or moral failing. So the first thing I want to say to everyone: it’s okay not to be okay, and ask for help.

But then it begs your question where there are some folks in our country who are privileged enough to have health insurance, even then there might be a long waitlist. I will say, parity laws have been on the books for several years. So for the parents out there, and this is more advocacy work, no one should be denying you care. If you have insurance, you should get coverage. It should be covered as the same on the same level as your medical and surgical benefits. So I’ll say that.

And the other issue is again, try all those options. You’re right. Churches, synagogues, mosques, they, they are offering at least some link to services. Again, if you don’t have insurance, there are community-based public services. I know here in Georgia, we have a one 800 number, but I would, and technology, I think there’s promise. There’s also parallel in that Katie. We have to make sure that we have security and privacy on those, because a lot of folks don’t want to go online.

Make sure online sources are credible

And we also have to make sure that, um, those services online are credible. I can say the American Psychiatric Association will not endorse a particular app or service, but they tell you what to look for to know. And you want to, I would say you want to look for, I know there are peer apps and that I’ve seen a lot of young adults do peer apps. So you want to know if it’s a peer app. If it’s not, you want to make sure that the professionals are licensed. So you want to do a little bit of digging, but I do think there’s promise there. The good news is I know Congress, even in some of the recent legislation, there’s a lot of money for mental health, but of course appropriating the money and getting it into the services and to the, to the folks who needed is a journey. But for now I would say explore all options. If you have insurance, or maybe state or local-based, or with your faith community. And I love online.

Katie: I love the fact that young people are so much more open. You know, I have folks who work with me, they say I’ve got to leave early cause I have my therapy appointment. Like I would no more say that when I was their age or even, you know, up until a few years ago, I would never talk about that. It would, you know, I would be embarrassed or ashamed. And I think it’s so awesome that these young people are just open about it. And the fact that they believe their mental health is just as important as their physical health

Dr. Harris: And a quick shout out to NBA players and a female player, Simone Biles, Naomi Osaka, who are saying, you know, we are going to be out loud about this and unapologetic about caring for our needs. We can take a lesson from these young people.

Katie: Well everyone, I’ve been talking to Dr. Patrice Harris. She’s an adolescent psychiatrist, and she’s the past president of the American Medical Association, which is a very big deal as you know, so at patients on that pass and thanks for, for spending some time with us. Um, and, and hopefully if it’s helped one parent or even a teenager or a young person who is watching this, that was really my goal. And, and, uh, and making them feel less alone and making them just be on the lookout for some of these signs of real emotional distress that so many kids are dealing with right now.

Dr. Harris: Absolutely Katie. And I know by the way, people should not be afraid to ask their children about suicide. And, uh, the, the national suicide helpline is very important that that number is available for anyone who is struggling.

Katie: That’s actually a really important point because I think people are really afraid of that because they don’t want to give kids ideas about harming themselves. But you say it’s perfectly fine and advisable to say: “Have you thought about hurting yourself?”?

Dr. Harris: Absolutely. And the data shows that asking about it or talking about it does not make someone more likely to think about it. So people need to feel that they have someone to go to and share those feelings with, but if they can’t always do that in their own circle of family or friends, that’s what that national helpline is for.

The National Suicide Prevention Lifeline is a U.S.-based suicide prevention network of over 160 crisis centers that provides 24/7 service via a toll-free hotline, with the number 1-800-273-8255.