Social Media
How Does Social Media Contribute to Teen Mental Illness?
Underscoring the problematic impact of online mental health information.
Updated February 4, 2025 Reviewed by Margaret Foley
Mental illness among teenagers is on the rise. The CDC highlights the scope of the problem in the recent Youth Risk Behavior Survey. While there has been some improvement, a significant fraction of teenagers experience problems ranging from persistent sadness and hopelessness (53 percent) to suicidal thinking (18 percent) and overall poor mental health (26 percent).
Experts believe that a significant contributory factor is low-quality and misleading information on social media. A 2022 study (Yeung et al.), for example, looked at the 100 most popular ADHD TikTok videos and found only 21 percent to be useful. Fifty-two percent were misleading, and 27 percent were based solely on personal experience. As a parent of teens, I've witnessed firsthand the impact of the good, the bad, and the ugly when it comes to mental health and social media.
In some ways most concerning is the risk that social media exposure could lead users to believe they have a variety of mental illnesses, when in fact they would not meet the criteria upon proper evaluation. While on the one hand, social media can and does support crucial awareness and advocacy, on the other hand, real harm can be done through unnecessary treatments, the impact on self-image and self-esteem, and the risk of becoming attached to various illnesses as aspects of overall identity and development, both individually and as part of an affinity group, especially when a particular mental illness becomes trendy. Exquisite care is required to address this issue to both validate peoples' authentic experience while also gently confronting areas of concern.
I was glad to interview Dr. Andrea Giedinghagen, a child and adolescent psychiatrist, on this topic. She recently authored a paper on a proposed construct to help understand the impact of social media on mental health when things go awry: Social Media Associated Abnormal Illness Behavior (SMAAIB). This framework is an alternative to prior models, more neutral in tone and intended to facilitate dialogue and identify and address problem areas, rather than pathologize.
Grant H. Brenner: How did you become interested in the impact of social media on adolescent mental health?
Andrea Giedinghagen: In 2020 I noticed an unusual phenomenon: adolescents presenting en masse to my clinic with symptoms seemingly acquired from viewing illness-related content on social media. Prior to the pandemic, patients came in and told me about their symptoms, and we arrived at a diagnosis by exploring together. Suddenly they were telling me up front, “I have Tourette syndrome,” or “I have dissociative identity disorder,” and I was backtracking to understand how they arrived at that. The parents were usually concerned that the tics, or concern for DID, appeared suddenly and rapidly worsened. “I saw it on TikTok” was a common refrain from the patients themselves. Everything was pathologized: Daydreaming in class became “dissociation,” and tapping a pencil was “stimming.” I set up social media accounts on a few new platforms and found it was rampant there as well.
GHB: What are "Munchausen's by Internet" and "mass psychogenic illness"?
AG: Munchausen syndrome is when someone deliberately feigns symptoms of illness to get care, sympathy, or belonging. Munchausen’s by Internet (MBI) just means the internet facilitates the syndrome. It’s occupying the sick role to get emotional needs met, whether physically mimicking tics or just writing a Twitter post about living with a disease you don’t really have. Someone feigning Tourette syndrome posts videos acting out tics—and viewers with Munchausen’s copy them, sometimes exactly. (Teens I saw in 2020 exhibited remarkably similar tics, but they were quite atypical for Tourette syndrome.) Adolescents are looking for a sense of belonging, and if there isn’t any more adaptive way to access it, Munchausen’s works. People can write about their fictionalized tics on a disability or chronic illness message board and immediately access an outpouring of support. Fabricating a diagnosis can feel like gaining entry to a coveted club.
Mass psychogenic illness (MPI) is when a distinct social group begins showing symptoms of a disease they do not actually have. It happens rapidly and involuntarily. It can be somatoform, with symptoms like vomiting or tics; or psychoform, with involuntary production of psychiatric symptoms. With the advent of the internet, symptoms can be transmitted across continents via social media. The verbal tic “Beans!” spread across Europe and the U.S. this way in patients with “TikTok tics” in 2021. In this case, patients seek out belonging by unconsciously creating the disorder.
GHB: Can you tell us how you derived Social Media Associated Abnormal Illness Behavior (SMAAIB) and why this is a useful reframing?
AG: It places the focus on the medium and is destigmatizing. You don’t have to parse etiology too much. SMAAIB doesn’t suggest a patient is doing it deliberately, but it also doesn’t enable it. Confronting patients with Munchausen’s doesn’t typically work anyway. SMAAIB acknowledges sometimes bodies manifest stress or feelings of isolation in illness behaviors—both deliberate and unconscious. Attention and belonging feel good; we’re social beings. The label lets me tell the patient yelling “Beans!” that the good news is they don’t have Tourette syndrome. With time away from social media and better control of stress, they can find other ways of getting connection needs met. Symptoms will abate. My pandemic-era SMAAIB patients were a decent mix of MBI and MPI, and the vast majority recovered simply by learning coping strategies and going back to school; that is, by disconnecting from social media and reconnecting in other ways.
GHB: What can parents do in the face of these powerful influencers and peer groups?
AG: Create a family media plan everyone (including parents) sticks to. The American Academy of Pediatrics has a great one. Certain places and times are no-phone zones, like dinner and bedtime. It’s essential to build real-life connections to peers and adults in the community. A teen getting a phone should also understand that it’s the parents’ phone—they're just getting to use it, with the expectation of access to social media accounts, texts, and so on. It’s a balance. If parents are too authoritarian, adolescents will go behind their backs. Too-permissive parents leave teens vulnerable to victimization online. I’ve been alarmed by how many of my patients have online boyfriends/girlfriends their parents knew nothing about.
Prioritize communication over confiscation. No one would drop an adolescent off in a neighborhood they didn’t know for seven hours a day and never talk about anything that happened there. The average teen spends that much time online each day, so don't do that in virtual spaces either. Ask what influencers they follow and who they talk to online (ideally, adolescents shouldn’t be talking with anyone they don’t know in real life). Teens also encounter content like disordered eating and suicide online. Those aren’t taboo topics, but they’re also not issues 13-year-olds need to grapple with alone.
In the conclusion of her paper, Dr. Giedinghagen writes:
"[I]t is essential to build rapport—not only to understand, but to enable recovery. This involves not only providing the physician’s explanatory model for SMAAIB (of whatever type), but also discussion of the patient’s model, and negotiation between the two. It is also essential to understand not only biological but also psychological, social and cultural contributions to the presentation. Providing care, understanding and face to face interactions outside the artificially hyperpersonal setting of social media is necessary. In cases of SMAAIB, healing comes first by disconnection, then connecting anew: disconnecting (in part) from social media, and disconnection of attention and belonging from illness representation. Connection necessarily follows, unpredicated on illness behavior: between adolescent and treater, adolescent and parents, and the adolescent with themselves. Health emerges when adolescents are supported for who they are as whole human beings, not diagnoses.
References
CDC Youth Risk Behavior Survey
Yeung A, Ng E, Abi-Jaoude E. TikTok and Attention-Deficit/Hyperactivity Disorder: A Cross-Sectional Study of Social Media Content Quality. Can J Psychiatry. 2022 Dec;67(12):899-906. doi: 10.1177/07067437221082854. Epub 2022 Feb 23. PMID: 35196157; PMCID: PMC9659797.
Giedinghagen A. The tic in TikTok and (where) all systems go: Mass social media induced illness and Munchausen’s by internet as explanatory models for social media associated abnormal illness behavior. Clinical Child Psychology and Psychiatry. 2023;28(1):270-278. doi:10.1177/13591045221098522