September is National Suicide Prevention Month and The 19th is looking at how gender factors into the political and cultural forces at play in suicide prevention.
In May, Surgeon General Vivek Murthy issued a new advisory on the effects social media usage can have on teen mental health, specifically calling attention to the way it can perpetuate body dissatisfaction, disordered eating behaviors and social comparison in adolescent girls.
Videos and pictures on image-based social media platforms can trigger intense episodes of self-comparison in adolescent and teen girls. Because of their still-developing brains, they may process this self-comparison in ways that can pose real risks to their mental health — and lives. Suicide is the second leading cause of death among those with anorexia nervosa, and suicidal behavior is more likely among those with bulimia nervosa and binge eating disorder.
“The more teenage girls are on social media and exposed to image-based social media in particular, the more likely they are to have poor body image,” said Amanda Raffoul, an instructor at the Harvard T.H. Chan School of Public Health and an expert on eating disorder prevention.
Since eating disorders have among the highest mortality rates of any psychiatric illness, and they also elevate a person’s risk of dying by suicide, awareness about the connection between social media and disordered eating is an important tool for parents and those who works with young people to have. Also important, though, is not scapegoating social media for adverse mental health outcomes without a more nuanced understanding of the dynamics at play.
According to a 2022 study done by the Pew Research Center, 92 percent of teen girls report using YouTube. Another 73 percent say they use TikTok, 69 percent say they use Instagram and 64 percent say they use Snapchat. Girls are more likely than boys to say they spend too much time on social media — 41 percent to 31 percent — and also are more likely than boys to say that it would be hard for them to give up social media, 58 percent compared to 49 percent, the survey found.
One problem that drives the development of eating disorders and self-harming behavior, Raffoul said, is a societal acceptance of body dissatisfaction in teen girls as a normal. That assumption can create a dangerous environment for teens to engage in social media, when the images they see can make them question their appearance and value, but the feelings they experience might be overlooked as “typical.”
Image-based platforms like Instagram and TikTok often force users by default to compare themselves to the people they are seeing online. When it comes to teen girls, this can “promote some really unrealistic appearance ideals,” Raffoul said.
“Even if someone knows or is aware on a surface level that everything they see might not be real, if you’re constantly bombarded with those images, it is going to alter your perceptions of yourself in some way, especially when you’re in adolescence,” she said. “The adolescent brain is wired differently than the adult brain or even a child’s brain, which puts them at a very specific risk when it comes to social media use.”
In adolescents, the part of the brain that processes emotions develops faster than the part that develops judgment and critical thinking. For adolescent girls, this can mean responding emotionally to content they see on social media before having the ability to think about it critically, yielding a situation in which they think that “weight loss techniques on TikTok need to be something they need to engage in in order to be happy, be successful and be valued,” Raffoul said.
Many parents don’t understand, Raffoul said, how different a teen girl’s social media feed might look then their own. For adolescent and teen girls, this can mean seeing content that shows increasingly radical thoughts about dieting and dieting trends, many of which emerge on platforms like TikTok long before they hit the radar of parents, educators and clinicians. Writing off girls’ concerns about their bodies as normal can heighten this danger, she said, especially if parents are on some level reinforcing negative body talk at home.
But just as parents’ need to be wary of not normalizing body dissatisfaction in their daughters, they also need to be cautious of not simply scapegoating social media as the source of all harm, and stopping the conversation there. Jacqueline Nesi, an assistant professor and psychologist at Brown University who studies the role of social media in adolescents’ mental health, told The 19th that there is often a strong desire from those who care about children’s wellbeing to pinpoint a single factor that leads to mental illness or suicide in teens. But hand-wringing about social media isn’t going to move the needle, she said.
“I do think that there are many things that can be done to improve the health and safety of social media platforms and that those things should be done, but I don’t think that even by doing those things that’s how we’re going to solve the mental health issues we’re seeing right now,” she said.
Janis Whitlock is a senior adviser at The Jed Foundation (JED), a nonprofit that protects emotional health and prevents suicide in American teens and young adults, and an expert on self-injury in girls. In addition to being attuned to how their child might be impacted by their social media intake, parents also must be aware that being on social media isn’t inherently bad. Whitlock also stressed that social media is “not intrinsically bad” and is a “core contributor to our evolution and our ability to thrive.”
“What it comes with, however, is an overwhelming responsibility for parents and schools in particular to help young people become self-aware,” Whitlock said.
She stressed that real help for young people means teaching them how to hone and develop a sophisticated level of awareness about how their social media diets make them feel, and how to monitor themselves for “red flag feelings” like overstimulation, depression or agitation — especially when these feelings feel rooted in self-comparison.
“Our young people need to have more self-awareness and we need to have more systems to cultivate that in them earlier,” she said.
Whitlock said parents and schools might overlook something critical to the work of suicide prevention in teen girls: teaching digital literacy and at younger ages. She said just like previous generations were taught to be aware of how advertisers might try to market things to them from shampoo to cigarettes, parents and educators need to help kids understand that social media is also about consumer choice and that they need to approach their social media diets with an awareness that they can always opt in and out.
And this can be a tipping point for disordered eating, self-harm, and even suicidal ideation in some girls. Teen girls, she said, can feel “hypervigilant about learning the rules of society” as they transition out of childhood, which also means taking in a lot of information about understanding what society expects and values out of them as young women and understanding that they need to master what other people find value in. The reality is that their developing brains are not designed to triage the amount of information they are receiving about bodies and value, she said.
“Teen girls are really hyper vulnerable to physical parameters because they learn early on that how you look and how you present comes with a value sign of some sort,” Whitlock said.
Teens as young as 13 and 14 can sometimes find themselves in a position where they are consuming massive amounts of information about femininity and bodies online and left wondering whether or not they can be successful in an imagined future. The ability to imagine a future for yourself, she said, is a key protective factor against suicide.
“There’s this alchemy of worry which can be contributed by what you’re encountering online, which is definitely linked to mental health,” Whitlock said.
Nesi, the researcher at Brown, listed the “real risks” — namely, the threat social media can pose to teen girls getting an adequate amount of sleep, preventing in-person socialization, and exposure to “explicitly dangerous” content, which can exacerbate eating disorders or encourage self harm or suicide. But she emphasized that too often, people saw all social media as the problem when there was more to it.
A better approach, Nesi suggests, would be drilling down into specifics, asking specifically how and for which demographics of teen girls social media is having disproportionate negative mental health outcomes. (According to the Pew research, Black and Hispanic teens say they are on image-based social media platforms like YouTube, TikTok and Instagram “almost constantly” at a five time higher rate than White teens.) It’s a question that also necessitates understanding that no two teen girls are having the same experiences online — and that simply blaming social media as the blanket cause for all negative mental health outcomes can fail to pinpoint the most acute factors at play for some individuals.
“I think what we really need to be thinking about is how we can maximize the benefits [of social media] for as many kids as possible while minimizing the risks that we know are very real for a number of kids. I think that nuance gets lost sometimes,” Nesi said.
Whitlock said that while parental fears about social media are understandable, the public health focus today needs to ensure that teaching parents and those who work with children that social media’s impact on girls’ mental health is a conversation requiring nuance.
Since social media isn’t going away, simply demonizing it as the root of the potential for mental health disorders, eating disorders, and suicide can be a misstep in understanding how teen girls are instead responding to real components of the world around them. And part of this, Whitlock said, means parents putting in the work to make sure there are designated times for connection with their children happening offline, so they can better listen to their children — and allow their daughters space to process any things they are feeling as a result of their social media lives.
“It’s really about self-awareness and education,” Whitlock stressed. “That’s why I think we need to help them understand themselves, their vulnerabilities, how they recognize when they’re getting triggered online and how to get out of it — how to pause or pull back. Those are very adult skills that our young people now have to learn because of what we’ve created.”
If you or a loved one are in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or contact the Crisis Text Line by texting TALK to 74174.