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    Social Media: A Complicated Story

    Feb 17 2022

    By Christina Macenski, M.D.,
    APAF Child and Adolescent Psychiatry Fellow,
    Resident Physician at Brigham and Women’s Hospital/Harvard Medical School

    The relationship between social media use and mental health is complicated and ever-changing. The strategies that social media sites use to engage us, their audience, can affect people differently depending on if they struggle with mental health challenges or not.

    The context behind social media use (e.g. motivation for use, time of day accessed, etc.) and the person using social media (e.g. type of mental health symptoms, gender, age, etc.) can help create a situation where social media use is either healthy or problematic. To make matters more complicated, the way we use social media can also affect mental health outcomes.

    Social Media Strategies

    Social media sites use various strategies to increase user engagement. The four strategies identified below can differentially affect people who struggle with mental health symptoms.

    Becoming “Trapped”

    Social media platforms encourage users to stay on their websites by using closed portals (where all links on a platform lead to other parts of the same platform) and infinity scrolls (where content is loaded automatically, rather than having to hit “next”). These features are marketed as a convenience; however, they also decrease the ability for a user to understand how long they are spending on social media by removing natural cues for cessation/breaks.

    Why it matters: individuals with Attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), anxiety, and depression might be more affected by these strategies. Additionally, children and teenagers may have trouble with time management to begin with, as their brains are less developed for executive functioning tasks.

    Fostering Misunderstanding

    Online environments may allow for negative interactions due to factors such as anonymity, disinhibition and reactivity. Once an online discussion becomes argumentative, it is hard to back track. This may produce environments that lead to negative interactions that shame and magnify counterproductive behaviors and thoughts.

    Why it matters: Individuals with mental health symptoms may think differently from their peers, leading to misunderstandings. Notably, thinking differently may provide discussions with variety and diversity. Children and adolescents may be particularly affected depending on their developmental stage at the time of social media use.

    Comparing Self-Worth

    It is easy for people to assess self-worth based on the numbers of “likes”, “shares”, or comments on their profile. For example, if unique/original content is not “liked” enough, someone might (incorrectly) assume that their content is not interesting. This may create a cycle where they share less, decreasing opportunities for positive engagement.

    Why it matters: People with mental health challenges such as ADHD, ASD, anxiety, depression, and eating disorders may affect how often they post, how they interpret engagement with their posts, and equate social media attention with self-worth. Children and teenagers may be more prone to related social media use with self-worth, as they are consistently trying out new identities and ideas about themselves.

    Lack of Customization

    Social media sites offer little in the way of customization. You cannot turn off the infinity scroll, nor can you easily block certain content.

    Why it matters: People with ADHD, ASD, anxiety, mood disorders, and eating disorders cannot control what they see, creating the potential in engaging in problematic content unique to their symptoms. Children and teenagers actually may be better able to control the content of social media given new apps/programs that allow customization for those skilled with technology.

    Potential Solutions

    • Education: Educating people on social media use and the potential for negative mental health outcomes is the first step to creating healthy social media use. Increasing self-awareness of how social media affects certain people can lead to better quality of life and healthy social media use. This is especially important for kids, as these concepts may be new to them.
    • Intentionality: Creating barriers so that social media is used intentionally (instead of impulsively or instinctually) is another way to create healthy habits. Deleting phone apps, so that social media can only be used on a web browser, and not automatically logging in are two ways to add to ability to self-regulate content.
    • Self-monitoring: teaching people to be mindful when they are using social media use can create healthy use, simply by creating self-awareness. This can be done by paying attention to what makes you feel positively or negatively on social media, and only participating in usage that is beneficial. For kids and teens, this may be helpful in other aspects of their lives as they learn better self-management skills.
    • Alternative activities: finding healthy, enjoyable activities outside of social media is vital for mental health. In-person connects can make all the difference. While this is more complicated in the setting of the COVID pandemic, many virtual platforms exist that may provide more real-life interactions (video chat, virtual reality, etc.).


    1. Macenski, C. L., Hamel, M. P., McDougle, C. J., & Thom, R. P. (2021). Challenges and Strategies to Mitigate Problematic Social Media Use in Psychiatric Disorders. Harvard review of psychiatry, 29(6), 409-415.