Is Instagram and TikTok to blame for increasing mental health challenges in children?

England is suffering from a mental health crisis. According to the NHS rates of children suffering from mental health problems have risen from one in nine in 2017 to one in six in 2021. The number of children using social media platforms such as Meta’s Instagram and TikTok, owned by Chinese ByteDance, has also risen. These two apps boast over one billion users each. Social networking apps have made communication fun and easy especially during a pandemic where socialising was restricted. But at what cost?

Data from the NHS shows increases in possible and probable mental health disorders in children and teenagers from 2017 to 2021, in every age bracket. This includes depression, anxiety and eating disorders. (See right)

Ex-employee of Meta (previously Facebook), Frances Haugen blew the whistle on how her employer put profits above the mental health of children. She revealed to the Wall Street Journal, in documents known as the Facebook Files, how Meta’s own research showed that one in three teenage girls who used photo and video sharing app Instagram had body image issues. One in five teens using Instagram had suicidal or self-injury thoughts

In 2020 Instagram made $24 billion, a rise of 36% compared to the previous year. TikTok, which was the most downloaded app of 2020, earned a modest $1.9 billion in comparison. Despite concerns, Meta continues to increase its profits year on year.

Impact on mental health

Adolescent psychologist Angela Karanja thinks Meta’s research is an underestimation, and the problem of body image and self-esteem is far worse. She explained that constantly seeing images of perceived beauty is going to heighten any insecurities in children as they have not developed the skills to critically analyse the content.

“When we are young the frontal cortex of our brain is very fragile. It is the reasoning part of the brain which is not fully formed so it is susceptible when it is bombarded with images of ‘perfection’. It drops into the subconscious part of the brain and drives decision making. What we have is young people being more destructible and they have less emotional stability as that part of the brain has not had the opportunity to develop properly,” she said.

Angela explained the way apps like TikTok work is by showing very short videos non-stop without a break and this overstimulation takes away a child’s natural curiosity and critical thinking ability. Neuro circuits in the brain then become accustomed to such addictive content and behaviour.

Algorithms on apps such as Instagram and TikTok work in a way that create echo chambers. If the user shows interest in particular types of content, Instagram will show the user more of that material. For example, if a teenage girl watches a few videos about extreme dieting, and “likes” it, Instagram will not only bring up similar content on the Explore page but also in her personalised feed.

TikTok takes this one step further. When a user opens the app on their phone it takes them straight to the For you page which shows videos that artificial intelligence has curated for the user based on past viewing.

TikTok said in December it will adjust its algorithm to stop young people from going down a rabbit hole when looking at content that is harmful to their mental health.

However, it is not just young people who are affected by continuous scrolling through social media apps. A poll by YouGov (see bar chart below) showed that almost half of 18–24-year-olds and 42% of 25–49-year-olds said that social media had a negative impact on their mental health.

The poll also demonstrates that in all age groups more people overall had a negative impact than a positive impact of using social media, as contrasted in blue and purple on the bar chart.

Using social media has become a normal part of life for most people and is essential to businesses as a form of highly effective and targeted way of advertising. Thousands of young people have made careers out of becoming YouTubers and influencers in different industries such as health and fitness, fashion and food.

Malvika Sheth in 2019

Malvika Sheth

Malvika Sheth 2022

Malvika Sheth is a 23-year-old South Asian content creator who started her account on Instagram in her late teens. As a teenager who wanted to go into the fashion industry, Malvika decided to use her Instagram profile as a portfolio for potential internships and future employment.

“Everyone wants to put their best foot forward on social media. Early on there was a big sense of ‘I’m not good enough’. I felt I needed to either overly edit myself or portray a certain version of myself that isn’t real,” she said.

Malvika was flooding her feed with curated images from the fashion world and struggled to keep up. She said: “I had a very long period of feeling very low and not like myself and not acting like myself in front of my friends. When you are feeling insecure you oddly put on an act that you are the best and nothing can phase you. That started affecting my relationships.”

Malvika had issues with her body image and weight in the past, having been bullied at school when she was 13, she would often faint from starving herself. “When I went into creating content on Instagram those feelings and similar sentiment started to resurface,” she said.

Malvika went for counselling when she was an adult and started to feel better. She decided to make her account about individual empowerment and now does not hugely edit or add filters to any of her posts.

She said: “Lots of South Asian girls follow me, and I know what it feels like to see images of beauty all the time. I used to use Lightroom to edit and unintentionally I was playing into the ridiculous South Asian notion that you need to be lighter to be beautiful.

“My goal is to show style over perfection. If for every 10 Instagram posts that are heavily edited there can be one post that is showing the texture of my skin or what I actually look like without editing, I want to be that person. It is important to be that example for young girls.”

Malvika has since strategically changed who she follows and what she sees in her social media feeds. She did this when she was an adult and mature enough to realise the damage it was doing to her.

What part do parents play?

Many parents are aware of the possible dangers that using social media can lead to such as speaking to strangers and pornography, but most are unaware of the lesser-known dangers.

In a survey of 80 parents of children aged 11-18, only 4% selected dieting and extreme weight loss as a top-three concern when it came to their children using social media. “Unrealistic expectations of what women should look like”, was cited as a top-three concern for only 11% of respondents. The survey also showed that 26% (the most popular response) said their child spends over four hours a day on social media. Coupled with the figure of 39% not putting any type of restriction on their children’s devices, is concerning. TikTok came up as the most popular app.

This data story has 5 different visualisations based on the responses from the survey

The survey found that over a third of respondents said social media had affected their children’s mental health. When asked about other concerns about their children one parent said: “They get dragged into unnecessary things. They stop thinking logically. They don’t understand that everything on social media is not true and believable. You need to check the facts. Overexposure to social media is ruining their own thinking capacity.”

The survey highlighted that most parents are not as concerned about body image issues as other more obvious risks (see slide 5 above). It also suggests that parents may often be unaware of their children’s mental health until it manifests in a more obvious way.

Psychologist Angela Karanja advised parents to ask their children what they are watching on their devices.

"Be curious, not furious. It’s a different ball game and parents must educate themselves about what is out there," she said.

Eating disorders

The bar chart below shows a substantial increase in children screening positively for potential eating disorders from 2017 to 2021.

This chart shows the number of 10 to 18-year-olds admitted to hospital from 2017-2020 with a primary diagnosis of an eating disorder. The data shows an increase in admissions for most age groups and a 50% increase from 2017 to 2020. (Data released in early January 2022 is even more alarming as it includes data when a patient is admitted, and an eating disorder is a secondary diagnosis and not the main reason they have been admitted to hospital).

Whilst Malvika managed to get help in time, others are not so lucky. Sophie Louise is 22 and has suffered from eating disorders since her early teens. As an autistic child, she didn’t make friends easily and social media was a lifeline for her. She made lots of friends online and as a fussy eater from childhood, she started following lots of healthy eating and fitness accounts.

“I was dealing with a lot of exam stress and anxiety about school. I ended up spending a lot of time online. I had read about food and that’s when my eating disorder started to develop. Clean eating was really in when I was 14, and I became obsessed with eating healthy. Cutting food groups and becoming vegan was cool. I followed healthy eating bloggers and bought their cookbooks.

“You start by slightly restricting your calories and then it continues and if you’re predisposed to an eating disorder then a dip in calories triggers something in your brain. It makes you preoccupied with food and weight and the more you look online the worse it gets,” she said.

Sophie was diagnosed with anorexia and later orthorexia nervosa which is defined as an unhealthy obsession with eating “pure” food. Going through treatment many times she learnt how to manage her eating disorder. By her own admission Sophie is still underweight but now recognises the dangers of certain types of content and trends online.

“Veganuary and veganism is another name for an eating disorder. Those who do it for the environment and planet that’s great, but most girls who say they are vegan have an eating disorder as it’s just an excuse to cut out food groups,” said Sophie.

Sophie pointed out that there are many anorexic people who use apps and websites to promote being skinny and social media platforms do not do enough to remove content.

Instagram gives a warning before displaying posts with certain hashtags like #anorexic and offers “resources that might help” before showing you the results. TikTok has made many words unsearchable but keeps the #eatingdisorder or #ED hashtags for recovery and support posts. But those who want to share posts promoting eating disorders without being blocked get around this by misspelling words like anorexia or pro-ana (pro-anorexia content) and anyone can go and search for these.

“If you’re unwell or underweight and you’re looking at images of people at the point of death with their illness you think you are not well enough to seek help or you don’t deserve help. There are people who sort of promote themselves when they’re in hospital, and you think you’re not as unwell,” said Sophie.

Even hospital photos with feeding tubes have been glamorised for those in the clutches of severe anorexia.

A study from 2017 showed greater Instagram use was associated with a higher tendency towards orthorexia nervosa, with no other social media channel having such a high association.

Sophie said: “People don’t eat for different reasons. It began with a worry about food being bad for you and thinking everything has to be perfect, perfect food, perfect diet, perfect grades and because of the content I saw on social media I would see this warped image of what ‘healthy’ is. Because of social media, I fell into an exercise addiction that made me very, very unwell,” she said.

Eugenia Cooney is a YouTuber and influencer with over 700,000 followers.

She has been in rehab and spoken about her weight in the past.

In the last year she has not spoken about her weight and continues to show off her body.

Fitness accounts advocating extreme diets

Another fitness account encouraging dry fasting

Mental health campaigner Hope Virgo agreed and said: “We see this pro-eating disorder stuff daily, but what scares me just as much is the accounts that mask themselves as ‘wellness influencers’, those accounts that share ‘what I eat in a day,’ offering unsolicited diet advice and dangerous messages. How is that we have got to a point in society where we normalise eating disorder culture?”

Hope was hospitalised when she was 17 years old with anorexia nervosa and thinks one of the main issues on Instagram is that there are many wellness accounts that have created another angle for those with eating disorders. Hashtags like #thinspo encourage girls to think they should be trying to lose weight and constant dieting tips are triggering for those with eating disorders.

“From the work I do in schools all over the world, I see first-hand the impact of social media on young people and through my campaigning the wider impact on society,” said Hope.

Regulation

Meta has been under fire many times for the way that hateful content or misinformation is shared and how its algorithm works. From the Cambridge Analytica scandal, the rise of far-right content, vaccine misinformation and more recently Facebook being sued by Rohingyas for the part it played in the genocide in Myanmar, it is obvious that certain social media companies have a lot of work to do in preventing different kinds of threats and dangers to democracy.

The Online Harms Bill, which is currently in its draft form, plans to make Ofcom the official regulator to inspect all sites that have user-generated content. Currently, Ofcom only has jurisdiction to regulate video-sharing platforms (VSPs) that are established in the UK or have a UK arm such as TikTok and Snapchat. However, it does not regulate YouTube, the largest video sharing platform, which has over two billion active users.

A request under the Freedom of Information Act was made to Ofcom to obtain the number of complaints it had received about VSPs since it started regulating them in November 2020. However, Ofcom said disclosure of this information is prohibited under an enactment that requires permission from each VSP.

Ofcom’s focus in protecting under-18s, as stated in their official guidance in regulating VSPs, is on “material inciting violence or hatred, and content constituting criminal offences relating to terrorism; child sexual abuse material; and racism and xenophobia”.

There is no reference to eating disorders.

Some of the safeguards that already exist are minimum user ages for apps. TikTok and Instagram users must be 13 or above but entering an incorrect date of birth when making an account is an easy thing to do.

One respondent of the survey said: “The minimum age allowing full access to content is too low. People can post anything, and once children are 13 they will be able to see it all. There are no filters or monitors on social media platforms. Why is pornographic, violent, extreme content permitted at all?! Even movies have higher age ratings.”

TikTok provides resources whenever someone searches for troubling hashtags like #anorex1a. Hope who has also consulted for the Department of Culture Media and Sport, in regard to the proposed bill, thinks the app puts its users at risk. She said: “TikTok provides a helpline, but this is simply not good enough, there needs to be proper legislation brought in to ensure these apps are safe for their audience. They need to educate themselves on eating disorders and realise the detrimental impact they are having on both children and adults.

“Eating disorders are serious mental illnesses, with the highest mortality rate of any psychiatric illness. They are still a massively stigmatised illness and one that few understand fully. But in order to create an environment where eating disorders do not thrive TikTok and other social media sites need to take responsibility and tackle these issues as a matter of urgency.”

Whilst the Online Harms Bill intends to protect individuals from harmful content, there is concern about censorship and limiting free speech as the power to remove content will lie with companies such as Meta.

Giving Meta or TikTok the power to remove content based on a bill that aims to protect journalistic and democratic content is troubling. Defining what is illegal and what is just free speech will be at the behest of these companies.

TikTok has been accused of suppressing content criticising Chinese leader Xi Jinping in the past. The app has also been banned on and off in many countries, including India and Indonesia both countries with massive populations, for various reasons including addiction concerns. TikTok responded by adding “take a break” reminders every 90 minutes, as did Instagram.

Instagram’s head Adam Mosseri said in a statement in 2021: “We’ve led the industry in combating bullying and supporting people struggling with suicidal thoughts, self-injury, and eating disorders. We continue to build new features to help people who might be dealing with negative social comparisons or body image issues, including our new ‘Take a Break’ feature and ways to nudge them towards other types of content if they’re stuck on one topic.”

It can be argued that the app makers are trying to make the user experience less harmful. Of course, there is a degree of regulating that goes on across all big social media sites, but the new bill will go a lot further.

The Covid-19 pandemic exacerbated existing issues in society such as loneliness, domestic abuse, and depression. But the lockdowns also led to children spending longer on their devices which in turn led to increased mental health challenges.

There is no doubt that social media has many advantages for teenagers but having unlimited access to unrestricted content can be harmful to mental and physical health. Until social media companies acknowledge the harm they are doing to young people and treat fixing it as a priority above profiteering, children’s mental health will continue to suffer.