
- Vol 40, Issue 5
Psychoeducation or Psychiatric Contagion? Social Media and Self-Diagnosis
"I have autism. All my friends say so. I do have autism. You just don't get it."
SPECIAL REPORT: CHILD AND ADOLESCENT PSYCHIATRY
"I have
Social Media: Chronically Online?
Humans are social beings. The complexity of our relationships can be credited for much of our success as a species. Organization into tribal groups allowed our ancestors to coordinate defense and delegate vital tasks such as hunting and care of the young. Understanding one another was necessary for effective competition for mates and resources. Social thinking is perhaps most relevant for adolescents—typically preoccupied with how they are perceived and valued by peers. A vital ingredient in socializing is imitation. Replicating the behaviors of others allows individuals to assimilate into groups and adopt customs and behaviors needed to perform important tasks or avoid dangers. Social imitation is not unique to humans, but it is necessary for the evolving culture which, accumulating over generations, allowed our ancestors not only to survive, but to progress from hunting and gathering toward modern civilization.1
Social media platforms such as
Most adolescents attempt to influence peers on
Social Contagion: The Online Spread
Based on the idea of biological contagion, social contagion is the process by which information, behaviors, or attitudes spread among individuals in close contact. Traditionally, this has occurred only among individuals living in close proximity, but media has made contagion possible among those who are distant. Goethe’s popular 1774 novel, “The Sorrows of Young Werther,” in which the protagonist commits suicide as a solution to unrequited love, was implicated in a string of suicides of young readers in Europe. Television reporting of
Social media appear to have the potential to spread mental health contagion on an unprecedented scale. Limited research evidence for contagion via social media has been documented for tics,8
In clinical practice, adolescent females may be most likely to present with a self-diagnosis. The most common inaccurate self-diagnoses include dissociative identity disorder, bipolar disorder, autism, and
When a patient presents with a self-diagnosis, our first step should be to assess their concerns using an inquisitive, open-minded approach. We may ask how they learned about the diagnosis, and then review any related symptoms, what exacerbates or relieves them, and ascertain impact on their daily functioning. Asking directly what the diagnosis means to the patient may be helpful. We can also inquire whether they have friends who suffer from the same condition, and how friends respond to the patient’s symptoms. It may help to ask to coview their social media feeds to assess any mental health content the patient relates to. It is vital to obtain collateral information about the patient’s symptoms and ascertain whether perspectives of teachers, family, and therapists align. If not, we may wonder what psychological or functional need of our patient is served by identifying with this diagnosis.
If we determine the patient has self-diagnosed incorrectly, we must share this perspective with the patient while avoiding unnecessary conflict. We should validate the patient’s genuine distress and help them make better sense of it, perhaps by emphasizing a biopsychosocial understanding and deemphasizing diagnosis. We can help the patient see that many aspects of life provide identity: neighborhood, school, cultural group, personal strengths, beliefs, and interests. Even an accurate diagnosis must not define the individual.
Concluding Thoughts
As clinicians, we can and should help all patients pursue healthy ways to address unmet psychological needs, including these patients influenced by social media. For example, if a patient reports online ruminations about depression function to garner social support, we may encourage that patient to meet this need elsewhere, such as engaging in team sports or after-school activities that provide social opportunities, or arranging in-person recreational time with a peer or family member. For adolescents whose social media involvement appears excessive, scheduled breaks may be helpful, such as implementing a new practice of removing screen media from the bedroom or moving the screens to another room during family dinner or homework. In cases in which online access threatens safety or severely impairs functioning, we may consider advising parents to remove internet access entirely for a limited time as a last resort, while also preparing for the contingency that doing so may provoke a crisis, as may be the case for patients who are psychologically dependent on social media connection.
The internal lives of adolescents are increasingly influenced by social media interactions, and it is the responsibility of mental health practitioners to incorporate an understanding of this process into assessment and treatment. We must be influencers of a different kind.
Dr Weigle is associate medical director at Natchaug Hospital of Hartford Healthcare and assistant professor of psychiatry at UConn School of Medicine. He serves as cochair of the American Academy of Child & Adolescent Psychiatry’s media committee, and on the National Scientific Advisory Board of the Institute of Digital Media and Child Development. He lives in Mystic, Connecticut, with his wife and 2 teenaged social media enthusiasts.
References
1. Henrich J, Muthukrishna M.
2. Rideout V, Peebles A, Mann S, Robb MB. The Common Sense census: media use by tweens and teens, 2021. Common Sense. 2022. Accessed February 16, 2023.
3. Pretorius C, Chambers D, Cowan B, Coyle D.
4. How accurate is mental health advice on TikTok? PlushCare. November 18, 2022. Accessed February 16, 2023.
5. Harness J, Getzen H.
6. Lembke A. Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop. Johns Hopkins University Press; 2016:98.
7. Bridge JA, Greenhouse JB, Ruch D, et al.
8. Samuels MA.
9. Chung A, Vieira D, Donley T, et al.
10. Lewis SP, Seko Y.
11. Swedo EA, Beauregard JL, de Fijter S, et al.
12. Littman L.
Articles in this issue
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Substance Use Among Adolescents and Young Adultsover 2 years ago
The Urgent Need to Address Youth Mental Healthover 2 years ago
White House Announces Record Health Insurance Enrollmentover 2 years ago
Hospital Foodover 2 years ago
Lithium: Past, Present, and Futureover 2 years ago
Investigating the Impact of ADHD on Smoking Cessation Outcomesover 2 years ago
Aerobic Exercise: Benefits Following Brain Injuryover 2 years ago
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