Addressing Problematic Social Media Use Requires Active Approach, Nuance

Social media has become a permanent part of today’s culture, and increasingly research is warning about the risks associated with its excessive use, particularly among adolescents. Yet social media has also been associated with benefits for some youth, which is why it is essential to discuss and evaluate social media use among adolescents with nuance, said Avani K. Patel, M.D., M.H.A., a PGY-4 resident in at the University of Mississippi Medical Center and chair of the APA/APAF Leadership Fellowship.

Patel spoke at an Annual Meeting session on problematic social media use and its implications for mental health. She was joined by Marc Potenza, M.D., Ph.D., Robert Lovern, M.D., and Simone Bernstein, M.D.

The way people use the internet has changed significantly over the past two decades, and even within the past five to 10 years, Potenza said. He pointed to gambling, social media use, online shopping and buying, and pornography viewing as important behaviors for psychiatrists to understand. Potenza is the director of the Division on Addictions Research and the Steven M. Southwick Professor of Psychiatry, Neuroscience, and Child Study at the Yale School of Medicine.

The presenters explained that problematic social media use is defined as excessively using digital media or internet/electronic communication to the point of becoming dysfunctional. Frequency of use, however, is not the defining factor of problematic use; rather, it is defined by the problems experienced through use of social media.

Potenza explained that determining when a patient’s problematic social media use should be considered a diagnosable addiction is complicated by the fact that there are no defined criteria for such a diagnosis. When internet gaming disorder and gaming disorder were added to DSM-5 and ICD-11, respectively, experts also discussed other forms of internet use, such as social media use, pornography, and online shopping, that also warrant consideration as the basis of disorders, he said. Some of these, like problematic pornography viewing, can be considered an aspect of the ICD-11’s compulsive sexual behavior disorder, he pointed out. But for others, such as problematic social media use or online shopping, there isn’t necessarily a formal, specified disorder that captures the behavior.

“When internet gaming disorder became a formal diagnosis, we wanted to make it clear that there can be people who engage in frequent gaming who do not experience significant impairment or problems,” Potenza said. The same considerations should be made in the context of social media use, he continued. All addictive behaviors must meet certain criteria, such as interfering with major areas of life functioning, displacing other activities, and often including a component of repetitive urging or craving to engage in the behavior.

In terms of addressing potential problematic social media use with patients, Potenza urged psychiatrists to ask about it in an open, nonjudgmental fashion. “Get an idea of how much time people are spending engaging in the behavior,” he said. “Oftentimes, with addictions in general, people may feel ambivalent about giving up a behavior or cutting back on the amount of time they engage with it. They may also feel shame or guilt about their degree of engagement.”

He also noted that patients’ motivations for engaging in the behavior are important to keep in mind. “For example, for children, especially boys, gaming is often a social phenomenon,” he said. “There may be cases in which boys who are not gaming may feel socially ostracized, which has its own mental health ramifications. Even for people who are engaging in behaviors at a problematic level, there is usually something positive that they are getting from the behavior.”

Patel outlined both the positive and negative aspects of social media use among adolescents. While there are known risks, such as worsening mood, self-esteem, and social development, there is also evidence supporting its benefits, such as creative expression, support groups that foster inclusivity, and peer connection that may promote help-seeking behaviors. “Psychiatrists must play an active role in educating adolescents on how to manage their social media use responsibly and safely, with their mental health in mind,” she said.

Potenza said he hopes psychiatrists begin to appreciate the extent to which the use of digital technologies may relate to mental health. There are many areas of innovation related to digital technologies that could help with the delivery of mental health interventions and patient support, he pointed out. ■