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Social Media and the Rise of Performative Mental Illness
The glamorization of mental illness as a social identity harms those who truly suffer.
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Social media has become a primary target of criticism for those attempting to explain why teens and adolescents in the West, especially females, are exhibiting all-time highs in a variety of mental mood disorders such as anxiety and depression, as well as their behavioral correlates of self-harm and suicide. Early social media exposure has made younger generations more comfortable and willing to share intimate details of their lives online, and social media’s emphasis on virality has facilitated a more rapid spread of ideas and information than previously. As real-world social networks have increasingly moved into the digital realm, the social dynamics of reward and punishment have also changed.
Social media’s influence on mental health awareness and presentation is complex: while some social media algorithms act to facilitate the spread of good ideas and accurate information, others can fuel the spread of harmful misinformation and seed dangerous social contagions. That rates of teen and adolescent depression, anxiety, and suicidal ideation have risen precipitously since the advent of social media and smartphones is likely no coincidence.
In recent years another concerning trend has emerged on social media in which adolescents present with various psychiatric impairments that are inconsistent with classical psychiatric disorder classification (i.e., using the Diagnostic and Statistical Manual for Mental Disorders [DSM]). While these individuals claim to have illness symptoms or suffer from a mental disorder, many fail to seek help. Instead, they appear to incorporate their perceived illness into their self-identity and glamorize it within their communities. This glamorization of illness is detrimental to those with clinically diagnosed disorders, as it may cause them to avoid seeking help. Further, symptoms may become exaggerated as individuals become socially incentivized to signal their disorder identity to others. The emergence of the COVID-19 pandemic and consequent increase in social media engagement has created a fertile environment for this phenomenon to become more problematic and underscores the urgent need to better understand the significance of social media use on adolescent mental health.
Last month, we and another colleague provided a detailed historical overview of this phenomenon in the journal Comprehensive Psychiatry, and further outlined a conceptual model to help organize thinking and research examining it. We believe there is an urgent need for focused empirical research investigation into this concerning phenomenon that is related to the broader research and discourse examining social media influences on mental health.
TikTok, a popular social media app, has received increasing criticism for being a potential “spread vector” for various mental health symptoms and disorders. The app has been known for short dancing, singing, and comedy videos but has recently seen a surge in content pertaining to mental health. Videos regarding mental illness, disabilities, and gender identity have gained widespread traction on the app, with hashtags like #DID (i.e., dissociative identity disorder) and #BPD (i.e., borderline personality disorder), for example, acquiring millions of views. Among many videos using these hashtags are short clips of individuals displaying and showcasing symptoms, such as the tic-like movements seen in Tourette’s syndrome, as well as clips discussing symptomatology of various common clinical (e.g., depression) and personality (e.g., borderline personality disorder) mental disorders.
Unfortunately, many content creators posting these videos are not medical professionals, but are instead self-identified patients or mental health advocates who often speak on mental disorders with little to no expertise on the matter. Many of these creators make overly generalized statements regarding symptoms and attempt to relate them to clinical diagnoses, which can easily mislead viewers into believing they have a disorder they may not.
TikTok videos on mental disorders often include content creators showcasing tic-like movements similar to those with Tourette’s syndrome (TS). Tourette’s-related content has seemingly resulted in a consequent increase in self-diagnoses as well as functional tic-like behaviors (FTLBs), which differ from tics in TS both neurotypically and phenotypically. FTLBs are displayed as an explosive presentation of symptoms over hours or days, consisting of complex motor and verbal tic-like behaviors, while symptoms develop over years with TS. Complex vocalizations are a notable feature of FTLBs, while motor tics usually precede vocal tics in TS. Individuals presenting with FTLBs at clinics are often adolescent females, which coincidingly makes up the core user base of TikTok, and many presenting to psychiatric clinics stated that they have seen videos on TS on social media platforms.
Along with TS, self-diagnosed dissociative identity disorder (DID) has become increasingly common, potentially due to popular videos of content creators “switching alters” or identities in real-time on camera. Since a DID diagnosis is usually synonymous with a history of abuse and trauma, some are concerned that many teens are simply acting out the latest “trends” on TikTok and may not be facing any real mental health challenges.
A common feature of DID and self-diagnosed mental illness content on social media is that it often tends to be romanticized and glamorized, transforming mental disorders into social identifiers that individuals quickly adopt without understanding their severity. Those engaging with this content may be unaware of what is accurate and what is created for views and popularity, making it easy to internalize content into their self-identity. They may incorporate mental illness symptom presentations they are exposed to in online communities to socially assimilate and build social capital within these communities.
The origins of this mental-illness-as-identity phenomenon can be traced to other social media platforms that were popular before the emergence of TikTok, such as Tumblr and Instagram. Tumblr was extremely popular during the first decade of the 2000s and contained a large amount of content regarding anxiety, depression, eating disorders, and gender identity-related conditions. Many people used Tumblr to express their feelings and find people they could relate to, but that evolved into an online environment in which mental disorders such as anxiety and depression were portrayed as “cool” and “trendy.” These disorders in time underwent a process of “pseudo-normalization” and were also promoted in communities on Tumblr through specific hashtags, with no emphasis on the importance of recovery.
As these disorders became an identity signifier for many adolescents who tied them to a particular community, seeking help and treatment appeared to be less prioritized. Instagram online communities organized by hashtags also often portray an oversimplified version of mental illness. Posts regarding mental health are often not intended to be taken seriously, but yet may be perceived as accurate educational information, and thus potentially leading to the spread of dangerous misinformation.
There is a complex space that exists in the professional and media venues between de-stigmatizing mental illness and normalizing or even glamorizing it, as well as between what is authentic and what is performative. While posting about personal struggles with mental illness online may be emotionally genuine to some, it is more accurately understood as behavioral display to fit in and appear unique to others online. The phenomenon of defining one’s uniqueness through claims of mental illness has been characterized by many as TikTok’s “sick-role subculture,” as many youths attempt to identify with popular creators on TikTok by taking on a sick role or personal identity.
Much remains to be understood about the social dynamics of such “sick-role subcultures.” This need for increased understanding into these subcultures exists alongside a broader urgent need to understand social media influence on youth mental health. Ultimately, clinicians and mental health professionals need to be aware of how TikTok and other audiovisual immersive online subcultures may influence symptom and disorder presentation in youth and adolescents. Asking adolescents questions about their social media usage, such as how much time they spend on it, what type of content they consume, and how social media makes them feel should be prioritized in assessments of their symptoms. In addition, parents should be strongly encouraged to communicate with teens on these issues and be aware of the content their children are consuming on social media.