Cassandra presents to the office anxious because of social media posts her peers have made regarding current events that she feels are inflammatory.

Jenna expresses suicidal thoughts in response to comments made by peers from several schools in the area about the nature of her friendship with a boy.

Social media was developed to increase connections between people, even despite geographic distances. It has helped create communities of people with similar interests or beliefs, as well as to help reconnect us with people. It can provide educational opportunities and enhance technical skills. These are all potential benefits, but risks exist as well.

Whereas television formerly was the primary concern with regard to media exposure, social media poses additional risks. Media exposure as a whole can become quite encompassing, with one study indicating that the average 8- to 10-year-old spends almost 8 hours per day on media, while preteens and teenagers spend more than 11 hours per day.1 This can have a negative impact on sleep, as well as engagement in other activities. A Pew Center study from 2015 indicated that 92% of teens state that they go online daily, 24% report being online “almost constantly,” 56% use social media several times per day, and 12% use it daily.2 This column will explore some of the risks of social media exposure.

Cyberbullying and harassment

Cyberbullying is defined as “willful and repeated harm inflicted through the use of computers, cell phones, or other electronic devices,” and can include sending denigrating messages or images.3 Studies have shown varying rates of victimization from cyberbullying, ranging from 6% to 72%, and perpetration ranging from 3% to 44%.4 Bullying in general has been associated with increased school drop-out rates, suicidal ideation, bringing weapons to school, and aggression. The sizable audience that social media can reach can amplify bullying’s impact.

Privacy concerns

Determining the appropriate amount of information to share and knowing that it is truly being shared with the person identified on the other end also can be a challenge. In addition, the digital footprint left by navigating different social media sites may have unforeseen effects on youth regarding inappropriate posts. They also may be particularly vulnerable to other predatory individuals. Other privacy concerns involve what information parents, guardians, or other family members may share online.


While social media has the possible benefit of creating a broader social network, particularly for someone who may be anxious in more traditional settings, it also can reinforce isolation from “real-world” experiences and the sense that no one else “gets” him or her. Without knowing who is on the other end of the keyboard, tablet, or smartphone, it can be difficult to ascertain if others in the community are reinforcing maladaptive behaviors and further withdrawal.

Self esteem

Images promulgated online often are highly idealized and edited, and are meant to exhibit a specific point of view. Exposure to these images can have a negative impact on self-esteem.

Another study of preteen girls (10- to 12-year-olds) indicated that increased time spent on social media sites such as MySpace and Facebook led to greater internalization of a thin ideal, increased body image concerns, and decreased self-esteem.5 Further data suggest that youth who are in need of more mental health support may engage in increased amounts of social media use. In a Canadian study, daily use of more than 2 hours per day was associated with increased reports of emotional distress as well as suicidal ideation.6

So, given all of this information, how to address this in an appointment?

First, it is important to screen about social media use, both the time spent and types of sites visited. Encourage parents to actively monitor usage and set limits on time used (such as maximum time allowed during the day, or shutting off/removing electronics from rooms after a certain time). It is important to encourage youth and their families to maintain an open dialogue about what one may encounter online, as well as openly discussing values and clear expectations about what types of sites are and are not considered acceptable. Families should model healthy social media usage, being mindful of what they share about the youth online and what they may choose to post as well. Limiting total screen time to less than 1-2 hours per day and encouraging families to not allow electronics in children’s rooms also is recommended.

Dr. Strange is an assistant professor in the department of psychiatry at the University of Vermont Medical Center and University of Vermont Robert Larner College of Medicine, both in Burlington. She works with children and adolescents. She has no relevant financial disclosures.


1. The Kaiser Family Foundation: Generation M2: Media in the Lives of 8- to 18-Year-Olds

2. The Pew Research Center: Internet & Technology, “Teens, Social Media and Technology Overview 2015.”

3. The Cyberbullying Research Center. Cyberbullying Fact Sheet 2009 .

4. Cyberbullying: An Update and Synthesis of the Research, in “Cyberbullying Prevention and Response: Expert Perspectives,” (New York: Routledge, 2012, pp. 13-35).

5. J. Early Adolesc. 2014. Vol 34(5) 606-20.

6. Cyberpsychol Behav Soc Netw. 2015 Jul;18(7):380-5.


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