Everybody loves to blame social media for eating disorders … I actually find that the way it affects kids with eating disorders is not what most people think. They have found a correlation between social media use and bulimia and binge eating disorders, but less so with anorexia … Purging can be similar to kids who cut and kids who have emotion regulation problems, and I think social media is very, very, very dangerous for those kids … You find whatever you want to find. At the end of the day, if a person is not in a healthy mindset social media is more likely to make them struggle more.
Dr. Colleen Cook Flannery, Ph.D. is a licensed psychologist in private practice in New York.
Dr. Flannery serves as Assistant Clinical Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai, where she completed externships in psychology as well as her postdoctoral fellowship at the Center of Excellence in Eating and Weight Disorders. She is also a Clinical Instructor at the Department of Child and Adolescent Psychiatry at the NYU Grossman School of Medicine.
Dr. Flannery additionally trained in clinical psychology at the NYU Child Study Center/Bellevue Hospital Center and New York-Presbyterian Hospital. She obtained her undergraduate education at Duke University and earned a Doctorate in Clinical Psychology from Hofstra University.
I recently spoke with Dr. Flannery about teenagers’ use of social media and the impact it can have on kids with ADHD and eating disorder co-morbidities.
This interview has been edited and condensed for clarity and space.
You work with a lot of teenagers, most of whom use social media extensively. In your opinion, is social media a positive or negative influence in their lives?
I think there’s a special level of danger in that you can just keep scrolling and it will never say you’re done. It’s really hard for teenagers to manage time around social media, that’s one big negative. Another one, in terms of teenagers and self-image, is that people post what I think is a very myopic perception of who they are; whats presented can be heavily slanted towards appearance for some kids. For example it can present as “I make a good kissy face” and “I’m wearing a Brandy Melville top” and “my friends are pretty and I’m skinny,” and for guys it’s “look, I’m an athlete.” In this case, it can filter out all the other things about people so that you are just seeing this very objectified version of who they are. Another negative is the permanence of social media. Technically in Snapchat the pictures go away, but even in my own case I look at pictures I posted ten years ago on Instagram and wonder why I posted them. Impulsivity is characteristic of teenagers and I don’t think everyone thinks of the permanence of these things and that as soon as someone takes a screenshot you totally lose control.
I can think of two more downsides. One is that a lot of these platforms have algorithms that learn what holds your attention. So if you stay longer on a certain video or if you’re looking at someone’s posts more than others it becomes a curated feed. You can say that could be good in some instances, but it tends to spiral people into this very consuming, narrow view of information and when you get that deep in the hole there are a lot of things that are out there. There are people who don’t necessarily have the right to say the things they are saying, people who are not necessarily good role models, and a lot of these things are very subtle. There’s actually a great podcast about this from the New York Times called “Rabbit Hole.”
And the last negative is that I think the anonymity involved is problematic. Yes, we can see who commented on our posts, but it is very easy for someone to create a fake identity online and post or comment in a very harmful and anonymous way. In general, cyber bullying is almost too easy.
I think those are the main negatives of social media off the top of my head. All that said, given the amount of teenagers I work with, the last thing I say to them is to stay off their phones, because this is the reality. You even have these new virgual goggles that let you literally be online all day, so I think it’s something we have to accept. I think, depending on the age of the teenager, the most helpful approach that I have found is curiosity instead of quick judgments, just wanting to understand what they are looking at and helping them to curate a more productive online experience.
One positive is that social media is a form of self-expression. I see all the time that parents think “you’re sexualizing yourself,” but there’s another side to it, which is “I feel really good about myself in this moment and I’m proud to get it out there,” or “I’m proud of my friends or this thing we did.” So I think it can get a bad reputation and people can miss the other side of it which can be good.
Do you think social media is intrinsically different from the way in which people interacted when you were growing up and are there ways in which these differences make it more dangerous?
Yes, across the board. When I was growing up you had to press the button three times to find the letter on your phone to even send a text, so it was not easy to communicate quickly! I think the difference is that now there is a level of disinhibition and that it’s very easy to interact with people without being able to exercise the judgment you have in person. I also think in some ways, to speak to the positive of it, it makes networking a lot easier and it expands the world and awareness of things for kids. I see this in a major way in mental health because a lot of patients who come to me have self-diagnosed based on something they saw in Instagram or TikTok, and often they’re wrong, but I think there’s a lot more access to information and sometimes support.
The most dangerous part is that I see a lot of teenagers are struggling with social interaction even in the presence of their own friends. You’ll see groups of friends standing around, both boys and girls, and they’re hanging around but they’re all on their phones. I think it also affects social interactions with adults, sustaining conversations, sustaining attention -- to me the commodity here is attention -- and what is getting hit the hardest is attention. Sitting at dinner and having a conversation with your family requires eye contact, requires tracking something that may be boring without being able to flip through it. So some of these really important skills for adulthood are being missed given how much of life is online. You can see this most when you ask teenagers to pick up the phone and call someone, its almost as if it’s a skill they cannot fathom.
I find Snapchat in particular to be the most pernicious, because it’s eliminated language in many ways and you are communicating things just through pictures (though of course there is messaging on it, the primary focus is on photos). You’re distilling human interaction to “here’s this picture of the side of my face.” So I think communication and connection is in a major way lost on social media. That said, it does allow you reach out to people you wouldn’t have otherwise been able to and expand your friend groups in ways that weren’t possible before.
Are there certain social media apps, for example, Instagram versus Snapchat, that you think are worse or better for teenagers?
I think it’s hard to say; I think it totally depends on what you’re looking at and how you’re using it. I find Snapchat to be very sneaky in terms of saying pictures disappear, but they don’t really disappear, and I think there’s this whole subtle language behind Snapchat, which is notably devoid of language, but truly there’s another form of language in it — how long you’ve had a streak with someone, for example. And now they’ve added sideswipping, where someone looks at your message and it looks like it hasn’t been read but you can know if they’ve acknowledged it if they’ve seen a little part of it. There are all these ways of teaching kids that it’s important to know who’s paying attention to you, and I think Snapchat in particular is the most nefarious application. Above all else, I think editing apps are very, very bad for teenagers, like the ones that auto-fix you and allow you to change your waist size and make you look for youthful and make it look like your boobs are bigger. These are becoming pretty standard for editing photos before people post them.
What do you think of TikTok?
I think TikTok gets a much worse reputation than it probably deserves. A lot of it is harmless, really boring and mundane and repetitive. I think there’s a way to use TikTok that is much less harmful.
With regards to ADHD and the various types of eating disorders, are there ways in which social media affects kids who have them more or differently?
Yes. We’ve talking about attention as a commodity. Kids with ADHD tend to have brains that are absorbing more of their world at one time than their peers. It’s hard to discern which thing to attend to, and when you look at something that captures your attention so fully that doesn’t have a stopping cue to tell you “ok go do your homework,” it is very, very hard for kids with ADHD to self-regulate around a lot of social media. Another facet is that people with ADHD tend to be more impulsive and therefore are more likely to post or send something that they’ll later regret or haven’t really thought through. I think they are also more likely to misread cues that are sent to them by either friends or strangers. Kid with ADHD can have a hard time reading the nuances of communications.
In term of eating disorders, that’s a whole other area. Everybody loves to blame social media for eating disorders. It’s a hot topic. I actually find that the way it affects kids with eating disorders is not what most people think. They have found a correlation between social media use and bulimia and binge eating disorders, but less so with anorexia. The rate of eating disorders has stayed relatively stable for a long time. The etiology of anorexia in particular is more challenging to discern but is more biological/genetic in nature than other eating disorders. If you have a risk factor for developing anorexia, extensive social media use may be a factor that triggers it, but no more than school stress or some sort of life disruption.
Other eating disorders are different. When you’re looking at people’s bodies all day that has probably led to an explosion in the level of body dissatisfaction (which is NOT the same as body dysmorphia), but that is different than having an eating disorder. There are probably a lot of kids that try out different things, but really it boils down to a lot of kids really not being happy with how they look. Which is a huge issue, but distinct from eating disorders. Some percentage of this can lead to kids acting on this dissatisfaction to change their bodies- for example when someone calls you fat on a social media platform, the next day you decide you’re not going to eat, then that doesn’t go well and you get home from school starving and you binge; then you’re really ashamed of binging so you purge or double down on your restriction for the next day. We see a lot more of that than kids who are developing pure anorexia as we really diagnose it.
Purging is a behavior that can be similar to self-injury in the context of emotion regulation and I think social media is very, very, very dangerous for those kids. That’s more where we see eating disorders in relation to social media, as opposed to a girl who looks at her favorite ballerina and decides to develop anorexia, that’s not really the pathway that’s common.
Important to note however, that almost all patients I treat who do have eating disorders use social media as a way of maintaining ED behaviors or motivating them to “keep going”. In that sense it can interfere with recovery, but that is less of a causal interaction than an issue with hastening recovery. More on that below.
So are you saying that emotional dis-regulation is more tied to eating disorders other than anorexia?
Yes. There’s a big overlap between borderline personality disorder and bulimia. With bulimia there’s a notable overlap with substance abuse, impulsivity, high rates of ADHD, cutting, and risky sexual behaviors. These are the kids to me that are the highest risk for what they are consuming on social media. Also, people with unstable identities are more likely to grab onto something they’ve see online, or a community that feels more accepting than their “real life communities” and that’s where I see social media and eating disorders really interact.
Then there’s the whole conversation about how people with anorexia use social media, but that’s not necessarily causal. There are videos that can help people in recovery; that’s actually been useful for some of my patients, though I usually vet them first. But there are all these pro-ana websites that people on Instagram or other platforms can follow which talk about how many calories people are eating and show pictures of their bodies and “cheerlead” anorexia and behaviors associated. I don’t think that causes anorexia, though if you’re in that rabbit hole I think it can be used as a way to sustain you and interfere with motivation for recovery and cause a lot of shame around eating. I’ve also seen a lot of kids with eating disorders across the board who develop a fascination with food on social media. They watch food videos, videos on how to bake things.
You find whatever you want to find online. At the end of the day, if a person is not in a healthy mindset social media is more likely to make them struggle more. It has the ability to amplify everything, for better or worse.
Are there ways in which you have seen teenagers limit or control their use of social media that makes it less potentially harmful?
With a lot of my patients we will do a sort of cleanse. We will go in and unfollow people that are toxic, we will mute certain content that is related to food, and we will realign the algorithms away from food and diet culture. I even do that for my own young kids every night, and its amazing what filters that are intended to protect actually miss, but in doing that I can try to reset the algorithm to more age appropriate content.
I never like to be in a role of adding more rules to people who are prone to being too strict with themselves and then when they break rules they go into self-hatred, so I don’t believe in time limits. I believe people have to figure it out for themselves. It should be guided by “how did you feel after you just spent an hour and a half looking at that?” So looking at it from a functional perspective can help.
There’s also another simple and effective strategy: there’s a setting on the iPhone where you change the screen to Grayscale, which makes it look like a newspaper from 1910. You won’t be able to look at your phone for even 10 minutes when it’s like that. Some of my patients who usually hit the screen of their phones every 5 minutes while they’re studying to see if anything new has popped up find absolutely nothing enticing about going on their phones when Grayscale is on. That’s something that I’ve used for patients to help them when they’re cramming for exams. Everything is dulled gray in a way that gives you a headache; it is intolerable and works well for people who really need a firm way to not look at their phone.
Where it’s tricky is that I see this new Wellness movement as a new repackaged version of diet culture. There’s even a new term now, orthorexia, which is not in the DSM yet. It’s not about weight, it’s a fear of putting anything in your body that’s not clean or healthy. A lot of this is packaged as promoting health (and some of it is) so people are consuming wellness media voraciously, but I think it’s a little bit dangerous when teenagers who either have eating disorders or are judging themselves about their bodies and they’re watching these people online who are supposedly not anorexic but are obsessed with talking about clean eating. In my opinion, the whole conversation about food and bodies should be close to zero for teenagers, my stance is body neutrality as a goal, and flexibility with food. The true measure of health in my opinion is a kid that stays on their growth curve over a long period of time and doesn’t need to think about food or their body. Social media makes this close to impossible.
I feel like during Covid there were a lot of these social media workout videos going around. My feed would show me a lot of videos about food and about people in recovery and about certain people who had different body shapes after recovering, and it made me think I would also have that body shape that I didn’t want if I recovered. It said to me that recovery only meant ending up with that different body shape that I didn’t want. That wasn’t helpful to me personally.
I also think that there’s almost no content that is helpful because the way to treat an eating disorder is to turn down the volume on the importance of bodies and eating and shape and weight in someone’s life, so even if you’re consuming media that is about being healthy, in the end we’re still talking about food. Move along with your life; it’s too boring.
Another trend was “what I eat in a day.” That was such a fad, and it’s not real. Bananas all day and some sort of chia thing for dinner. If someone has an eating disorder they are bound to find something to make them “work harder at their ED” online, depending on their mood and their motivation that day. But do I think there is a causal relationship between social media and anorexia? No.
Are there ways in which you have seen teenagers limit or control their use of social media that makes it less potentially pernicious?
I think there can be, but to me the premise is that the headspace someone is in is going to dictate whether those interactions are going to be helpful and positive or dangerous and self-harming. I think there’s very little we can do on a bigger scale to change that, but if you’re someone who understands what you’re looking at and why you’re looking at it and knows who to get around things that don’t make you feel good it can be used for good. I always encourage patients to get information from sources other than social media. Your algorithm becomes so narrow that you have no concept about the broader conversation on either side. I feel really strongly that social media shouldn’t be used to get information about health, about news events; misinformation can actually be really dangerous.
Do you think the age restrictions on certain apps are helpful?
Rarely, for example- age restrictions entail entering your birthday and even my 7 year old knows to change the year to bypass that, too easy. I always put apps on Restrictive Mode, but even with the Restrictive Mode apps are so good at getting around it. For example, they are able to curse; they just change one letter in the word. Or say the word and beep out the second half of it. So Restrictive Mode has nothing to do with what people are saying. It’s filtering out nudity and bad language that’s not beeped out, but it’s not filtering out hatred, racism or conspiracy theories. They do a horrendous job, particularly on YouTube of helping parents filter for their kids. And the more kids realize there’s more out there that’s restricted the more interest they have in understanding what it is. I don’t think that’s changing or going anywhere.
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