‘SIGNS YOU HAVE ADHD’, the white text boldly proclaims over a red-tinted video in which two teenage girls dance erratically. More white text set against red speech bubbles appears on screen, delivering the wisdom that will tell you whether or not you too have attention deficit hyperactivity disorder:
‘Eat too much or eat too little.’
‘Not being able to listen when being spoken to.’
‘Having lots of new obsessions.’
‘Talk a lot and can’t sit still.’
‘Having RSD [rejection sensitive dysphoria].’
‘Trouble falling asleep at night.’
‘Getting hyperactive when understimulated.’
‘Getting good ideas but not going ahead with them.’
Welcome to TikTok’s mental health community – a place where everyone can create video content giving others advice on mental health issues, from anxiety to PTSD and everything in between. The account giving this advice belongs to neither a mental health professional nor someone well versed in healthcare, but an anonymous user with the account name random.tips.4u, who also gives advice on topics such as how to be popular in school (the answer, in case you were wondering, is ‘be nice to everyone’, ‘wear crop tops and jeans’, ‘wear your hair down’ and ‘wear lip gloss and mascara’).
TikTok’s rise to popularity has been meteoric since it launched internationally in 2017. TikTok is a free platform created and owned by the Beijing-based company ByteDance that provides templates to allow users to quickly and easily create and upload short-form videos, from 10 seconds to three minutes in duration, via their smartphones. The TikTok app had been downloaded 3.5 billion times worldwide as of January 2023. Official statistics show 43% of TikTok’s global audience as aged from 18 to 24 years old, with 32% of users aged 25 to 34,1 but what’s less clear is how many children and young teens are among the regular users who spend on average 52 minutes a day on the app. It comes with a recommended lower age limit of 13, but according to Ofcom’s 2022 Children parents: media use and attitudes report, half of children from three to 17 used TikTok in 2021, making it the third most used social media platform of all (first being YouTube, the original short-form video platform, and the second, messaging app WhatsApp).2 It also found that four in 10 five- to 16-year-olds used TikTok on a daily basis. Girls were more likely than boys to use TikTok regularly; one in three boys (34%) were daily users compared to half of girls (48%).
What started out as a platform for entertainment has quickly grown into somewhere users go for information and advice, with hashtags such as #mentalhealth, #anxiety and #adhd racking up billions of views. With one in six children and young people in the UK now reporting mental health issues,3 and NHS mental health services overwhelmed with increased demand, it’s perhaps not surprising that mental health-themed content on the platform has taken off – why wouldn’t young people seek information and support through an app they enjoy using? And while the established video platform YouTube is also popular with young people, what has raised concerns about TikTok is its heavy emphasis on personalisation – as a user interacts with videos by watching, skipping, liking, commenting or sharing, TikTok’s algorithm learns what the user is interested in, and uses that information to recommend content to the user’s personalised ‘For You’ page. That means a young person who has shown interest in mental health-related content is likely to see more of the same every time they use the app. The question it raises for us as a profession is how much of this information is accurate and useful – and what is our role in dealing with the impact of being bombarded with it on younger clients?
Misleading
A 2022 study published in the Canadian Journal of Psychiatry analysing the top 100 most popular videos about ADHD on the platform found that 52% of them were classified as medically misleading, 27% were based entirely on personal experience, and only 21% were considered useful when compared against diagnostic criteria.4
A similar study published by medical health group PlushCare painted an equally disheartening picture.5 Five hundred TikTok videos that included the #mentalhealthtips and #mentalhealthadvice hashtags were analysed by medically trained professionals to assess the recommendations and advice for accuracy, and potential risk. The researchers concluded that 83.7% of mental health advice on TikTok is misleading, while 14.2% of videos include content that could be potentially damaging. Only nine per cent of those offering advice on the platform had a relevant qualification in the respective field, but 99% of videos didn’t have a disclaimer disclosing that the creator was unqualified to give mental health advice.
‘As with all social media, people who post and share information on the platform may have good intentions, but the content could be inaccurate, misleading or potentially dangerous in some cases,’ says Marie Chellingsworth, Senior Lecturer in Psychology at Arden University and a cognitive behavioural therapist. ‘For instance, a large amount of the mental health advice on TikTok includes generic tools such as practising “self-care” or going for walks for improving mental health. Although these activities are something that can aid in improving wellbeing overall, those suffering from a mental health condition may require tailored, individual treatments in line with clinical guidelines.’
Self-diagnosis
One of the more alarming potential consequences of this spread of misinformation is the rise in self- diagnosis. In my work for Kooth plc, an online digital therapy platform that provides anonymous support to 11- to 25-year-olds, I encounter adolescents on a near daily basis who are convinced that they have conditions such as ADHD, or are hearing voices in their head, after seeing someone their own age posting about it on TikTok. This has seemingly led to a wave of young people diagnosing themselves with everything from a minor neurosis to a full-blown psychosis, sometimes at the expense of seeking a formal diagnosis.
One of the more worrying TikTok trends is for young people to post videos introducing their multiple identities, referred to as ‘alters’, which have their own names, pronouns, styles, accents and mannerisms – some may even be animals, mythical creatures or hybrids. The trend has led to concerns about a potential rise in young people self-diagnosing with dissociative identity disorder (DID). ‘A number of mental health clinics across the country, including ours, have recently seen an influx of adolescents who are presenting with self-diagnosed dissociative identity disorder (DID) and claiming that within themselves there are a number of different personalities that emerge at different times,’ said US child psychiatrist Dr David Rettew in Psychology Today in March 2022. ‘Much of this seems to be driven by a small number of influential people on TikTok who have posted very popular videos in which they describe their DID in great detail.’6
During the pandemic, the popularity of videos demonstrating symptoms of tics and Tourette’s syndrome was linked with the increase of young people, especially young girls, seeking help for tics. One researcher called it ‘an example of social contagion or mass sociogenic illness’.7