Eating disorders were already on the rise among teens. TikTok is ‘like a trap,’ health experts say.

While scrolling through TikTok during the early months of the pandemic, Haley Collins often encountered videos showing people’s exercise routines or the foods they ate throughout the day. Collins, a 19-year-old sophomore at Catholic University in Washington, has struggled with body-image issues and anxiety, both of which were worsened by COVID-19 restrictions.

“[TikTok] was super-triggering for me,” she said. “I would see that and be, like, ‘Oh, I guess I should do something like that.’”

One of the effects of the pandemic is that adolescents and young adults are spending more time on social media to stay connected with their friends. A survey of 2,000 parents conducted by researchers at Ann and Robert H. Lurie Children’s Hospital of Chicago last September found that 63% of respondents believed their teens were spending more time on social media during quarantine.

“If you’re a young girl comparing your body to someone in the media, like an actress or model, you might try to modify your body to meet that societal ideal,” said Alix Timko, a psychologist in the department of child and adolescent psychiatry at Children’s Hospital of Philadelphia who focuses on eating disorders. “Put in the context of the pandemic, teens are on social media more. ... That means they’re potentially exposed to more content that could potentially trigger the development or maintenance of an eating disorder.”

Collins downloaded TikTok, which differs from Instagram because much of the content is created by regular people instead of influencers, during her freshman year in college, but it wasn’t until she went home to Massachusetts when the lockdown began last March that she began spending a significant amount of time on the app.

“It was during the first stay-at-home order that I even identified I was having issues with my body and negative self-talk,” Collins said. “That was kind of the time I had to sit down and be, like, ‘OK, there’s something wrong here.’”

More adolescents and adults have been developing eating disorders for the first time during the pandemic, Timko said. Those who were already struggling with eating disorders are often struggling more — a survey published in the International Journal of Eating Disorders found that 62% of those with anorexia experienced more severe symptoms when the pandemic hit.

“Many teens are reporting that their eating disorder began after shutdown,” Timko said. Some had a desire to eat a healthier diet. Others exercised more because they were inside all the time, or because they are athletes trying to stay in shape for their sport.

“When dietary and activity habits change, it’s usually a positive thing, but for people who are at risk for developing an eating disorder, it can be the start of that,” she said. “Their weight loss can continue and become problematic, which causes a lot of medical complications.”

Numerous studies have documented the negative effects of social media on people with eating disorders, but there are some especially concerning aspects specific to TikTok, Timko said.

Although TikTok does not allow pro-anorexia content, which promotes such harmful behaviors as hiding weight loss from parents and doctors, there is a lot of pro-recovery content, which focuses on fighting disordered eating habits and developing healthier lifestyles. But there can be negative side effects to the positive messages, Timko said.

“Those videos can potentially promote a false understanding of what recovery is, for example,” she said. “Someone can talk about recovery and how great they’re doing, when in fact they’re not 100% recovered because they only eat clean, organically, or have a lot of rigidity around their dietary intake.”

Over the last year, Colleen Reichmann, the founder of Therapy for Eating Disorders and Body Image in Philadelphia, has heard from clients in high school about how triggering TikTok can be. Because of the way TikTok’s algorithm works, users often see content from creators whom they do not actively follow, making it hard to avoid triggering content.

“It really stinks because if you click on these videos where people talk about anything having to do with an eating disorder, you start to see more and more videos along those lines,” Reichmann said. “It’s like a trap. All of a sudden you’re sucked into this triggering material, which for the most part is uncensored.”

Melissa Harrison’s clients also have struggled with TikTok’s algorithm. Harrison, a licensed professional counselor and cofounder of the Center for Hope & Health, a treatment center for eating disorders in Ardmore, said that she worked with teens as young as 12 last year who learned ways to restrict their eating on TikTok.

“They were so young that they didn’t understand purging was a bad thing,” Harrison said. “Teens are seeing some quite intense material on TikTok. Because of how scary accurate their algorithm is, if you spend an extra couple of seconds watching a video chosen for you, there’s now a self-fulfilling prophecy that you’re going to get more of it.”

There are also TikTok users who are “actively disordered and recording it,” which can be triggering for viewers even if the videos are not directly promoting disordered eating habits, Reichmann said. This culture is similar to the one that existed on Tumblr, a blog site millennials used during the 2010s to share tips on how to maintain and hide eating disorders, she said. Recently, eating disorder specialists have raised concerns about how TikTok moderates content surrounding this issue.

“I really feel for the people who are sucked into it and are watching it, as well as the people making the videos,” Reichmann said. “It’s complicated but pretty toxic at the end of the day.”

That’s why it’s so important to teach teens social media literacy, Timko said. Practicing critical thinking while on social media can help combat some of the messages that young people encounter and help them identify when something they’re seeing is not healthy.

Harrison said that when users see things that make them feel uncomfortable, they should move on to the next video quickly or unfollow someone.

“If you’re inundated with videos about dieting and exercise, it’s naturally going to distort your brain on what the average person looks like,” she said. “If you’re already unsure about how your body looks, it’s just going to reinforce those thoughts.”

Both experts encouraged parents to be mindful of what their kids are doing online and on social media, even if they’re older, and to talk openly about misrepresentation of body types on TikTok.

“Be aware of the kind of pages and the kind of people they’re following,” Timko said. “It can be hard to keep up with, but it’s important to understand how TikTok is different from Snapchat and Instagram.”

One way for parents to do this is to watch TikToks with their teenagers so they can have conversations about any unhealthy content that comes up, said Harrison.

For Collins, therapy has helped change her approach to social media because it taught her how to reframe negative thoughts about her body. She started disengaging from accounts that posted content she found triggering by refraining from liking or posting comments on the videos.

“There is a side of TikTok where disordered eating and exercising habits are normalized,” Collins said. “Just being aware of it and purposely engaging with content that makes you feel good can be helpful.

“Like for younger girls, I know they might not be as educated or aware that a TikTok saying only eat grapes for the day is unhealthy,” she continued, “but I would just encourage younger girls to listen to themselves and their feelings and really consider unfollowing or not liking something if you feel badly about yourself after you watch a certain type of TikTok.”