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The rise of social media activism and wide circulation of news on police killings of unarmed Black men might have increased the prevalence of collective and race-based trauma in adolescents, especially with the unprecedented isolation of the COVID-19 pandemic, according to mental health professionals.

A fictionalized case involving "Carter," a Black 15-year-old from Brooklyn, served as a discussion point on the topic at a session of the American Psychiatric Association (APA) virtual meeting.

In the example, the teen was referred for treatment at the end of June 2020 by his father for what he thought was social media addiction and depression, noted Asha Martin, MD, of NYU's Grossman School of Medicine in New York City, who presented the composite case with Stephanie Alexis Garayalde, MD, a psychiatrist in Jacksonville, Florida.

Carter entered treatment just 4 weeks after the murder of George Floyd. While the killings of Ahmaud Arbery and Breonna Taylor had occurred before then, Carter told clinicians that he had only recently learned of their deaths through social media.

Carter grew up in a turbulent neighborhood where he and his family frequently witnessed different forms of violence. When the family moved to a more affluent neighborhood, Carter began attending a new school. There, he received short-term in-school counseling due to incidences of bullying, in which Carter was made fun of and called names because of his darker complexion.

"At the individual level, we consider Carter's own developmental level. He's consolidating his identity and his place in the world," said session panelist Tresha Gibbs, MD, in discussing possible risk factors for collective or race-based trauma. "He's a young Black man who could identify very much with the victims, and so I think that would reinforce some of his own concerns about his bodily integrity and safety."

on collective trauma after the Boston Marathon bombings found that individuals who reported consuming hours of media in the days following the attacks had higher acute stress levels than the individuals who were directly exposed to this violence by being at the marathon's finish line at the time of the bombings. Race-based trauma has shown more days of poorer mental health among Black Americans in states where a police killing of a Black resident recently occurred. For teenagers in particular, has also linked repeated exposure to traumatic discriminatory events on the internet with increased post-traumatic stress disorder symptoms among Black and Latinx adolescents.

In the case scenario, Carter told clinicians that he had been using social media -- Instagram, Twitter, Facebook, and TikTok -- for approximately 7 hours a day, consuming and sharing content related to Black Lives Matter protests and posting about racism and ways to support Black communities.

The teen said that he's able to disconnect from the initial feelings of sadness he experienced after watching videos of police killings and denied any symptoms of hopelessness or depression. His father, though, told clinicians that Carter is glued to his phone and has started blocking some of his friends.

Although Carter has had more trouble sleeping and increased levels of anxiety regarding his own safety as a Black male teenager, the panel of psychiatrists at the conference session interpreted Carter's mental health state as relatively normal. Social media addiction, as it stands, is not recognized by the DSM-5 as a disorder.

When looking at the general criteria for other addictive disorders, session panelist Caitlin Costello, MD, of UCSF Benioff Children's Hospital in San Francisco, said she views Carter's social media use as being in "yellow flag" territory rather than "red flag" territory.

But after another 3 weeks passed, Carter's father reached out to the clinical team, expressing concerns that his son has taken a deep dive. Carter is afraid, on edge, having nightmares, and yelling in his sleep. His father is worried.

When the team spoke to Carter, he himself said that he can't stop, and that his social media usage has increased to 12 hours a day. He gets stuck in a loop searching for murders and looking to see if there's been justice. Even when the teen tries to disconnect, there's always another video.

Carter felt guilty about wanting to disconnect; his friends had told him that if he disconnects, then he's not woke. He told clinicians that he's been experiencing overwhelming anxiety whenever he goes out in public and has been losing more sleep. He also reported having disturbing intrusive thoughts and nightmares that incorporate the violent media he has consumed, sometimes visualizing himself in the same scenarios. Psychiatrists noted that Carter expressed grave concerns about the chances of him making it to adulthood and worries for his Black peers and loved ones.

"We're becoming increasingly worried about how much social media is exposing him to trauma, and he's describing a lot of symptoms suggestive of that effect," Costello said, pointing out that the causal relationship between social media use and Carter's worsening psychiatric symptoms is a complicated one.

Carter is showing symptoms of acute stress disorder -- flashbacks of violence, sleep problems, disassociation, and depersonalization -- partnered with an obsessive-compulsive need to keep up with social media, argued panelist Gabrielle Shapiro, MD, a child and adolescent psychiatrist at Icahn School of Medicine at Mount Sinai in New York City.

Other psychiatrists on the panel recommended that Carter's dad open up the lines of communication within the family, encouraging him to be curious about exactly what content Carter is seeing on social media. This kind of collective processing, having open discussions about racism, could help the family as a unit and even lead to joint participation in activism.

Gibbs said that there is an opportunity here for Carter and his dad to ask each other about their personal experiences of racism and discrimination, rather than run away from that line of dialogue.

"There's obviously also this intergenerational piece that is part of this family dynamic of the level of concern that dad has and the level of response that this child is having," Gibbs said. "So us being able to be comfortable asking those questions... [Taking] inventory of episodes that were triggering racially and the ways in which it may be impacting their mental health is another way of building that alliance with this family."

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