On paper, this is the decade when girls have finally come into their own. Having always outperformed boys academically at school, girls are now a third more likely to gain university places, outnumbering boys in law, medicine and veterinary science. Teenage pregnancy rates are the lowest since records began in 1969. And it was a 16-year-old girl, Greta Thunberg, and the thousands of other young women who missed school to protest, who forced international leaders to wake up to the climate crisis.
Yet a growing raft of research suggests that, while girls may be achieving, they are not thriving. Young women are three times more likely to experience a common mental health problem than their male peers, according to the most recent national Adult Psychiatric Morbidity Survey. One in four young women has self-harmed, and one in five has suicidal thoughts. Top-line concerns among girls calling Childline are low self-esteem, self-harm and mental health conditions.1 Eighty-two per cent of girls and young women aged 11–21 think that adults around them do not understand the pressures they are under.2
The factors that are undermining girls’ wellbeing are multi-layered and complex. There is no doubt that our increasingly results-driven education system and competitive workplaces are taking their toll. But research consistently shows that two significant cultural changes are having a greater impact on girls’ mental wellbeing than on that of boys: the pervasiveness of social media and the growing incidence of sexual harassment. As a profession with a key role to play in both prevention and treatment of mental health problems, what do we need to know to help girls become aware of and overcome these challenges, so they can truly thrive, not just in their smartphone and Instagram personas, but in real life?
The beautiful self
A recent meta-analysis of 41 global studies by King’s College London found that 23% of teenagers now show symptoms of PSU (problematic smartphone usage), with girls aged 17–19 most likely to be affected.3 The researchers found a consistent association between smartphone usage and depressed mood, anxiety, stress, poor sleep quality and educational attainment.
The ubiquity of the smartphone and 24/7 access to social media present young women with unique pressures, including the expectation to be ‘aesthetic entrepreneurs’, says Rosalind Gill, co-editor of the book Aesthetic Labour: rethinking beauty politics in neoliberalism. ‘It is a time of 360-degree surveillance, of uploading photographs all the time. We have been talking to young women about their photographic practices and some are taking as many as 50 selfies a day and pre-filtering them to enhance their presentation.’
Girls are aware of being looked at all the time, says psychologist Dr Terri Apter, Fellow Emerita of Newnham College, Cambridge. ‘We know that they post more photos of themselves than boys and they are more concerned about who likes those pictures.’ The effect of this self-consciousness on girls’ body image has been well-documented, but there is also an emerging pressure to curate and create a holistic ‘beautiful self’ – a social-media persona that is kind, relatable and adventurous, as well as physically attractive. Girls aged 17–21 are the most vulnerable to this pressure to ‘always seem happy’ online, and ‘do more interesting things’, according to the Girls’ Attitudes Survey 2019 published by Girlguiding.4
As one 17-year-old said: ‘So much thought goes into an Instagram post; not just what photo to use, but also what to say under the photo and when to post it. Then there is the wait to see how many ‘likes’ you get. If a post does not seem to be getting likes, you have to take it down before it becomes embarrassing. It can affect how you think about yourself for the rest of the day.’ Forty-five per cent of girls and young women aged 11–21 say they need to check their phone first thing in the morning and last thing at night.4
Identified by the Royal Society for Public Health as the platform most likely to undermine young people’s health and wellbeing,5 Instagram has recently been trialling hiding visible likes from users’ posts. ‘It’s a step in the right direction, but at the same time it’s also just scratching the surface as a way of protecting mental health and wellbeing,’ says Jo Holmes, BACP Lead for Children, Young People and Families. ‘Counsellors have a huge role to play when working with children and young people with low levels of self-esteem who may view the world though a lens of constant pressures from social media.’
As well as being more concerned about likes, girls differ from boys in the content of their social media, according to a large-scale, data-based quantitative study into social-media use in young people aged 14–17 by social change organisation The Female Lead.6 ‘We wanted to explore the relationship between teen aspiration, mental health and influence of social media,’ says founder and data entrepreneur Edwina Dunn. ‘This research asks whether teenage girls can be encouraged to use social media to expand, guide or reinforce their interests and aspirations by following more high-achieving women on social media.’
Their initial research, using Starcount’s global social media database,7 found that girls predominantly follow beauty, fashion, celebrities and boy bands on social media, whereas boys’ interests are wider, encompassing gaming, sports, business, politics and comedy. ‘What is striking is how consumed girls are with content that they know is bad for them, which they call “cringe binge”,’ says Dunn. ‘The scope is further limited by edge-ranking, where a platform’s algorithm offers you more of what you’re already following to maximise engagement. But we aren’t fully mature at ages 12,13 or 14, so we don’t always know what we like. The girls we interviewed talked about a constant sense of not living up to ideals, of not meeting the images of perfection. There was a lot of pressure on how they should look, but also how happy they should be with their life. In the old days, we would advise our children to surround themselves with people who make them feel good about themselves. Now girls are surrounded by people who whisper things to them that make them feel less satisfied with themselves and their lives.’
The negative effects can be significant, despite young people being social-media savvy, says Apter, who worked with The Female Lead to launch Disrupt Your Feed, a project based on a qualitative study involving interviews with girls from five schools. ‘Girls talked about knowing the photos they looked at were filtered and carefully curated, presenting an artificial view of someone’s life. As one girl said: “I know this is fake, but I still look at how her external image presents and compare it with how I feel inside”. It results in girls believing they have to be a certain way for people to like them,’ she says.
Although a recent report from the House of Commons Science and Technology committee8 found evidence of only a weak link between social media and screen use and young people’s health, girls themselves are reporting a significant impact, says Apter. ‘We are creatures of our social environments; thousands of psychological studies support that. How you feel about yourself is influenced by what surrounds you. Social media surrounds girls and it gets up close to them. It could be that teens who use the most social media are those who are most vulnerable to anxiety or depression. In our research, there were girls who said they were more likely to go on social media when they felt low. They talked about experiencing an initial improvement in mood, but the longer they stayed on, the worse they would end up feeling.’
Cutting back on social media is a big ask for young girls, says Apter, but they can be encouraged to use it more positively. ‘We wondered what would happen if we asked girls to follow some high-achieving women whose interests matched their own. We suggested they follow between one and four new women, based on their interests, by directing them to profiles of young British women achieving in technology, science, sport, politics, environmental, media and creative industries. When we followed up with the girls after eight or nine months, their view of social media was transformed. There was surprise that there was a social-media feed beyond looks, lifestyle and riches. Having found posts that informed and inspired them, many then decided to do a clean-up and unfollow feeds and influencers that didn’t make them feel good.’
Almost without exception, it improved the way the girls thought about their future and themselves, says Dunn. ‘The conversation changed from “I can’t” to “I could” and “I might”. The inspirational female role models taught in schools are Marie Curie and Ada Lovelace. Where are the vibrant women from today? As soon as girls are shown successful women they can relate to, they feel positive, energised and excited. Seeing is believing and girls are desperate to believe.’
Whether the effects will last has yet to be seen, says Apter. ‘I want to know, could the shift created by the social-media use continue to have an impact in 10 years’ time? Or does this initial effect disappear?’
But the negative impact of new technology on girls goes beyond ‘compare and despair’. The widespread availability of smartphones has created new opportunities for sexual harassment, including cyber-flashing – the unsolicited sending of pictures of male genitalia (or ‘dick pics’) direct to a smartphone’s homescreen via apps such as AirDrop or Beam. According to a 2019 NSPCC survey, 52% of girls aged 16–18 say they have been sent a sexual image.9
Virtual indecent exposure can be as undermining as an act committed in person, says psychotherapist Claudia Croppo, who specialises in working with sexual trauma. ‘It can create a sense of being unsafe, or even of being watched. In some girls, they can feel that they are somehow to blame. They often feel out of control. My work involves normalising their reactions, explaining that the panic, anxiety and insomnia they feel are the brain and nervous system reacting to a perceived threat. We then work on managing those reactions.’
As well as receiving unwanted sexual images, girls are increasingly pressured by male peers to send explicit pictures. The NSPCC report found that 21% of girls aged 11–18 say they have been asked to send an explicit image.9 ‘We are only just beginning to realise the potential long-term impact of children being persuaded to share intimate pictures that are then in the internet domain for eternity,’ says Catherine Knibbs, psychotherapist and clinical researcher in human behaviour in the digital world. ‘Self-generated images can end up on child-abuse sites and shared millions of times. We are going to wake up too late about the impact of this, after the damage has been done, just as we have with climate change.’
Sexual harassment has become normalised behaviour for young people, impacting young women disproportionately and leading to girls feeling isolated and blaming themselves, according to a report by Fixers.10 In one survey, nearly 60% of young women aged 13–21 said they experienced sexual harassment at school, college or work in the previous year,2 with only 20% saying they report it. ‘In secondary schools, when I ask a class of 30 students who has been asked to send an intimate picture of themselves, nearly every single girl will put their hand up,’ says Jo Holmes. ‘It seems that asking for such a photo has become something that is expected of boys, part of the process of developing a relationship.’
More than a third of young women say they have experienced unwanted slapping, choking, gagging or spitting during consensual sex, according to a recent survey for BBC5 Live.11 One university student said, of a consensual sexual experience: ‘It started with hair pulling then moved on to strangulation. I had made no indication that this is what I wanted sexually. I asked my female friends and all had had similar experiences. These are just normal guys, but they watch porn and they assume it’s what women want.’ Even younger girls are aware of this; in the 2015 Girlguiding survey of 11- to 16-year-olds, 53% said girls are coerced into sex acts because boys are copying what they see in pornography.2
What’s disturbing is that the majority (80%) of young women in the BBC survey said they were not affected by the sexual violence they experienced – perhaps suggesting how normalised it has become. But such experiences can have a lasting effect on mental wellbeing, according to a new study from University College London and Young Women’s Trust.12 The research found that girls who had experienced feeling unsafe, or felt threatened, were five times more likely to suffer from greater psychological distress five years later.
‘We talk a lot about girls lacking in confidence as if this is the cause of their problems,’ says Esther Sample, Research and Evaluation Manager for Young Women’s Trust. ‘Our research with UCL found that young women face constant sexism in public spaces, school or work, with 82% saying they have been subjected to street harassment. Young women experience multiple acts of sexism and discrimination over their lives. Lack of confidence is not the issue that women are grappling with. They are trying to thrive in surroundings that repeatedly tell them that they are not of value and that threaten and limit them.’
Therapists have a key role to play in helping young women become aware of the cultural and environmental factors that may be undermining their confidence, rather than seeing it as a personal failing, says Sample. ‘What we have found is this awareness gives young women the tools to challenge sexism and feel in control of their lives, with huge benefits to mental health. Linking to peer support, such as young women’s groups, forums and campaigns, is also vital, so that young women do not feel alone when challenging inequality.’
BACP is currently working with a number of partners, including NSPCC and Barnardo’s, to develop a toolkit promoting digital awareness for all practitioners who work with young people. Says Jo Holmes: ‘We are also aiming to do a short piece of research in this area exploring how often issues such as online harassment and abuse are brought up in therapy, with particular emphasis on what the current picture is and how therapists are responding. I would be interested in hearing from any therapists about their experiences.’
Helping young women navigate this landscape is not just about talking to them about ‘internet safety’, she believes. ‘Young people assume they know it all because they’ve had the talk at school countless times. But I think we do need to talk to girls and boys about digital self-care. We can ask questions that will help a young person explore and do their own thinking about how they need to manage their digital life.’
Identifying the triggers and factors undermining girls’ mental wellbeing is complex, and we must always hold individual differences and experiences in mind. But there are two simple things that every therapist can do: be curious and be informed, says Knibbs. ‘We need to take an interest in every aspect of our clients’ online and sexual life and do it from an informed perspective,’ she advises. ‘Therapists may think they are more clued up than they are. Counselling training courses still don’t cover this and few of us have specialist training in this area. We need to look at our profession and ask why we are not being more proactive.’
If you have experience of working with girls affected by social media and online harassment, please contact Jo Holmes at email@example.com
Sally Brown is a counsellor and coach in private practice (www.sallybrowntherapy.com) and a freelance journalist.
1. NSPCC. Under pressure: what’s affected children in April 2013–March 2014. Childline review. London: NSPCC; 2015. bit.ly/38v6O18
2. Girlguiding. Girls’ Attitudes Survey 2015. London: Girlguiding; 2015. bit.ly/35a2rGz
3. Sohn S, Rees P, Wildridge B et al. Prevalence of problematic smartphone usage and associated mental health outcomes amongst children and young people: a systematic review, meta-analysis and GRADE of the evidence. BMC Psychiatry 2019; 19: 356. bit.ly/2PzvwEG
4. Girlguiding. Girls’ Attitudes Survey 2019. London: Girlguiding; 2019. bit.ly/38pl5MU
5. RSPH/Young Health Movement. #StatusOfMind. London: RSPH; 2017. bit.ly/358BAKV
6. Apter T. Disrupting the feed. London: The Female Lead; 2019. bit.ly/38pE49Q
8. House of Commons Science and Technology Committee. Impact of social media and screen-use on young people’s health. 14th report of session 2017–19. London: House of Commons; 2019. bit.ly/2PvLX4X
9. NSPCC. How safe are our children? 2019. An overview of data on child abuse online. London: NSPCC; 2019. bit.ly/2LIn5Wz
10. Fixers. Fixers investigates: the trouble with... sex in schools. [Online.] bit.ly/2LHcL14
11. Harte A. ‘A man tried to choke me during sex without warning.’ BBC Radio 5. 28 November, 2019. https://bbc.in/36uPvLA
12. Young Women’s Trust. The impact of sexism on young women’s mental health. London: Young Women’s Trust; 2019. bit.ly/35aMDDF