Problematic Social Media Use in Psychiatric Adolescents: Clinical Vulnerability and Maladaptive Engagement Patterns

Background: Problematic social media use (PSMU) has been increasingly conceptualized as a form of behavioral addiction, characterized by loss of control and continued engagement despite negative consequences. Adolescents with psychiatric disorders may represent a particularly vulnerable group, yet clinical evidence remains limited. This study examined the prevalence of PSMU in help-seeking adolescents and investigated how psychological vulnerabilities influence social media (SM) engagement, platform selection, and content preferences. Methods: A cross-sectional study was conducted on 265 adolescents (12–18 years) undergoing psychiatric evaluation. Participants completed validated measures of PSMU (Social Media Disorder Scale-9) and perceived stress, along with items assessing screen time, platform usage, engagement style (active vs. passive), and content preferences. Diagnostic data were retrieved from clinical assessments. Results: PSMU prevalence was 14.4%, rising to 19.2% among adolescents with internalizing disorders. Female and gender-diverse adolescents showed significantly higher PSMU scores. PSMU was associated with greater screen time (OR = 2.41) and nearly threefold higher odds of intensive TikTok use. Overall, SM engagement was predominantly passive, particularly among adolescents with depressive disorders, while those with neurodevelopmental disorders more frequently engaged actively. Higher stress levels were linked to greater SM use, especially on TikTok and Instagram. Conclusions: PSMU appeared to be relatively prevalent among adolescents receiving psychiatric care, particularly those with mood and anxiety disorders and high stress levels. Findings highlight the importance of assessing PSMU in these groups of adolescents and analyzing qualitative patterns of SM engagement to identify at-risk youth and inform targeted clinical interventions.