This fall, clinicians and researchers around the world will gather at conferences to discuss the future of psychiatric care, including the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), expected in 2030.
It will be the first revision since 2013, when TikTok didn’t exist and generative AI wasn’t a source of health information. That same year, Facebook retired its old ranking system and moved to a machine learning model built to predict what would keep someone scrolling. The way algorithms now shape how people think about food, their bodies, and themselves would have seemed like science fiction in 2013.
Clinicians already routinely assess family dynamics, trauma history, and substance use when evaluating someone for an eating disorder. At a time when social media has become one of the primary ways many people encounter messages about bodies, food, and exercise, a patient’s digital environment deserves the same scrutiny. The next DSM should encourage clinicians to assess algorithmic exposure as part of a comprehensive eating disorder evaluation.
The DSM focuses on observable symptoms and diagnostic criteria rather than offering a theory of etiology. It addresses context separately through descriptive text, explicitly considering external influences, including environmental, genetic, physiological, and temperamental risk factors, as well as cultural and gender-related issues, and the development and course of a condition. These sections provide clinical context rather than a definitive account of why a disorder develops. For example, in its discussion of eating disorders, the DSM can describe factors associated with increased risk while leaving the underlying causes open to multiple biological, psychological, and social explanations. This structure allows the manual to acknowledge influences of a disorder without taking a firm stance on etiology.
Within that framework, social media algorithms could be considered a modern environmental influence added to those already addressed by the DSM. Algorithm-driven exposure may contribute to the onset, maintenance, or exacerbation of eating disorder psychopathology by increasing repeated exposure to body comparison, restrictive eating content, compulsive exercise messaging, and appearance-focused social reinforcement.
In May of this year, the National Eating Disorders Association surveyed nearly 2,700 people — including those who have experienced eating disorders, clinicians, and caregivers — about social media’s effect on body image. Eighty-two percent said social media had triggered eating disorder thoughts or behaviors. Clinicians described patients in treatment constantly bringing up GLP-1 content unprompted. People in recovery described specific ads and videos triggering relapse.
None of that proves social media causes eating disorders, which remain complex conditions shaped by biology, psychology, and environment together. However, it does show that digital exposure now belongs in the same category as the other environmental factors clinicians are trained to ask about. That’s the gap the DSM-6 could close.
For many adolescents and young adults, an algorithm-driven feed may be as psychologically influential as their in-person peer group, while remaining largely invisible in the clinical interview. Recognizing digital reinforcement as a clinically relevant maintaining factor wouldn’t require changing a single diagnostic criterion. It would simply bring the manual into closer alignment with what clinicians are already seeing in practice.
There’s also a related piece that current diagnostic language mostly misses: the emotional response to digital exposure. Feelings of guilt, inadequacy, and anxiety after viewing triggering content are not incidental side effects. For someone with an eating disorder, those responses can be part of the cycle through which symptoms are reinforced and recovery becomes more difficult. A DSM revision could direct clinicians to assess that loop of exposure, emotional response, and symptom reinforcement as part of a comprehensive evaluation, rather than relying on it to surface during treatment.
From its first edition in 1952 to the current DSM-5-TR, the diagnostic manual has shifted alongside major changes in psychiatry’s understanding of mental illness. DSM-I reflected the dominant psychodynamic thinking of its era, while later revisions moved toward standardized, symptom-based diagnostic criteria designed to improve reliability across clinicians and research settings. Over time, the DSM expanded its attention to cultural considerations, risk factors, prognostic factors, and the broader context in which disorders develop and persist. That history matters because it demonstrates that the DSM was intended to evolve as the world around it changed. We are in just such a moment.
Many will point out that the manual isn’t designed to explain every cause of every mental illness, and they’re right. But it is designed to give clinicians the context they need to assess patients accurately. Right now, a clinician following the DSM to the letter has no structured prompt to ask a patient with an eating disorder about their digital environment, even when that environment may be actively reinforcing the illness.
By 2030, when the next manual arrives, the platforms will look different, and so will the content on them. What shouldn’t change is the expectation that clinicians ask about it. In the next four years, DSM-6 has a chance to make that expectation explicit by recognizing digital environments as part of the broader clinical context in which eating disorders develop, persist, and recover. It should take it.
Jessica Scheer is CEO of the National Eating Disorders Association. Riley Nickols, Ph.D., is a sports psychologist and clinical adviser for the National Eating Disorders Association.
