Teen 'Sexting' Estimates Vary Widely

Pediatricians will likely face the issue of "sexting" in their office practices. A sufficient number of teenagers are sending by text message nude, nearly nude or provocative pictures – often of themselves – to their friends.

Dr. Michael Jellinek

Pediatricians will be asked by parents what they should do if they discover that their teenagers have sexted. Teenagers may mention, ask, or complain about sexting during a visit. Less commonly, schools or even the police may be involved and may even be the source of questions. Texting messages and/or images is a frequent and common activity by most teenagers. Teenagers often do not have the best judgment and typically do pranks, jostle for social status, act impulsively, or demonstrate a deeper problem in a number of areas. Therefore, it is not surprising that a topic as meaningful and developmentally relevant as an adolescent’s sexuality and relationships quickly becomes part of a texting habit and culture.

Adolescent sexuality is a common concern and routine part of primary care. Sexting is obviously a new feature because it is now technologically feasible and so easily done. As is the case with other adolescent sexual and general behavior, the pediatrician has to understand the context of sexting to determine whether it merits counseling or is part of a potentially high-risk activity.

Some questions to consider: How old is the teenager? Clearly a young teenager being more explicit is of greater concern then a college student. However, a preteen sexting a new boyfriend or girlfriend may simply be immature and naive. What is the social context? Is the sexting part of what could be seen as exploration and experimentation between two adolescents in an increasingly close relationship that is age appropriate – between equals who are sensitive to privacy? Or is there a dynamic of unequal power involved? For example, does the teenager sending the text feel coerced by a partner who is threatening to end the relationship, has control in some way over the relationship, is older, or is an adult? Or is the teen sexting to impress or obtain some kind of leverage in the relationship? What is the meaning of the sexting and what does the behavior imply in her or his life? Is the teenager who sexted vulnerable because of low self-esteem or depression, or in the context of alcohol or substance use? Has the image been unexpectedly shown to others? How many, and under what circumstances? What has been the consequence, intentional or unintentional? Are there family conflicts that are driving the teenager to "leave" home emotionally, rebel against over-control, or take risks? Could or has the activity crossed the line of legality, as in blackmail, bullying, child pornography, or prostitution?

Pediatricians often have to assess adolescent behavior in the context of the teenager’s overall functioning in the family, with friends, in school, with activities, and their mood. Clearly, if sexting is an isolated lapse of judgment in a new, equal relationship, simply suggesting that caution be taken – given the ease of digital spread – may be all that is indicated. If sexting is part of low self-esteem, repeated poor judgment, frequent risk taking, poor choices in relationships, and poor overall functioning, then sexting becomes another key indicator requiring a comprehensive mental health consultation.

Most sexting involves a small percentage of adolescents and should be seen as a variation of normal or a minor risk factor to be followed. However, sexting also can indicate real vulnerability to power relationships, reflect low self-esteem and high risk, indicate poor judgment, or be part of illegal, abusive situations.

Pediatricians might want to be attuned to sexting and include some counseling about electronic media in their individual sessions with teenagers. In addition, they should be prepared to counsel parents in digital media literacy. This new high-tech aspect of primary care includes an awareness of excessive use of computers that over time substantially interferes with life tasks (playing of video games, social media), sexting, and whatever comes next!

Adolescents communicate their emerging identity, their self-esteem, the quality of their relationships, and their mental health through their interaction with the world and the choices they make. Electronic communication is another window into that emerging identity.

Michael S. Jellinek, M.D., is professor of psychiatry and of pediatrics at Harvard Medical School, Boston. He is also president of Newton (Mass.) Wellesley Hospital. He said he had no relevant disclosures.