what to make of..... digital stupidity?

In my state, involuntary admission requires the patient to have a mental illness that makes them a danger to self/others. The mental health district court judge actually came and gave us a talk, and essentially said that you need an Axis I disorder that's causing this problem.

And I think that's reasonable. If they don't have an illness that you can treat, then what will you achieve by holding them in a hospital? Also, people have the right to make bad decisions, and doctors shouldn't have the privilege to take away that right unless we have a specific medical justification.

Plus, if they're teenagers, then they have a legal guardian who can decide on their behalf. If you inform the parents appropriately about the potential benefits of hospitalization and the potential risks of discharge, then I think it's perfectly reasonable to leave the decision to them.

Pretty sure that at least half of the people I knew in high school were somehow a danger to themselves. Most of them probably weren't sending nude photos to strangers, but I'll bet that a good chunk of them could be convinced to do so by a sociopath and/or a sexual predator.

Mental illness? Probably not.
Behavioral problem? Definitely.
Seems like what's needed is some sort of intensive outpatient option that would teach good decision making, healthy relationships and self respect.
(And then, while we're at it--as long as the NSA is seeing all of this anyway, maybe they could target a few drones on the idiot grown males that are taking advantage of them.)

Whoops, I guess I just presumed the "involuntary" thing. I should have assumed that you know better.

If you think that the patient is at risk for suicide, that's a great reason to hold somebody. But if the patient has no clear suicidal intent, I don't think that online sexual indiscretion is any different from offline sexual indiscretion in terms of suicidal intent. Actually, the online variant is probably less risky than the offline variant, but it gets more media attention because it's a relatively novel phenomenon and it's easy to prove. I agree that a girl with low self-esteem might be at higher risk of attempting suicide than the general population, but you could say the same thing about anybody who has a gun, a bottle of vodka, a swimming pool, or a medical degree. "I saw somebody else do this on the news" isn't a medical justification.

And again, if you don't think that the patient has an illness that you can treat, then what's the point of keeping them in the hospital? If anything, hospitalization is probably making things worse for them from a psychosocial perspective. If you're not treating a mental illness, why expose them to that? You'll have to let them go eventually - and when they leave, they'll probably be worse-off than when they came in, since they've probably fallen behind in school, lost touch with friends, etc. Not to mention the fact that suicidal intent can be contagious, so even if they hadn't thought seriously about suicide upon admission, you're putting them in a locked unit with a bunch of other people who have been thinking about it. If you treated a mental illness in that time period, then you probably lowered their suicide risk overall. But if you didn't treat the mental illness, then you just added more psychosocial stressors, and their suicide risk is probably higher upon discharge than it was upon admission (although still low).

OldPsychDoc said:

(And then, while we're at it--as long as the NSA is seeing all of this anyway, maybe they could target a few drones on the idiot grown males that are taking advantage of them.)

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Jokes aside, can't we report these people to local law enforcement? That might be a better solution to this quandary.

gibits said:

Outpatient therapy is certeinly war rented as oldpyschdoc mentioned but not so much inpt? So when I get another case like this should I just file a CPS report and refer them to the cops instead of admit them?

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I don't think anybody would fault you for admitting them for a couple of days, just to make sure that there's no actual mental illness involved.

I'm sure that many of these girls are well on their way towards a Cluster B diagnosis. I don't know enough about child psychiatry to know how to prevent that...

Good grief, this is a can of worms. I am a layman, so excuse me if I don't say the right things, but maybe I can supply more information, as this is becoming a big problem.
If you are trying to sum it up as a disorder, I suggest looking at Histrionic Personality Disorder, which is certainly close to the Amanda Todd story.
If you are looking for examples, then try Aurora Eller, Jessi Slaughter and perhaps even Megan Meier.
Reasons? Plenty. After Demi Lovato and others confessed to self-harm, her fans thought it was cool to do so and to broadcast it online. Worse, a group of girls calling themselves the Árianators' decided that it was cool to threaten suicide online after a certain event concerning the release of an Ariana Grande album. If you're looking for overt examples, may I suggest my blog, and in particular chatlogs referring to Amanda Todd's online behaviour, quoting Amanda herself. http://philipjrose.wordpress.com/2013/04/25/amandas-last-appearance-as-cutiielover/
I would be interested in knowing if there is a connection with Amanda Todd and any increase in this activity. There is a famous picture online that says 'Beware - the copycats are coming'.
Historically, this has been going on for some time now and is only just beginning to get noticed. In case you need some online vocabulary 'heroes' have been trying to deal with this for some time, and met with very little assistance, and, as you say, a lot of enmity both from parents and the children. Being a hero entails tracking various events online and trying to do something about it (in short). Not to be confused with an hero of course.
You may also be interested in the Hannah Smith story and Ask.fm. When the authorities asked for a check, 95% of the abuse came from her laptop - see self-cyber-bullying.
As far as trying to call it a mental illness, well that's a doozy. The only solution would seem to be denying Internet access, but then the kids go crazy and threaten suicide. In the UK, it was suggested that Hannah Smith (seriously) was suffering from PTSD after phone confiscation. One of the commenters hit it close by saying it's a behavioural problem. Whose responsibility is that? YouTube and Facebook need to be very much on the ball, and I guess you already know about Omegle etc. I have hinted at Histrionic Personality Disorder, but I'm not sure.
One of your commenters mentioned pedophiles and predators. Beware - a lot of that is simply untrue, and is used to try and explain things in more acceptable terms - people simply don't want to come to terms with the fact that young girls are going online and soliciting responses without any coercion or encouragement. Another thing to watch out for is alcohol and marijuana - both lower inhibitions, and are factors in online behaviour (Aurora Eller's father suppled beer; Amanda Todd smoked weed).
Low self-esteem? Well, I don't think so. In fact, I would argue perhaps the opposite. Amanda Todd in particular adored the attention (until it all went wrong). She could not resist the lure of the Internet, posting videos of herself singing, taking drugs, the works. Not exactly a low-esteem shrinking violet, and I think this thing of 'looking for love' is a red herring.
Miley Cyrus Syndrome? Well, almost definitely.
Cops? Forget it. They would be inundated, and have no clue about how to deal with it. Amanda Todd simply cooked up a pack of lies to cover her actions, as do most of the other kids.
Doctors? Equally useless.
Parents? Don't get me started. Fingers have been pointed at Aurora Eller's dad; Jessi Slaughter's father is an internet legend.
We are in a totally new digital world. More positively, I have noticed one thing - there was an upward trend in online activity like this but kids are quite good at sort of healing themselves. Slowly but surely, self-harm, suicide ideation and online exhibitionism are on the wane - after all, if everyone's doing it, it's no longer special. However, the most impressionable age group - 11 to 12 year olds - are most in trouble. They are shown the Amanda Todd video at school, and believe you me that's not wise. However, I'm wandering off topic. All I can say is - I hope in some way I've helped.

I'm no expert, but this sounds more like a cultural phenomenon. It's not ideal, but I'm not even sure that it's abnormal. I was never a typical teenager, so I'm not sure, but I could imagine this being normal. Maybe the difference is that parents are more aware of what their children do now?

When I took a sociology class (only intro), the text said that adolescents who seek out adults online tend to have family problems to begin with . . . so maybe family therapy?

gibits said:

Hey Mr. Rose I wanted to finish some of your blog before I replied to you. Interesting blog but it only emphasizes what I always suspected: teenagers are dumb. They make mistakes and they hopefully learn from it. Amanda Todd is nothing special, but she did present a poignant picture of something most of the older generation didn't know about.
Your pop assessment about her self esteem is a bit off to me. Most teenagers are uncertein of themselves and seek validation from their peers (especially of the opposite sex). Seeking validation from others is a sign of poor sense of self (ie self esteem). If anything Todd and my patients seek this kind of attention because they want others to valadite their worth/beauty.


Oldpyschdoc mentioned that it was not a psych issue but a behavioral issue. But when your hospital called the psych ward "department of BEHAVIORAL health" then where would you draw the line? This behavior is hardly healthy, so maybe a case can be made to treat them as an inpt. BTW I usually give these girls a non specific diagnosis of "mood disorder NOS". Histrionic PD might be a bit too strong.

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I thought histrionic PD was thrown out with hysteria (given the what some would say sexist connotations).