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Cyberbullying

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Cyberbullying

para>Recommendations to physicians

Signs consistent with depression: flattened affect, fatigue пїЅ

11 Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance System (YRBSS). http://www.cdc.gov/healthyyouth/data/yrbs/index.htm.Accessed May 22, 2015.22 Carter пїЅMA. Third party observers witnessing cyber bullying on social media sites. Procedia Soc Behav Sci. 2013;84:1296-1309.33 Bauman пїЅS, Toomey пїЅRB, Walker пїЅJL. Associations among bullying, cyberbullying, and suicide in high school students. J Adolesc. 2013;36(2):341-350.44 den Hamer пїЅAH, Konijn пїЅEA. Adolescents' media exposure may increase their cyberbullying behavior: a longitudinal study. J Adolesc Health. 2015;56(2):203-208.55 Cantone пїЅE, Piras пїЅAP, Vellante пїЅM, et al. Interventions on bullying and cyberbullying in schools: a systematic review. Clin Pract Epidemiol Ment Health. 2015;11(Suppl 1 M4):58-76.66 Messias пїЅE, Kindrick пїЅK, Castro пїЅJ. School bullying, cyberbullying, or both: correlates of teen suicidality in the 2011 CDC Youth Risk Behavior Survey. Compr Psychiatry. 2014;55(5):1063-1068.

  • Screening for cyberbullying should be included in adolescent mental health assessment: "Have you ever received, sent, or seen messages on the Internet that might be seen as bullying?"пїЅ

Screening for cyberbullying should be included in adolescent mental health assessment: "Have you ever received, sent, or seen messages on the Internet that might be seen as bullying?"пїЅ

Recommendations to schools and communities (5)

  • Regular discussions with youth and parents/guardians about online use and cyberbullying.
  • Multimodality, long-term, school-wide interventions have been effective in decreasing rates of cyberbullying.
  • Vigilance and intervention during after-school and extracurricular activities
  • Some bullying behaviors may represent delinquent or criminal offenses.Of 48 states with antibullying legislation, the majority have specific provisions addressing cyberbullying.

Regular discussions with youth and parents/guardians about online use and cyberbullying.

Multimodality, long-term, school-wide interventions have been effective in decreasing rates of cyberbullying.

Vigilance and intervention during after-school and extracurricular activities

Some bullying behaviors may represent delinquent or criminal offenses.

  • Of 48 states with antibullying legislation, the majority have specific provisions addressing cyberbullying.

Of 48 states with antibullying legislation, the majority have specific provisions addressing cyberbullying.

COMMONLY ASSOCIATED CONDITIONS

  • Traditional bullying
  • Behavioral health comorbidities
  • Internet addiction
  • Bully victims are more likely to bring guns to school and engage in school violence. Half of adolescents expressing shooting threats online had prepared to carry out threats.
  • Victims report more depressive symptoms; bullies report more problems with substance use.

DIAGNOSIS

HISTORY

  • Avoiding computers, cell phones, and other devices
  • Stress when receiving electronic communications
  • Avoiding conversations about computer use
  • Emotional or peer problems; feeling unsafe at school; fear of a particular person
  • Poor academic performance
  • Somatic complaints: headache, abdominal pain, difficulty sleeping
  • Withdrawal from family, friends; reluctance to attend school and social events
  • See "Risk Factors."пїЅ

PHYSICAL EXAM

DIFFERENTIAL DIAGNOSIS

  • Traditional bullying: physical, sexual, or verbal abuse
  • Child abuse or neglect
  • Depression
  • Conduct disorder
  • Malingering, prevarication
  • Cyberbullying as a feature of underlying psychiatric illnesses

TREATMENT

GENERAL MEASURES

  • Community-based approach: Parents, teachers, and school officials should be aware of communications technology used by youth.
  • Encourage cyberbullying reporting to parents, teachers, and other supervising adults.
  • School-wide programs addressing traditional bullying may also be effective in cyberbullying.
  • Prepare parents to discuss online safety.
  • In traditional bullying, mediation between bully and victim may be counterproductive as mediation is only successful if both parties have equal power and incentive to end conflict; less evidence is available for cyberbullying.
  • Gather information about the methods and context of cyberbullying.Duration: Establish timeline, previous history as victim or bully.When and where does the bullying occur?How does bullying occur? Mediums of online communication, traditional bullyingRelationship between victim and bully: power differential, age differences, previous conflictsCheck for external and internal consistency, malingering.Bullies may view behavior as joking or not malicious.Identify other participants because cyberbullying may occur with multiple offenders or onlookers.
  • Duration: Establish timeline, previous history as victim or bully.
  • When and where does the bullying occur?
  • How does bullying occur? Mediums of online communication, traditional bullying
  • Relationship between victim and bully: power differential, age differences, previous conflicts
  • Check for external and internal consistency, malingering.
  • Bullies may view behavior as joking or not malicious.
  • Identify other participants because cyberbullying may occur with multiple offenders or onlookers.

ISSUES FOR REFERRAL

  • Psychiatric sequelae such as depression, anxiety
  • Suicidal or homicidal ideation should be referred urgently for psychiatric care.
  • Any online sexual solicitations of minors by adults should be reported to law enforcement.
  • Severe cases may require legal referral.

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Screen for cyberbullying at medical visits.
  • Discuss efficacy of online privacy measures.
  • Screen for traditional forms of bullying.
  • Consider psychiatric referral.
  • Screen for depression, substance and alcohol abuse, suicidality, and homicidal ideation.
  • Monitor technology use.
  • Effective coping measuresRemove profile from Web sites.Avoid Internet use.Inform school or adult.
  • Ineffective coping measuresBullying othersPretending to ignore the bullySubstance use
  • Remove profile from Web sites.
  • Avoid Internet use.
  • Inform school or adult.
  • Bullying others
  • Pretending to ignore the bully
  • Substance use

PATIENT EDUCATION

  • Directed toward both youth and parents
  • See "General Measures."пїЅ
  • Efforts must be multidimensional, repeated, and involve school and health care personnel and community-wide involvement.
  • http://www.stopbullying.gov/cyberbullying/
  • http://kidshealth.org/parent/positive/talk/cyberbullying.html
  • http://www.commonsensemedia.org/cyberbullying

PROGNOSIS

  • Varies widely; lack of long-term demographic studies
  • Bullying and cyberbullying may have chronic social, psychological, and medical sequelae.

COMPLICATIONS

  • Linked with depression and suicidality. Highest rates of suicidal ideation are associated with victims of both traditional and cyberbullying. Middle school males with depressive symptoms are as much as eight times more likely to have been cyber victims.
  • Popular media has linked high rates of suicide to cyberbullying (6)[C].
  • Decreased self-esteem, poor interpersonal relationships, loneliness, and often drop in grades
  • Both cyberbullies and victims have increased rates of future aggressive behavior.
  • Legal complicationsSome Web sites have installed automatic bullying monitoring. Sites such as Facebook and YouTube have settings for users to report inappropriate content.Over 20 states have clauses pertaining to electronic communication in stalking and harassment laws. Several jurisdictions have cybercrime units.A question facing courts is how far to pursue cases and if this infringes on free speech.
  • Some Web sites have installed automatic bullying monitoring. Sites such as Facebook and YouTube have settings for users to report inappropriate content.
  • Over 20 states have clauses pertaining to electronic communication in stalking and harassment laws. Several jurisdictions have cybercrime units.
  • A question facing courts is how far to pursue cases and if this infringes on free speech.

REFERENCES

ADDITIONAL READING

  • Moreno пїЅMA, Kolb пїЅJ. Social networking sites and adolescent health. Pediatr Clin North Am. 2012;59(3):601-612.
  • Olweus пїЅD. School bullying: development and some important challenges. Annu Rev Clin Psychol. 2013;9:751-780.

CODES

ICD10

  • T74.32XA Child psychological abuse, confirmed, initial encounter
  • T74.31XA Adult psychological abuse, confirmed, initial encounter
  • T76.32XA Child psychological abuse, suspected, initial encounter
  • T76.31XA Adult psychological abuse, suspected, initial encounter

ICD9

  • 995.51 Child emotional/psychological abuse
  • 995.82 Adult emotional/psychological abuse

SNOMED

  • victim of bullying (finding)
  • bullying (finding)
  • Emotional bullying (finding)
  • Victim of bullying when not in school (finding)

CLINICAL PEARLS

  • Cyberbullying is anonymous, occurs anywhere anytime, may leave a permanent record, and occurs with or without witnesses, thus, more difficult to protect against; parents are unaware of extent.
  • Cyberbullying can affect mental health.
  • Rarely reported to adults; daily microaggressions may have severe cumulative effects not perceived by parents, guardians, or school officials.
  • Students viewed as different due to disability, socioeconomic status, gender identity, sexual orientation, race, or ethnicity are more likely to be cyberbullied.