A few years ago, patients of child and adolescent psychiatrist Niranjan Karnik, MD, PhD, began talking to him about online harassment. Some of the youths were teased on social networking sites. Others received threatening text messages.
Since then, such complaints have been on the rise at the University of Chicago clinic where Dr. Karnik works. To address the growing problem, he continues to ask about traditional bullying but has added a new topic to office visits -- cyberbullying, in which technology is used to repeatedly harass an individual. The incidents can occur through e-mails, text messages, Twitter and social networking sites.
"We do see more of this happening, [partly because] it's so simple to do," said Dr. Karnik, assistant professor of psychiatry at the University of Chicago. "It doesn't require you to stand in front of a person to bully them."
Mental health professionals are urging primary care physicians to address this mounting problem with their young patients by educating them on the topic and screening for possible victims and perpetrators. They say leaving the issue unchecked can result in anxiety, depression and, in some instances, suicide among those involved.
Suicide rates for cyberbullying victims and perpetrators were above those of students not involved in the activity, just as the rates for victims and perpetrators of traditional bullying also were elevated, according to a July 2010 Archives of Suicide Research study based on 1,963 sixth- through eighth-graders in one of the largest school districts in the U.S. Cyberbullying has gained more public attention recently due to several high-profile suicides in 2010 that followed such harassment.
Cyberbullies and their victims have higher suicide rates than their peers.
Although research indicates that cyberbullying seems to occur most frequently among teenagers, anyone who spends time online can be harassed, according to child and adolescent psychiatrists.
To help identify youths who are affected by such incidents, pediatricians and family physicians should ask all of their patients if they use the Internet and have a cell phone, said Boston psychiatrist Tristan Gorrindo, MD. Patients who answer "yes" to either question are vulnerable to being a cyberbully victim or perpetrator, he said.
Despite the growing prevalence and publicity of cyberbullying, many physicians are not yet seeing patients with complaints of such harassment, said Gwenn Schurgin O'Keeffe, MD, an executive committee member of the American Academy of Pediatrics' Council on Communications and Media. She said the topic won't be brought up in a doctor's office until primary care physicians ask patients about it.
"I recognize that doctors have a lot on their plate. This is all new for everybody. But everyone has to have a heightened sense of awareness that children are being bullied [with technology], and it's happening more than people want to admit," said Dr. O'Keeffe, a Hudson, Mass., pediatrician.
Technology spreads, cyberbullying follows
About 43% of teenagers age 13 to 17 reported being cyberbullied during the previous year, according to 2006 data from a National Crime Prevention Council survey. The council is a Virginia-based nonprofit that addresses the cause of crime and violence and aims to reduce it.
That study is among the most recent and widely cited on the prevalence of cyberbullying. But mental health experts estimate that these numbers have increased with the growth of mobile access to the Internet and the involvement of youths in technology at younger ages. In fact, many psychiatrists said the cyberbully victims they see in their practices are getting younger.
About 43% of teenagers age 13 to 17 reported being cyberbullied in 2005.
In 2009, 58% of 12-year-olds owned a cell phone, up from 18% in 2004, according to a survey of 800 adolescents by the Pew Research Center's Internet and American Life Project. Overall, 75% of teens age 12 to 17 had a cell phone in 2009.
Experts say the rise of social media is making cyberbullying more common. In 2009, 73% of teenagers who spent time online used a social networking site. The figure was 55% in 2006.
But even as younger children become more active online, cyberbullying probably will remain most problematic for teenagers, said Dr. Gorrindo, a child and adolescent psychiatrist at Massachusetts General Hospital in Boston.
He noted that the developmental task of teenagers is to figure out who they are. This group already has an unstable image of themselves, which can be further weakened by moving to a new school or uncertainty about their sexuality, he said.
Dr. Gorrindo stressed that for many individuals, cyberbullying is largely a nuisance and will not lead to suicide or other serious mental health issues. A 2006 Pediatrics study of 1,500 Internet users found 38% of 10- to 17-year-olds who were the target of Internet harassment reported "emotional distress."
But for adolescents who have a less stable sense of their identity, including individuals with mental health issues and those who are perceived as outsiders by their peers, cyberbullying can drive them deeper into depression.
"In children with these [types of] vulnerabilities, cyberbullying is probably worse" than traditional, face-to-face harassment, he said.
Dr. Gorrindo noted that taunts on social networking sites can be viewed by hundreds of Internet friends, compared with traditional bullying, which often is witnessed by a small group of people. Cyberbullying is difficult for victims to escape because the attacks can occur in private moments over a computer and through cell phones.
Identifying victims and perpetrators
To identify potential victims and perpetrators of such harassment, Dr. Gorrindo suggests that physicians ask all their patients who use the Internet what they do online. He recommends that physicians specifically inquire about whether they use social networking sites and ever felt as if they were harassed. Additionally, he said doctors should ask patients if they bully other people. Dr. Gorrindo, in his experience, said children will be honest and forthcoming with their answers.
Adolescent medicine specialist Elizabeth Alderman, MD, said that children bully others for a reason, which could include depression or abuse by a parent. If a patient admits to cyberbullying, physicians should help the individual identify his or her actions as a problem and then involve the parent or guardian in the situation, said Dr. Alderman, a professor of clinical pediatrics at Montefiore Medical Center and Albert Einstein College of Medicine in New York.
58% of 12-year-olds owned a cell phone in 2009, up from only 18% in 2004.
When patients acknowledge that they have been victims, doctors first should assure the individuals that it's not their fault and then determine their level of danger for self-harm or acts inflicted by others, said Dr. O'Keeffe, of the AAP.
She said patients who need counseling should be referred to a mental health professional. Physicians should urge families to contact police if threats made against a patient seem credible, she added.
"Like almost any disease, the earlier we recognize [cyberbullying] and treat it, almost without exception, the better the outcome will be," said Henry J. Gault, MD, a child and adolescent psychiatrist in Deerfield, Ill.
"If you can intervene, you can protect a child from a great deal of harm," he said.
This content was published online only.
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ADDITIONAL INFORMATION:
Identifying cyberbullies and victims
All adolescents are at risk of cyberbullying, according to mental health professionals. But there are characteristics that make certain individuals more vulnerable to such harassment than others -- and more likely to commit cyberbullying.
Most susceptible patients:
- Individuals with mental health issues
- Those with a developmental disability
- Adolescents who are gay or lesbian, or those who are struggling with their sexuality or gender identity
- Youths who recently moved to a new school
- Children who are perceived as outsiders by their peers
- Adolescents who spend a lot of time online
Signs that a patient could be a cyberbully victim or perpetrator:
- Problems sleeping
- Anxiety
- A sudden disinterest in school
- Increase in somatic complaints, such as stomachache and headache
- Bed-wetting in younger children
- A decrease in social activity
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Copyright 2010 American Medical Association. All rights reserved.
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