As technology advances, so too do the problems that come with it. In 2008, Jessica Logan, 18, of Ohio, committed suicide after sexting (sending a nude photo to her boyfriend) led to the posting of the photo for all to view when they broke up. In 2009, 12-year-old Sarah Lynn Butler hanged herself after numerous derogatory MySpace posts. In 2012, Iowan Kenneth Weishuhn, Jr., 15, was tormented by an anti-gay Facebook page created by his classmates, something that led him to suicide. (You can read their stories, among others, at http://bit.ly/TccPSq.)

There are countless tragedies linked to what is commonly known as cyberbullying. With our growing dependence on technology as a source of socializing comes a new vulnerability to the darker aspects of social behavior.

Bullying was once something that primarily occurred at school or local hang outs for youth. Now it infiltrates our homes 24 hours a day. Cybervictims do not have to act inappropriately, make the wrong friends, be in obviously dangerous environments, or even know their bully. For cyberbullying, the only criterion is that you are connected.

Texting, social networking, e-mail, blogs, and other technological avenues make us all vulnerable to emotional battery and degradation of esteem. Every person connected is a potential victim, but it is children that are most affected because they are at the crossroads of intense developmental change and self-exploration, and because they are at the forefront of technological socializing.

Epidemiology of Cyberbullying

The epidemiology of cyberbullying and cybervictimization is poorly defined. Reported prevalence is highly variable between studies and country to county. What remains consistent is that cybervictimization appears more prevalent than cyberbullying. In the US, the prevalence of cybervictimization is 9% to 72% and cyberbullying is 4% to 36% (Suzuki K et al, Int J Adolesc Med Health 2012;24(1):27–35).

The association with gender is also unclear. Some studies indicate there is no gender difference, while others suggest that more males are cyberbullies and more females are cybervictims or dual bully-victims (Suzuki ibid; Bauman S et al, J Adolesc 2013:36(2):341–350). One gender difference that may affect cyberbullying susceptibility is that females tend to engage more in emailing and perhaps other forms of technological communications, while boys tend to spend more time playing online video games. In addition, girls often multitask, allowing them to have a greater exposure to risk.

Regarding age, trends remain vague. Most studies focus on middle and high school. Some of these studies suggest that there is an inverse relationship between age and cyberbullying, while other studies suggest the opposite holds true (Suzuki op cit; Heirman W & Walrave M, Psicothema 2012;24(4):614–620).

Cyber Versus Traditional Bullying

Lack of supervision creates an environment for cyberbullying to thrive. It can be carried out discreetly and quickly. Moreover, technology is accessible nearly everywhere and at any time of day. With traditional bullying, the majority of acts occur on the school grounds where supervision is relatively well developed. Aside from texting, cyberbullying tends to occur off school grounds. This creates not only an issue with supervision, but also confusion for victims as to where to bring their problems.

In addition, the qualities of anonymity and broad publicity are available through technology in a way that they are not in the schoolyard. With anonymous bullies, the victim loses the ability to anticipate the act, which lends to a sense of helplessness and constant fear. (Anonymity can be preserved through unrevealing screen names.) Research has shown that among cyberbullies, 84% knew their victims personally, whereas only 31% of cybervictims knew their perpetrators (Ybarra MI & Mitchel KJ, J Adolesc 2004:27(3):319–336). Consequently, interactions with others may be compromised by a nagging concern about who the faceless perpetrator might be.

Publicity obviously means more observers, and reduced control over how many people will witness the aggression. Once posted, material remains accessible for long periods of time and by many observers. Dehumanization of others is also easier when one is not in the presence of environmental and social cues that one would experience in traditional bullying, and this could potentially allow for greater escalation of acts with little thought of impact or consequence (Suzuki op cit). One study found that people who cyberbully primarily do so because it is “fun” (38%), for retaliation (25%), or because they have a negative self-image (6%) (Kiriakidis op cit).


Identification of Potential Perpetrators and Victims

Cybervictims may fail to come forward in part because policies regarding cyberbullying are often lacking or unenforceable, making efforts to report the abuse appear meaningless. Because it happens “in the ether,” it can be hard for victims to know to whom to report. Studies also seem to indicate that adults are often seen as uninformed or impotent to address the cyberbullying.

There are character traits associated with both victims and bullies. Those who are perpetrators of cyberbullying tend to use computers and the Internet requently, are savvier with technology, have poor academic performance, and are commonly also cybervictims (Heirman & Walrave op cit). Cyberbullies typically have increased levels of undesirable behaviors, aggression, hyperactivity, and substance abuse. They also often have less social support and have negative views towards school (Suzuki op cit).

Cybervictims miss more school and have poor performance, relationship problems, and inadequate social skills. Insomnia, somatic complaints, strained relationships with loved ones, and social anxiety are often correlated with cybervictimization. Decreased empathy and greater aggression in their relationships with others may be seen. Not surprisingly, those that are traditional victims are also more likely to be cybervictims (Suzuki ibid).

Bully-victims often have poor empathy (Suzuki ibid). Additionally, people who are found to have elevated reactive aggression tend toward retaliation, thereby taking the trauma of victimization and perpetrating acts upon their bully or even others. Bully-victims also usually have more experience with traditional bullying and victimization, poor emotional relations with parents, and often associate with peers of poor moral character.

Consequences

As with other forms of bullying, cyberbullying produces an array of consequences, including suicide and, conceivably, homicide. Research indicates that the effects of cyberbullying manifest in many ways. Its victims may feel worry and sense of threat (65%), emotional distress (38%), and indifference (22%) (Suzuki ibid). Cybervictims are at two to three times the risk compared to their peers for problems such as depression and substance abuse. More frequently they also demonstrate delinquent behavior such as increased rates of suspension, detention, and likelihood of carrying weapons. Cybervictims are also twice as likely to attempt suicide. There has also been found to be a direct association between the act of cyberbullying and suicide attempts in males (Bauman op cit).

Prevention and Interventions

Cyberbullying is a real threat to our patients, particularly those in middle school and high school. Poor school performance, difficult relationships, maladaptive behavior, and depressed mood may all be closely associated with exposure to cyberbullying. Since youth tend not to divulge involvement with cyberbullying to adults, catching this through screening and close evaluation may be even more crucial than with traditional bullying. Once patients are identified as cyberbullies and/or cybervictims, mood and risk for depression should be vigilantly monitored in these patients, as should risk of suicidality. Skills deficits should be identified and addressed. For example, cyberbullies could be educated on relational problem solving, anger management, and the impact of their acts, in an effort to induce greater empathy. Education for cybervictims might include social skills, improving comfort in social settings, and increasing assertiveness. Training in cooperation and compromise, comfort in seeking help, and basic skills like problem solving and making decisions could prove to be very beneficial as well (Suzuki op cit; Kiriakidis op cit). Therapeutic techniques such as cognitive behavioral therapy may prove very effective in receptive individuals.

Once individuals are identified as being involved in some capacity with cyberbullying, further exploration is necessary. A thorough evaluation should include questions such as:

• When, how often, and through which means does the cyberbullying occur?


• What are the contents of the attacks, and what is the extent of public exposure ?


• Did the individual knows the perpetrator?


• How did the victim responded to the attacks and with whom did they shared?

Given its strong association, questioning about traditional bullying is highly pertinent as well.

To further help an individual identified as a cyberbully or cybervictim beyond the clinical setting, communication with schools and parents is needed to provide greater awareness and support for the child. Many youth see adults as either indifferent or incapable of addressing this novel problem, driving them to either keep silent or only share with friends (Suzuki op cit; Hinduja S & Patchin J, J Youth Adolesc 2013;January 2013 online). Creating a sense that adults are knowledgeable and capable of addressing cyberbullying is needed. This must be backed by hard evidence that adults are part of the solution. Public workshops, school-led events, and government announcements can create understanding of the technology involved, indicate how to identify cyberbullying and victimization, and suggest means to respond to such events.

Changing attitudes toward cyberbullying and perceived social norms is paramount. Cyberbullies often believe that attitudes toward their acts are either neutral or positive and that their behavior is acceptable and common (see for example Hinduja & Patchin op cit). By addressing these and other misperceptions, acts may be averted. The opinion of others is critically important to cyberbullies’ self-esteem and worth. Peers, teachers, and parents all impact the individual’s perception of right and wrong. Social pressure by those who provide significant influence upon individuals has the best potential to effect change.

Cyberbullies may believe that they can carry out their acts without consequence and with pure anonymity. But most actions through technology leave a trace, and dispelling the myth of anonymity will create a better sense of accountability. Sanctions at school have been shown effective in reducing cyberbullying (Hinduja & Patchin op cit), so these along with other means of reprimand should be identified and clearly announced. Cyberbullies need to recognize that their actions may warrant investigation and punishment ranging from interventions at school to prosecution under laws such as the Protection from Harassment Act of 1997 (Kiriakidis op cit). Since people who cyberbully often do not appreciate the ramifications that their behavior has upon their victims, helping expose the consequences may deter some events.