Neeraj Shukla, MD Chief Fellow Child & Adolescent Psychiatry April 17, 2013

• Background • Tactics • High Profile Cases in the Media:
– Megan Meier – Tyler Clementi – Rehtaeh Parsons – Steubenville, Ohio – Audrie Pott – Amanda Todd

• Prevention • Obstacles in Treatment

• Online Social Networks (OSN):
– Identity of online persona linked with patient’s own identity – Reputation of online presence carries over to real life – Offers opportunities for positive peer interaction, self-expression, control of selfpresentation and experimentation that users find difficult to obtain in face-to-face interactions

• Bullying:
– Abusive treatment that is repeated over time – Intentionally harmful and occurs without provocation – Behaviors range in severity:
– Mild – pushing, spreading rumors – Moderate – stealing, spitting, making intimidating phone calls and using racial slurs – Severe – inflicting bodily harm, threatening with a weapon and spreading malicious rumors

• Bullying:
– A large number of people participate in an indirect manner as an audience – Bystanders may witness the bullying event but remain uninvolved – Afraid of becoming the next victim if they interfere – Historically, not seen as a problem: “normal part of growing up…helps toughen you up…Relax, just teasing!…rite of passage…character building”

• Bullies:
– Interest in their own pleasure, desire for power over others, willingness to manipulate others to get what they want and the inability to see things from another's perspective – Disproportionately from lower SES families with poor childrearing techniques – Impulsive and are frequently unsuccessful in school – Regardless of their intelligence, usually receive poor grades and lack good connections with their teachers

• Bullies:
– Find it difficult to solve problems without violence – Strong self-esteem – Low levels of anxiety – Bullying persists because it is rapidly and substantially rewarded:
– Status, domination and material possessions

• Aggression becomes a problem-solving mechanism early in life

• Bully consequences:
– Conduct disorder, serious antisocial and criminal behavior in adulthood – Most bullies remain bullies throughout their lives – Drop out of school, have trouble holding jobs and fail at maintaining positive close relationships – 60% of bullies in grades 6 to 9 had their first criminal conviction by age 24, compared with 10% of controls who were neither bullies nor victims as children (Olweus, D. 1991)

• Victims:
– Insecure, react submissively and anxiously to situations – Smaller, cautious, sensitive and quiet – Negative view of themselves, seeing themselves as failures and feeling lonely, stupid, ashamed and unattractive – Children with learning disorders and/or physical disabilities – Lack social graces and friends – Close to their parents, who may be overprotective

• Victim consequences:
– Low self-esteem, depression, anxiety, poor academic progress, isolated because their peers fear losing status or becoming victims themselves – Female victims may later find themselves in abusive relationships – Suicide – Retaliation shootings

• Bullying used to be confined to schools, neighborhoods, or some small geographic location that the bullied child could leave and seek respite • Cyberbullying allows no escape from taunting and harassment • Verbal bullying not as embarrassing if done alone, but cyberbullying can be read over and over by entire peer group indefinitely • As of 2011, across 35 peer reviewed articles, 5.5-72% of students had been cyberbullied (

• Cyberbullying:
– Introduced a form of bullying never seen before – Attitudes starting changing in 1999 with a report from Attorney General Janet Reno to Vice President Al Gore, suggesting that cyberspace harassment incidents were an increasing problem for law enforcement officials (Beckerman & Nocero, 2003)

• Wide variance, rarely see numbers lower than 10% or higher than 40% • 6-30% of students admit to cyberbullying others • Increase in suicide attempts (
– Offenders:
– Traditional bullying 2.1 times more likely – Cyberbullying 1.5 times more likely

– Victims:
– Traditional bullying 1.7 times more likely – Cyberbullying 1.9 times more likely

• Duke study (Copeland et al, 2013):
– 1420 participants across 11 counties in NC in 1993 – Bullies 4x likely to develop antisocial personality disorder – Victims 5x agoraphobia, 3x GAD, 3x panic disorder – Both (5%) 5x MDD (HPA axis changes resulting in altered cortisol response leading to depression), 15x panic disorder, 19x suicidal

• Exclusion:
– Indirect, without the need for verbal deprecation – Developmentally fixated on being recognized by their peers

• Flaming:
– Passionate online arguing that frequently includes profane or vulgar language in public communication environments for peer bystanders to witness – Flamers endeavor to assert their power or establish a position of dominance

• Exposure:
– Includes the public display, posting or forwarding of personal communication or images that are personal to the target – More detrimental when it is sensitive personal information or images that are sexual in nature

• Harassment:
– Sending hurtful messages to the target child that is worded in a severe, persistent, or pervasive manner, causing the respondent undue concern

• Phishing:
– Tricking, persuading, or manipulating the target child into revealing personal and/or financial information about themselves and/or their loved ones (e.g. passwords, credit cards, etc.)

• Chicanery:
– Similar to phishing in that a cyberbully purposely tricks a target child into divulging secrets, private information, and/or embarrassing information about themselves and then publishing that information online

• Impersonation:
– Aka “imping” where cyberbullies impersonate the target and make unpopular online comments on social networking sites and in chat rooms – Cyberbullies set up websites that include vitriolic information, leading to the target being ostracized or victimized

• Denigration:
– Sending, posting, or publishing cruel rumors, gossip, and untrue statements about a target to intentionally damage their reputation or friendships – Aka “dissing”

• E-mail & Cell Phone Image Dissemination:
– A form of information exchange that can be a criminal act if the images are pornographic or graphic enough depicting underaged children

• Images & Videos:
– E-mailed to peers, while others are published on video sites such as YouTube – Usage of video and images are extremely dangerous, and criminal in most states

• Interactive Gaming Harassment:
– Having the ability to exchange information with gaming opponents and fellow peers, children will verbally abuse others, use threatening and profane language, lock others out of games, pass false information about others and depending on their computer savvy, hack into other children’s accounts

• “Griefing”:
– Habitually and chronically causing grief to the targets, their peers, and other members of an online community or game

• Password Theft/Lockout:
– Stealing a target’s password and then chatting with other people pretending to be the target – Communicate provocative and adversarial messages that are offensive and anger the target – Target’s friends or even strangers

• Website Creation:
– Cyberbully creates websites that insult or endanger the target child

• Voting/Polling Booths:
– Examples include the ugliest, fattest, dumbest, most sexually promiscuous and a plethora of other deprecating attributes

• Bash Boards:
– Posts that are often frequented by the cyberbully and target’s peer groups and school acquaintances – Encourage postings that are mean, hateful, malicious and embarrassing

• “Happy Slapping”:
– Target child is physically attacked or embarrassed and an accomplice video records or takes pictures of the incident – Image or video is then posted online at video and social networking sites for public consumption

• Text Wars and Text Attacks:
– Cyberbully and a group of his/her accomplices’ gang up on the targets by sending them hundreds of emails or text messages – Besides the emotional toll it can take on the target, their cell phone charges may escalate

• Sending Malicious Code:
– Cyberbullies deliberately send viruses, spyware, and hacking programs to a target that can be very costly to repair – Usually reserved for children and adolescents advanced in ICT (information and communications technology)

• Warning Wars:
– Internet Service Providers (ISPs) offer a way for consumers to report an online user who is posting inappropriate or abusive information – Make false allegations to the ISP regarding the target posting inappropriate information – By doing this frequently enough, often times the target has their profile and/or account suspended

• Screen Name Mirroring:
– Constructing a screen name or user name that is very similar to the target’s name – May have additional or removed letters, numbers, or combinations of the two to appear the same as the target’s screen name

• Cyber Drama:
– Gossip that was not supposed to be shared on a blog or a flame war that ends after a few messages

• Sexting:
– Use of a cell phone or other ICT to distribute pictures or video of sexually explicit images

Megan Meier
• Oct 2006, 13 y/o Missouri girl who hanged herself as a result of cyberbullying on MySpace • 47 y/o mother of friend of Meier was indicted in 2008 as per the Computer Fraud and Abuse Act but acquitted in 2009 who created a fake profile allegedly in retribution for Megan spreading gossip about her daughter • She pretended to be a 16 y/o boy whom the patient fell in love with to eventually obtain personal information that she later spread to humiliate Megan • “Cyber Harassment” law passed in Missouri

Tyler Clementi
• Sept 2010, 18 y/o Rutgers student posted to Facebook, “jumping off the gw bridge sorry.” • Roommate and hallmate used a webcam to view, without Clementi’s knowledge, Clementi kissing another man • Roommate and hallmate were indicted for their roles in the webcam incidents, though they were not charged with a role in the suicide itself:
– Roommate sentenced to 30 days in prison, though served just 20 of them

Rehtaeh Parsons
• Nov 2011, 17 y/o Nova Scotia girl hanged herself after photos of alleged rape went viral • Endured months of cyberbullying • Taken off life support April 7, 2013 • No charges filed against 4 teenage boys being investigated

Steubenville, Ohio
• August 2012, two OH high school football players found guilty of raping a 16 y/o WV girl after a night of heavy drinking • 12-minute online video, text messages and posts from Facebook and Twitter described the details • Victim testified in court that she had no memory of the 6hour period in which the rapes occurred, except for a brief time in which she was vomiting on the street as she was transferred from party-to-party

Audrie Pott
• Sept 2012, 15 y/o San Jose girl posted on her Facebook that her life was ruined, "worst day ever," and hanged herself 8 days after allegedly being sexually battered while passed out at a party • Humiliated by cell phone photos of the attack that went viral • Three 16 y/o boys charged with sexual battery • “Audrie’s Law” – family calling for harsher penalties for cyberbullying

Amanda Todd
• Sept 2012, 15 y/o British Columbia girl posted a 9-minute YouTube video • 7th grader received compliments on the photo that she selected to use for video chat • Christmas break 2011, topless photo was circulating on internet as her “new” Facebook profile pic where he was contacting her friends despite her changing schools twice • Old male friend had sex with Amanda and then his girlfriend plus 15 other physically attacked her at school

Amanda Todd
• Diagnosed with depression, anxiety, panic disorder and abused drugs and alcohol • Drank bleach, overdosed, started cutting • Teased about her low grades, a consequence of a language-based learning disability and time she spent hospitalized for severe depression • Hung herself at home Oct 2012

Amanda Todd

• Educate yourself:
– Research what constitutes cyberbullying as well as how and where it is most likely to occur

• Protect your password • Keep photos “PG” • Never open unintended or unsolicited messages:
– Delete them without reading as they could contain viruses that automatically infect your device if opened to collect your personal or private information – Avoid being charged with possession of child pornography

• Raise awareness:
– While you may understand what it is, it is not until others are aware of it too that we can truly prevent it from occurring

• Always logout:
– Do not save passwords in form fields within web sites or your web browser for convenience – Do not stay logged in when you walk away from the computer or smart phone

• Setup privacy controls:
– Restrict access of your online profile to trusted friends only to ensure maximum protection

• “Google” yourself:
– Regularly search your name in major search engines (e.g., Google, Bing, Yahoo) – Try to remove any personal information or photos which may be used by cyberbullies

• Parental Supervision:
– Just as teachers patrolling school grounds reduces physical bullying, parents should place desktop computer in area visible to others – Avoid filtering/spy software with older children who are more computer savvy than their parents and they will likely circumvent or go underground and become more secretive

• Empower bystanders:
– Social and school curriculum awareness that allows reporting of cyberbullying

• Do not be a cyberbully yourself:
– By cyberbullying others, you are reinforcing the idea that the behavior is acceptable

• Report:
– Do not retaliate, save the evidence and report to ISP

• “Internet Use Contract” or “Cell Phone Use Contract”:
– May work in some families to foster a crystal‐ clear understanding about what is appropriate – Post in a highly visible place

• MD rating sites:
– Give patients name of website and encourage their comments to dilute negative/harassing comments

• MEAN – managing bullies (Kepple et al, 2013):
– Model alternative positive social behaviors – Empathize with victim by focusing on their own pain that is likely driving their aggression – Assess costs/benefits of behavior, such as lost privileges, detentions etc. – Nurture pro-social strengths to build self-esteem to reduce aggressive acts as a means of gaining a sense of control or personal security

• Less than 25% report their incidents of being bullied (Rigby, 1997) • Students do not want to be labeled as a snitch/rat • Feel that teachers will trivialize/ignore complaint • Embarrassed to show adults the nature of their complaint (e.g. anything involving nudity, drug paraphernalia, etc.) • U.S. court rulings have held that even the most provocative internet bulletin boards cannot be held liable for their content if there is no attempt to edit the site, so web sites owners cannot be sued for what appears (Guernsey, 2003)

• Beckerman, L. & Nocero, J. (2003). High-tech student hate mail. The Education Digest, 68 (6), 37-40. • Campbell, M.A. (2005). Cyber bullying: An old problem in a new guise? Australian Journal of Guidance and Counselling , 15(1):68-76. • Copeland, W. et al. (2013). Adult Psychiatric Outcomes of Bullying and Being Bullied by Peers in Childhood and Adolescence. JAMA Psychiatry; 70(4):419-426. • Guernsey, L. (2003, May 8). Telling tales out of school. New York Times, G1. • Hinduja, S. & Patchin, J. (2012). Preventing Cyberbullying: Top Ten Tips for Teens. Cyberbullying Research Center.

• http://

• Kepple, A. & Madaan, V. (2013). MEAN: How to manage a child who bullies. Current Psychiatry, 12(4), 28. • Nuccitelli, M. 2012 Cyberbullying Tactics: An Introduction. The Forensic Examiner, Summer 2012, pg. 20-22. • Nuccitelli, M. 2012. Cyberbullying Tactics: The Forensic Examiner, Fall 2012, pg. 24-27. • Olweus, D. 1991. Bully/victim problems among school children. The Development and Treatment of Childhood Aggression , pg. 411-448. • Rigby, K. (1997). What children tell us about bullying in schools . Children Australia, 22(2), 28-34. • Sivashanker, K. 2013. Cyberbullying and the Digital Self. JAACAP, 52(2), 113-15. • Supervision provided by Manuella Zisu, MD

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