Cyberbullying: an Update on Intimidation in the Digital Playground

By Arshya Vahabzadeh, M.D.

Follow @VahabzadehMD

American Psychiatric Association Leadership Fellow

Resident Physician in Child and Adolescent Psychiatry at MGH/McLean/Harvard Medical School

What is cyberbullying?

Cyberbullying is bullying, intimidation, and harassment that happens with the aid of electronic technology. Cyberbullying can happen through text messaging, social media, and emails. The boundaries of cyberbullying continue to expand as new communication technologies emerge.

Cyberbullying is emerging as a major problem, with new research from the Bureau for Justice Statistics revealing that 9% of teenagers aged 12-18 have reported being cyberbullied in a given year.

Female students are more likely to experience cyberbullying. The most common forms of cyberbullying include harassment by text or instant messaging, or the posting of hurtful information on the internet. Despite the high levels of cyberbullying, an adult is notified in only a quarter of cases.

How is cyberbullying different than traditional bullying?

Cyberbullying can continue 24 hours a day and is not dependent on location. While traditional bullying often requires the physical presence of a bully, a child can be cyberbullied at anytime and anywhere they are in contact with communication technology, including their own cell phone. There may be no “safe” zone and this may intensify the level of distress that the cyberbullying can produce.

Material such as digital pictures, text messages, or social media posts designed to hurt an individual can be rapidly distributed to a large group of people. Often it is difficult to find out the source of the information, giving a degree of anonymity to the cyberbully.

Harassing and intimidating material, once distributed through digital means are also much more difficult to remove. Often videos or pictures may stay indefinitely available through digital means.

What are the effects of cyberbullying?

People who are cyberbullied are thought to be at risk of the same consequences of traditional bullying. These effects include increased depression, decreased self-worth, hopelessness, and loneliness. There is some evidence to suggest that being cyberbullied may result in suicidal feelings in 20% of teenagers, a higher rate than in traditional bullying.

What can we do about cyberbullying?

Promote Good Digital Habits

• Keep your children informed about the risks of the technology they are using.
• Engage your children in a discussion on how to best deal with cyberbullying by formulating a plan for dealing with text messages or other digital content that is upsetting to them. Children should be made to feel as comfortable as possible in discussing their experiences with trusted adults.
• Review and teach them about privacy settings for digital media. Talk to them about limiting the amount of private information they share about themselves.
• Tell children to keep their passwords safe and not to share them with friends or people they don’t know.

Take Action

• Approach a child if you notice signs of changing behavior, especially if it is happening when they are using the computer, their cell phone, or any other communication device.
• Consider discussing the situation with the suspected bullies’ parents, the child’s school, and other organizations they may be involved in.
• Identify and archive the cyberbullying material, it may be useful when contacting the Internet service provider, cell phone company, or in severe circumstances, the police.
• Consider closing down targeted social media accounts or changing cell phone numbers.
• Some cyberbullies thrive on obtaining a reaction, avoiding replying to messages or engaging with the cyberbully may also be useful in some situations.

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Where can I get more information?

More on cyberbullying from stopbullying.gov and girlshealth.gov  and onguardonline.gov

More on bullying

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What You May Not Know about ADHD

By Ahmed Khan, MD 
@AhmedRazaKhanMD

Attention-Deficit/Hyperactivity Disorder (ADHD) is an illness that affects many people living in this country. It's reported that 7-10% of Americans have ADHD - a disorder that alters one’s attention and concentration in a negative manner. 

Oftentimes, parents and children conceptualize this lack of attention and concentration leading solely to problems at work and school. Unfortunately, ADHD has a number of adverse health outcomes that you may not be aware of. Hopefully my post will help you understand the various adverse health outcomes associated with ADHD.

Substance Use and Smoking: Several studies show a significantly increased rate of substance abuse disorders and smoking in patients with ADHD. This could be due to the increased impulsivity apparent in many people with ADHD.

Sleep Problems: It's pretty clear that ADHD leads to dysregulation of sleep. This is often displayed by resisting sleep at bedtime, difficulty falling asleep once in bed, and problems awaking in the morning.

Car Accidents: Did you know people with ADHD have a higher risk of traffic violations and car accidents? Some studies found this to be due to increased risk-taking behavior and poor frustration tolerance.

Physical Injuries: Studies have also revealed children with ADHD can have almost twice the injury rate as those without it (20.4% vs. 11.5%). A study looking at an insurance data base of over 100,000 people, from children to adults aged 64, found that those with ADHD had 1.55 times greater chance of injury versus those without ADHD.

Risky Sexual Activity: Studies suggest that the impulsivity, poor self-esteem, and risk-taking behaviors that are prevalent in people with ADHD can lead some to engage in risky sexual behavior and increase their risk of receiving and transmitting sexually-transmitted diseases.

Obesity: There is no direct correlation between ADHD and obesity yet, but some studies show that children with ADHD are more likely to be obese than those without it. This could be due to various reasons, but researchers are looking at genetic similarities between the two conditions which could provide more insight in near future. 

So, did you learn something new about the often misunderstood ADHD? I hope my post provided you with a better idea of the toll that ADHD can take on one's life. With a thorough diagnosis and proper treatment by a trained psychiatrist, a person with ADHD can greatly limit these adverse events and, many times, avoid such negative health issues all together. 

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How to Help Loved One w/ Postpartum Depression?

By Nada Stotland, MD, MPH

Postpartum depression simply means depression occurring after childbirth---any time from days after to up to a year after the birth of a baby. 

When we diagnosis depression---at any time in life---we don't mean the kind of "down" mood everybody experiences from time to time. We mean a real disease that causes symptoms including interference with sleep and appetite; thoughts of death; guilt; lack of interest in the activities of life; inability to feel pleasure---every day for weeks. It's a very painful, but fortunately very treatable, disease. 

Depression is particularly painful for a mother with a new baby. People are often telling her that this should be the happiest time of her life, that she should appreciate her good fortune in being able to conceive and bear a child when many others have so much trouble. 

Other people---and even the new mother herself--may also confuse the symptoms of depression with the inevitable interruptions of sleep and meals by the demands of a newborn and the common concerns about being a good mother. 

It's important to distinguish postpartum depression from postpartum psychosis. Postpartum psychosis begins within days after birth. The new mother with postpartum psychosis is seriously agitated, unable to relax. She is haunted by irrational ideas about herself and the baby--ideas, for example, that God wants her to send the baby to heaven or that the baby is a devil of some kind---and sometimes by irresistible urges to harm the baby. Postpartum psychosis is rare; it occurs after far fewer than 1% of births. It is a medical emergency. 

When postpartum psychosis is suspected, the new mother must be seen immediately by a physician, preferably a psychiatrist. 

Postpartum depression seems to be caused by a combination of genetics, the abrupt changes in hormones after birth, physical exhaustion, and the strain of adapting to a new role and the reactions and demands of friends and family. Postpartum depression is often a continuation of depression that was present, but not recognized, during pregnancy. In our society, we take it for granted that we shower medical and social attention on the pregnant woman---frequent visits to the obstetrician, baby showers---when all she has to do for the baby is to take good care of herself. 

After her baby is born---when she is exhausted from labor and delivery and when she has responsibility for the 24/7 care of a helpless infant--all that attention falls away. She may live far away from supportive family members. She may either have to go back to work before she is ready, or may feel isolated, away from the familiar duties and social contacts of the workplace. Usually there are no postpartum visits from nurses, and quality childcare is expensive and hard to find. Postpartum depression, although it occurs everywhere in the world, may be more common in our country for those reasons (occurs in about 15% of U.S. births). 

Postpartum depression can be successfully treated with psychotherapy and/or medication. Group therapy reassures the new mother that she's not alone and others are going through same issues. Family and friends can play major roles in the new mother's recovery. They should remind her that she is not responsible for her depression, and she can recover from it. 

Helping with her baby can be useful, but it's not a good idea to take over baby care completely; that will just make her feel more inadequate. 

It's better to take care of the mother herself. Offer simple diversions, like an outing, but without expecting them to treat depression. We don't want to make her feel unappreciative. Sympathize with her grief over missing the joys of new motherhood. Remind her of all the lovely things she planned and did for the baby before it was born, and point out what a good mother she is working to be. 

Depression makes people feel helpless and hopeless, so she may need encouragement to get the professional care she needs. Friends and family can help by contacting her family physician or obstetrician and by locating a mental health professional available to treat the new mother. With proper care, she will probably start to feel better within a few weeks.

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