In June 2014, numerous news outlets told the chilling story of 2 Wisconsin preteens who had lured their best friend into the woods and stabbed her 19 times. When asked why, these girls reported that the internet meme “Slenderman” drove them to do it.
Following this horrific crime, the typical questions of how and why were asked, but soon came another question: Was the internet, in fact, an accomplice? Had their online activity led to a blurring of fiction and reality in such a way that had allowed them to commit attempted murder?1
This case revives a long-standing debate: Does media exposure influence acts of violence in youth? Recently, the American Psychological Association Task Force re-reviewed the existence of a potential link between violent video game exposure and acts of real-life violence.2 The authors examined the literature from 2009 to 2013 and concluded:
Consistent with the literature that we reviewed, we found that violent video game exposure was associated with: an increased composite aggression score; increased aggressive behavior; increased aggressive cognitions. . . . Our task force concluded that violent video game use is a risk factor for adverse outcomes, but found insufficient studies to examine any potential link between violent video game use and delinquency or criminal behavior.2
Video games are only a small part of the wide expanse of media readily accessible to youths throughout the day. While teenagers engage in an average of over 6 and a half hours of screen time daily (including social media and online videos), the average daily time spent playing video games was just 56 minutes for boys and 7 minutes for girls.3 With adolescents attached to their devices for so much of the day, what should the practicing psychiatrist know about a potential connection between aggressive behaviors and online activity?
There is limited research to indicate that an increased number of hours on social media correlates directly with aggressive behavior, but there is literature that connects certain types of internet use to increased aggressive behavior. For example, quality of online exposure may be contributory; youths who perpetrated serious crimes were significantly more likely to have viewed violent online content.4 Moreover, similar to the way media coverage of suicide can act as a contagion for “copycat” suicides,5 there is also evidence that some mass killings may be influenced by other violent acts in the immediate past.6 Now that the internet provides unfettered access to images of real-life violence—eg, recent videos of murders and gang violence uploaded to Facebook Live—overall exposure to, and potential for, copycat violence may be increased.
1. Jones A. The girls who tried to kill for Slenderman. Newsweek. August 13, 2014. http://www.newsweek.com/2014/08/22/girls-who-tried-kill-slender-man-264218.html. Accessed July 10, 2017.
2. Calvert SL, Appelbaum M, Dodge KA, et al. The American Psychological Association Task Force Assessment of violent video games: Science in the service of public interest. Am Psychol. 2017;72:126-143.
3 . Rideout V. The Common Sense Census: Media use by tweens and teens. Common Sense Media. https://www.commonsensemedia.org/research/the-common-sense-census-media-use-by-tweens-and-teens. Accessed July 10, 2017.
4. Ybarra ML, Diener-West M, Markow D, et al. Linkages between internet and other media violence with seriously violent behavior by youth. Pediatrics. 2008;122:929-937.
5. O’Carroll PW, Potter LB. Suicide contagion and the reporting of suicide: recommendations from a national workshop. United States Department of Health and Human Services. MMWR Recomm Rep. 1994; 43(RR-6):9-17.
6. Towers S, Gomez-Lievano A, Khan M, et al. Contagion in mass killings and school shootings. PLoS One. 2015;10. doi:10.1371/journal.pone.0117259.
7. Hahn C, Kim DJ. Is there a shared neurobiology between aggression and internet addiction disorder? J Behav Addict. 2014;3:12-20.
8. Shapira NA, Goldsmith TD, Keck PE, et al. Psychiatric features of individuals with problematic internet use. J Affect Disord. 2000;57:267-272.
9. Kim K. Association between internet overuse and aggression in Korean adolescents. Pediatr Int. 2013;55:703-709.
10. Lim JA, Gwak AR, Park SM, et al. Are adolescents with internet addiction prone to aggressive behavior? The mediating effect of clinical comorbidities on the predictability of aggression in adolescents with internet addiction. Cyberpsychology Behav Soc Netw. 2015;18:260-267.
11. Ko CH, Yen JY, Liu SC, et al. The associations between aggressive behaviors and internet addiction and online activities in adolescents. J Adolesc Heal. 2009;44:598-605.
12. Liu TC, Desai RA, Krishnan-Sarin S, et al. Problematic Internet use and health in adolescents: data from a high school survey in Connecticut. J Clin Psychiatry. 2011;72:836-45.
13. Blitstein JL, Murray DM, Lytle L, et al. Predictors of violent behavior in an early adolescent cohort: similarities and differences across genders. Heal Educ Behav. 2005;32:175-194.
14. Zhou Y, Lin F, Du Y, et al. Gray matter abnormalities in internet addiction: a voxel-based morphometry study. Eur J Radiol. 2011;79:92-95.
15. Yuan K, Qin W, Wang G, et al. Microstructure abnormalities in adolescents with internet addiction disorder. PLoS One. 2011;6:e20708.
16. Altbäcker A, Plózer E, Darnai G, et al. Problematic internet use is associated with structural alterations in the brain reward system in females. Brain Imaging Behav. 2016;10:953-959.
17. Morioka H, Itani O, Osaki Y, et al. The association between alcohol use and problematic internet use: a large-scale nationwide cross-sectional study of adolescents in Japan. J Epidemiol. 2017;27:107-111.
18. Lee BH, Lee HK. Longitudinal study shows that addictive internet use during adolescence was associated with heavy drinking and smoking cigarettes in early adulthood. Acta Paediatr Int J Paediatr. 2017;106:497-502.
19. Younes F, Halawi G, Jabbour H, et al. Internet addiction and relationships with insomnia, anxiety, depression, stress and self-esteem in university students: a cross-sectional designed study. PLoS One. 2016;11:e0161126.
20. Jang KS, Hwang SY, Choi JY. Internet addiction and psychiatric symptoms among Korean adolescents. J Sch Health. 2008;78:165-171.
21. Yen JY, Ko CH, Yen CF, et al. The comorbid psychiatric symptoms of Internet addiction: attention deficit and hyperactivity disorder (ADHD), depression, social phobia, and hostility. J Adolesc Health. 2007;41:93-98.
22. Kross E, Verduyn P, Demiralp E, et al. Facebook use predicts declines in subjective well-being in young adults. PLoS One. 2013;8:1-6.
23. Shakya HB, Christakis NA. Association of Facebook use with compromised well-being: a longitudinal study. Am J Epidemiol. 2017;185:203-211.
24. van den Eijnden RJJM, Meerkerk GJ, Vermulst AA, et al. Online communication, compulsive internet use, and psychosocial well-being among adolescents: a longitudinal study. Dev Psychol. 2008;44:655-665.
25. Pantic I, Damjanovic A, Todorovic J, et al. Association between online social networking and depression in high school students: behavioral physiology viewpoint. Psychiatr Danub. 2012;24:90-93.
26. Ioannidis K, Chamberlain SR, Treder MS, et al. Problematic internet use (PIU): associations with the impulsive-compulsive spectrum. An application of machine learning in psychiatry. J Psychiatr Res. 2016;83:94-102.