Megan Moreno, MD, MSEd, MPH

Cyberbullying, sometimes referred to as electronic victimization, is a public health concern in the Internet age and has been associated with multiple negative mental health outcomes. It remains under-recognized among college students; however, it is not surprising that cyberbullying occurs in college, given that college students are among the most frequent users of digital technology.

Cyberbullying among college students may represent a continuation of behaviors from middle and high school but in new contexts. Aggressors may use more subtle attacks that are meant to exclude or leverage power over others rather than being overtly aggressive. Prominent components of cyberbullying in college can include electronic criticisms of identity, sexual harassment, and “outing” of private information such as sexual orientation or health diagnoses without consent (eg, sexually transmitted infections, psychiatric conditions). These behaviors are considered in the context of a spectrum of aggressive behaviors that are typical concerns on college campuses, such as intimate partner violence and physical and sexual assault.

In addition, the alarming issue of students bullying faculty members has been anecdotally described.

 Several campuses have debated banning the location-based, anonymous app Yik Yak following postings of abusive content about faculty and students.

College students are an important population on which to focus regarding cyberbullying because older adolescence can be formative for habits that persist into young adulthood. Promotion of open dialogue and free speech is a hallmark of the college experience; however, heated online debates have the potential to devolve into personal attacks and harassment. Bullying behaviors that attack college students’ identities may have a considerable impact, given that the undergraduate years are critical for adult identity formation.

The most concerning potential negative consequence of cyberbullying is suicide, which has been reported in mainstream media but not empirically studied in college students. One notable example is that of Tyler Clementi, a young man who died of suicide following the spread of derogatory content regarding his sexuality through social media by his college roommate.

 There is no current research published about actual suicide attempts or completion among college students involved in cyberbullying.

A few studies have examined the negative health sequelae of cyberbullying among college students. In a study of college students who were members of fraternities or sororities, behavioral characteristics of those involved in cyberbullying included callous, unemotional traits (reflective of sociopathy).

 Moreover, both perpetrators and victims had increased depressive symptoms and fewer social skills.

Two other studies suggest increased depression, anxiety, and suicidality in victims of cyberbullying and depression and alcohol abuse in perpetrators.

 Among younger adolescents, cyberbullying has been associated with suicidality, depression, substance abuse, somatic symptoms, and school problems.

Reactions to cyberbullying can include feelings of depression and suicidality or feelings that may be less extreme, such as transient distress, embarrassment, and sadness.

 In addition, bullying in college may be either electronic or face to face. Regardless, it is important to consider potential negative sequelae of cyberbullying because depression and alcohol use are already among the most common and consequential health concerns for college students.

 Given the high prevalence of depression and alcohol abuse in this population, examination of risk factors is crucial for prevention of morbidity and mortality.

When a student presents for mental health care, screening for bullying or harassment can uncover key stressors that can be targeted in treatment (

). Students may not recognize a behavior as “bullying” because they may consider it to be childish or more “extreme” than their own situation.

The roles of aggressor and target are not always static. They may reverse over time, and the cyberbullying victim may choose to become an aggressor in response to the experience. Although it may seem counterintuitive, consider the aggressor as vulnerable. Adverse mental health outcomes are common not only in victims of bullying but also in the perpetrators. Research shows that aggressors may be even more at risk.

 If a student discloses that he or she is perpetrating the cyberbullying, explore potential triggers and alternate coping mechanisms for anger and distress in a nonjudgmental way.

Recognize that cyberbullying may be just one step along the continuum of aggression. It may be taking place in the context of other forms of aggression, such as sexual harassment; or it may escalate to include offline behaviors. When you see patients involved in cyberbullying, continue to screen for escalation of experiences and behaviors to include other types of aggression. Assessment for antisocial traits and actions may aid in decisions about subsequent pharmacologic therapy for aggressive behavior.

While many middle and high schools have policies regarding consequences for bullying, such policies are rare at universities or colleges, where free speech and adult responsibility are priorities. However, most colleges consider harassment and discrimination to be unacceptable; thus, look to campus policies and consult with an ombudsperson if a student is struggling with bullying. If threats have been made that make you concerned about a student’s safety, use campus security resources as appropriate.

Mental health providers are limited in the number of individual students they can reach, but they have a powerful voice when advocating for positive, prosocial use of technology on campus, and they have allies in the students. Social media can be a platform for disclosure of mental health concerns-resident advisors can be trained to recognize “calls for help” on social media (eg, suicidal statements). And students can be educated to watch out for one another and stand up for peers if they see someone being bullied or harassed.

The undergraduate years represent the last opportunity to provide institutional support to prevent and intervene with bullying behavior. College leadership should recognize that if left unchecked, bullying tendencies may continue into the adult workplace. Workplace bullies are often characterized as manipulative and are described as using subtle techniques that are not necessarily openly hostile; such characteristics bear similarities to those of cyberbullies. As such, kindness, respect, and support of peers should be among the skills that young adults take away from college when they graduate.

Cyberbullying can be best understood as a form of behavior along the spectrum of campus aggression and violence. Clinicians caring for college students who report episodes of cyberbullying should recognize the links between these experiences and other health concerns, such as depression and alcohol use. Future research should focus on a better understanding of the connection between cyberbullying and other types of campus aggression, as well as interventions for those who experience cyberbullying as a victim or perpetrator. Clinicians have a powerful voice that can be used to address cyberbullying, improve campus climate, and support a positive undergraduate experience to set undergraduates on a course for success in adulthood.

http://www.stopbullying.gov/cyberbullying/index.html

•  The JED Foundation. Promoting Emotional Health and Suicide Prevention: 

Dr Selkie is Clinical Lecturer in Adolescent Medicine at the University of Michigan in Ann Arbor. Dr Moreno is Associate Professor in Adolescent Medicine at the University of Washington/Seattle Children’s Hospital and Principal Investigator, Social Media and Adolescent Health Research Team. The authors report no conflicts of interest concerning the subject matter of this article.

 Mahler J. Who spewed that abuse? Anonymous Yik Yak app isn’t telling; 2015.

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Clinicians have a powerful voice that can be used to address cyberbullying, improve campus climate, and support a positive undergraduate experience.

Megan Moreno, MD, MSEd, MPH

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