Cyberbullying: A 21st Century Health Care Phenomenon

Jemica Carter, PhD, RN; Feleta L. Wilson, PhD, RN, FAAN


Pediatr Nurs. 2015;41(3):115-125. 

In This Article


Nurses may be familiar with traditional bullying that has a physical outcome, but they know little about cyberbullying. To understand the phenomenon, viewing its relationship to traditional bullying is helpful. Definitions of traditional bullying found in the literature include negative physical and/or verbal actions by one or more aggressors against a weaker victim that occur repeatedly over time (Olweus, 1993, 2007). Cyberbullying, on the other hand, is an indirect form of bullying via electronic media. It is a form of relational aggression in which adolescents try to damage the social relationships or social status of their peers, which can be psychologically devastating for this age group (Young, Boye, & Nelson, 2006). Shariff and Gouin (2005) highlighted the acts involved:

It [cyberbullying] is verbal (over the telephone or cell phone), or written (flaming; threats; racial, sexual, or homophobic harassment) using the mediums available: cellphones, weblogs and websites, online chat rooms, "MUD" rooms (multi-user domains where individuals take on different characters), and Xangas (online personal profiles where adolescents create lists of people they do not like). (p. 3)

Although a distinct phenomenon, it is important to remember that cyberbullying can overlap or coexist with traditional bullying (Patchin & Hinduja, 2006; Raskauskas & Stoltz, 2007; Shariff & Hoff, 2007; Ybarra & Mitchell, 2004). Due to its adaptable nature, however, cyberbullying may be more dangerous than traditional bullying. The potential for cyberbullying increases with the advent of each new technology, computer network system, and electronic device that young people use to communicate. The ability of the bully to remain anonymous and use these electronic media at any place and time makes victims vulnerable and keeps them in a defenseless position even in their own homes (Raskauskas & Stoltz, 2007; Slonje & Smith, 2008; Ybarra & Mitchell, 2004).

Other substantial differences from traditional bullying exist. The latter behavior is often witnessed by small groups of students during approximate school hours in areas with limited or no supervision, such as playgrounds, hallways, bathrooms, school buses, or on the way to or from school (Patchin & Hinduja, 2006). In contrast, the use of technology to harass others can result in a larger audience witnessing the aggression (Breguet, 2007), with a substantial number of incidents occurring outside school hours (Agatston, Kowalski, & Limber, 2007; Slonje & Smith, 2008; Smith et al., 2008). Agatston et al. (2007) emphasized that cyberbullying can cause disruptions in the school environment even if it occurs offsite because harassment-related text and images are available to audiences 24 hours a day. Further, cyberbullying affords bullies the ability to remain anonymous or shield their identity behind screen names (Kowalski & Limber, 2007; Shariff & Gouin, 2005; Slonje & Smith, 2008). The Anti-Defamation League (ADL) (2009) has emphasized that effects of this form of aggression are "far and wide in an instant…and usually irrevocable" (p. 3).

Negative Outcomes Of Cyberbullying

In addition to symptoms of depression or emotional distress, other negative consequences of online harassment may present to the nurse in a clinical setting. For example, in their review of the literature, Patchin and Hinduja (2006) cited eating disorders as a manifestation of the stress that accompanies the cybervictim cyberbully experience. Online sexual solicitation, although distinct from online bullying, has been reported in relation to victims' experience of online harassment (Shariff & Hoff, 2007; Ybarra, Espelage, & Mitchell, 2007). Youth who present to the nurse with symptoms that appear related to bullying victimization (i.e., emotional distress, including fear or anger) or sexual exploitation should be questioned about their personal technology habits.

Prevalence of Cyberbullying in Adolescence

The prevalence of cyberbullying in adolescence has been steadily reported in the 21st century. An early investigation was conducted by the United Kingdom's Action for Children (2002) (formerly National Children's Home). Researchers surveyed 856 adolescents between the ages of 11 and 19 years and found 16% had been bullied via text messaging, 7% through Internet chat rooms, and 4% via email. In Canada, Li (2007b) examined the prevalence of cyberbullying among 177 adolescents in the 7th grade. Li (2007b) reported 23% had been bullied by email, 36% in chat rooms, and 41% by cell phones, with some students bullied by combination tactics.

Patchin and Hinduja (2006) conducted an Internet-based pilot study of 571 respondents between the ages of 12 and 20 years who completed a survey assessing their experiences with various types of cyberbullying. The ma jority of participants were Caucasian females younger than 18 years; 60% self-reported living in the United States (U.S.). The researchers found that 29.4% of the minor-age respondents reported be ing victims of online bullying, 10.7% reported being the bully, and 47.1% reported witnessing this aggression. Although more than half (56.6%) of the victims disclosed online bullying experiences to their friends, they were reluctant to report it to an adult. Due to the cultural secretiveness of bullying experiences, it is important for health care professionals to recognize the impact of cyberbullying among adolescents.

A recent study of bullying and cyberbullying prevalence indicates that both types of aggression continue to be entrenched in U.S. culture. Wang et al. (2011) found that 21.2% of youth who participated in a national survey (N = 7,313) reported an experience with physical bullying and 13.8% with cyberbullying. Thus, a substantial number of adolescents remain at risk for negative health outcomes and psychosocial problems related to cyberbullying incidents. Early assessment by nurses as well as intervention programs led by nurses and community leaders may help to counter the risk.

Public Advocacy Against Cyberbullying

Documented cases of public outrage have contributed to the introduction of proposed laws to address cyberbullying, but more attention is needed. The Megan Meier Cyberbullying Prevention Act was introduced in Congress in 2009; however, the bill was never enacted (GovTrack US, 2010). The introduction of the bill occurred in response to a teenager in Missouri who committed suicide in 2006 after being cyberbullied by an adult who had created a fictitious online identity as a 16-year-old boy. Several states have enacted cyberbullying laws in response to public outrage against cyberbullying and teenage suicide. Currently, 49 states in the U.S. have enacted anti-bullying laws, while 16 states have anti-bullying laws that include the term cyberbullying or cyber-bullying (Hinduja & Patchin, 2012).

In Healthy People 2020, the overall goal of the injury and violence prevention focus area is to "understand the trends, causes, and prevention strategies related to bullying, dating violence, and sexual violence among youth" (U.S. Department of Health and Human Services, 2012, p. 1). Nursing and educational researchers (Kiriakidis & Kavoura, 2010; Swartz, 2009) have emphasized the importance of addressing this problem in clinical settings, schools, and communities, along with the need to develop and implement comprehensive public health approaches to prevent cyberbullying.

In summary, cyberbullying and traditional bullying may coincide, and we do not know how fast cyberbullying is expanding. Prevalence in world populations has been noted, and the phenomenon has been studied in the U.S. (Juvonen & Gross, 2008; Ybarra et al., 2007), but absent in the literature are investigations of relations between access to and/or use of technology and experiences with traditional bullying and cyberbullying among adolescents in U.S. urban and suburban communities. The following questions guided the study:

  • To what extent do adolescents included in the study access technology (e.g., cell phones, email, computers) that can be used for cyberbullying?

  • To what extent do adolescents use technology on a daily basis?

  • To what extent do adolescents experience cyberbullying and traditional bullying?

  • To what extent do personal and academic characteristics influence traditional bullying or cyberbullying?