Meg Barbor, MPH

October 25, 2017

NEW ORLEANS ― Approximately 10 million children in the United States have access to the Internet, and 1 in 5 children are solicited for sex online. These disturbing statistics have brought recent attention to the threat of "cyberstalking," the use of Internet media to follow, watch, or communicate with someone who does not desire it, often a child.

"What makes cyberstalking different from bullying or harassing is the presence of a credible threat," said Paul Elizondo, MD, DO, clinical psychiatry fellow at the University of California, San Francisco, speaking here at the Institute of Psychiatric Services (IPS): The Mental Health Services 2017 Conference.

Cyberstalking is particularly dangerous to children, because the perpetrators are typically older. In contrast, cyberbullying typically occurs between peers.

A study from Tokyo revealed that almost 50% of children in grades 1 to 3 use the Internet. By grade 9, that number rises to 93%, and 40% use communication sites such as chat rooms. Dr Elizondo said these statistics are nearly identical to US statistics.

In 2009, the Bureau of Justice Statistics identified 5.3 million cases of cyberstalking or harassment (including cases in which the victims were adults). Many of these cases were never investigated. "That speaks to the nature of cyberstalking," said Dr Elizondo.

"There's a lot of anonymity and a lot of difficulty investigating it in the first place. This is one tension point when it comes to making laws and executing statutes," he added.

"It's also been argued that the credible threat involved in cyberstalking is not as credible when it's over the Internet, but in reality, it's a medium for perpetuation," he continued. "Cyberstalkers can take it offline, and the cycle is more easily perpetuated by the fact that we have this very easily accessible medium in the Internet."

Unlike physical stalking, cyberstalking is not bound by borders or geographical location. The average physical stalker is between 30 and 42 years of age; the male-to-female ratio is 9:1. About half of cyberstalkers are younger than 25 years; the male-to-female ratio is 3:1. Cyberstalkers are much more likely to be strangers, and boys and girls are at equal risk of being targets of cyberstalking. One in 5 youth are victims of cyberstalking, whereas 1 in 22 youth are physically stalked. There are more female victims of cyberstalking than male victims.

Dr Elizondo noted that federal laws regarding cyberstalking are not comprehensive enough, and there are often obstacles to the implementation of those laws. State laws vary and are inconsistent and arbitrary.

Caitlin Costello, MD, child and forensic psychiatrist at the University of California, San Francisco, who was co-chair of the session, said, "Teenagers are sharing a lot of their personal information online, and they're not very concerned about what happens to that information." This makes them easy prey for cyberstalkers. A Pew Research Center survey in 2015 found that only 9% of teenagers said they were "very concerned" about third-party access to their personal data, and 39% admitted to having lied about their age online.

Outdated Protection Law

The Children's Online Privacy Protection Act ― a federal law passed in 2000 that requires parental consent for the collection or use of personal information about children younger than 13 years ― is now outdated.

At the time the law was enacted, the concern was not about children disclosing private information that might be accessed by someone who would do them wrong. Rather, the concern was about marketing to children, she said.

The law only applies to children younger than 13, because it was thought that persons that age would more likely be "tricked" by online marketers. This is why many social media sites use age 13 years as the minimum age for participation. However, children can easily bypass this firewall on most sites simply by entering a date of birth different from their own.

In 2007, the Child Online Protection Act, which had been passed in 1998, was ruled unconstitutional by the Third US Circuit Court of Appeals. "The bind that the federal government is in is that they're trying to protect First Amendment rights while also protecting kids," said Dr Elizondo. "There's already been one failure in passing a law that could potentially protect kids from cyberstalkers."

Cyberstalking laws vary greatly from state to state. In Florida, if a victim is younger than 16, cyberstalking is a third-degree felony. In Missouri, it is a felony if the perpetrator is aged 21 years or older and the victim is aged 17 or younger, and in Tennessee, it's a felony if the victim is younger than 18, but only if the perpetrator is at least 5 years older than the victim.

In Louisiana, physical stalkers are required to undergo psychiatric evaluation, but cyberstalkers are not.

"It's important to also think about the cyberstalker's mental health needs, because we want to reduce recidivism," said Dr Elizondo.

Perpetrators and victims of cyberstalking can, and often do, reside in different states ― a fact that underlines the urgent need for more consistency in the law. "It's not just difficult to investigate, but it's also difficult to prosecute," he explained. If the law does not explicitly state that a certain county will prosecute a particular cyberstalking incident, it may go uninvestigated and unprosecuted.

The Process

When cyberstalking goes offline, sexual abuse can occur. Dr Elizondo outlined one process through which this can happen.

  1. Profiling: Using spyware ― so-called Trojan horse software, or "sniffers" ― the cyberstalker eavesdrops on a child's online activity and views their files. They then access historical and demographic data to gauge vulnerability. Of note to mental health providers, risk factors for susceptibility to "grooming" include low self-esteem, social alienation, poverty, family dysfunction, being physically attractive, having a history of behavioral or emotional problems, and being a teenager (because teenagers are more mobile and independent).

  2. Initial prosocial contact: The cyberstalker gains affection and trust by sharing personal interests and stories.

  3. Desensitization: The perpetrator starts talking about sex in a nonchalant way or sending sexually suggestive images to gauge whether or not the victim might engage in sexual activity.

  4. Meeting established: A meeting is planned, and money is provided wirelessly. When meeting in person, the perpetrator might casually touch the victim.

  5. Sexual abuse occurs.

  6. Evasion of consequences: The cyberstalker attempts to conceal the abuse.

Have "The Cyberstalk Talk"

"There's a lot of shame in this," said Dr Elizondo. Children who are victims of cyberstalking often feel as though they were involved and contributed to the poor outcome by doing something they weren't supposed to. They worry they might be monitored or be faced with restrictive consequences if they disclose what happened.

Mental health care providers should talk to parents about how to have the "cyberstalk talk" with their children, he said. When addressing this sensitive topic, curiosity and self-blame should be normalized, and anxious and sad feelings should be validated. He advised that providers talk about safety and potential restrictions with a warm affect, rather than an intimidating one, and advise children about mental and physical health risks. He also advised healthcare providers to be aware of relevant laws and to know where to report infringements.

Dr Elizondo also advised mental health care providers to take a thorough history with collateral, refer, and provide appropriate care on the basis of their diagnosis. In addition, he advised that providers know their legal obligations to document and report cyberstalking incidents. "It's reasonable to use your clinical judgment and report, even if it's not explicitly the law in a certain state," he said. "Err on the side of caution."

Dr Elizondo and Dr Costello have disclosed no relevant financial relationships.

Institute of Psychiatric Services (IPS): The Mental Health Services 2017 Conference. Presented October 19, 2017.

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