Discord and Distress: Cyberbullying and Adolescent Mental Health

Social media platforms have been under scrutiny for their implication in exacerbating the ongoing mental health crisis among children and adolescents.¹ The relationship between the ubiquitous² use of these social media services has entered the mainstream consciousness and raised alarm, going as far as to spur government action.³ Previous studies have examined the relationship between mental health symptoms and use of Facebook, X, Instagram, Snapchat,⁴ and TikTok,⁵ but there is limited literature investigating Discord despite its popularity with 560 million registered users.⁶ We will discuss 2 patients admitted to an inpatient psychiatric unit for suicidality who cited interactions with users on Discord as a significant stressor contributing to their presentation.

Case Reports

Case 1. A 12-year-old girl with a history of posttraumatic stress disorder and depression was admitted to an inpatient psychiatric unit after a suicide attempt by overdosing on venlafaxine. She endorsed multiple depressive symptoms and suicidal thoughts that were precipitated by bullying on the messaging app Discord. The patient’s mother reported that she found messages received by the patient that had encouraged her to attempt suicide and that their attempts to report the bullying to the school were futile because the offending users on Discord were pseudonymous.

The patient reported she felt that social media use, specifically Discord, had a negative influence on her symptoms due to rumors that had been started about her. She noted that although her parents believed TikTok was “bad,” she found that scrolling TikTok distracted her from negative thoughts and helped her calm down. Prior to discharge, the patient proposed a solution of exiting certain group chats on Discord and giving her cellphone to her parents after curfew hours to mitigate her difficulties related to social media.

Case 2. A 16-year-old girl with a history of major depressive disorder and generalized anxiety disorder was admitted to an inpatient psychiatric unit for worsening depression and suicidal ideation. The patient stated that she did not feel that social media had impacted her depression symptoms and that she took breaks from TikTok and Reddit to avoid the negative content that typically appeared in her algorithmic feeds. The patient reported she was a victim of significant bullying on Discord and had exited several Discord groups related to hobby interests due to bullying. The patient’s parents described messages she received on Discord as “inflammatory” and cited difficulty monitoring the patient’s multiple devices at school and at home. They stated that Discord users had been encouraging the patient to research criteria for psychiatric diagnoses and to endorse certain symptoms to health care providers to be admitted to an inpatient psychiatric unit.

When asked about her intentions regarding use of social media and messaging apps upon returning home, the patient proposed continuing the previous plan of taking breaks from scrolling-based social media apps. She stated that she intended to continue using Discord, explaining that she enjoyed connecting with friends from school as well as people from around the world. She stated that Discord was “the only way I talk to people.”

Discussion

Popular social media platforms including Facebook, Instagram, YouTube, X, and TikTok provide users with a continuous stream of algorithmically curated content. Discord differs from its contemporaries in that it is first and foremost a messaging platform where pseudonymous users in chatrooms engage in conversation with others who they may or may not know offline. Smaller groups serve as a facsimile of group text messages, whereas large groups can be joined through a link or invitation. These larger groups are subdivided into channels surrounding different themes where users can send messages, post media, and voice chat.

Though Discord is surging in popularity among adolescents, it remains a blind spot for many parents, clinicians, and caregivers who are not among its target demographics. In this blind spot, it has not received the same scrutiny for possible deleterious effects on mental health as other platforms. The lack of accountability and deindividuation on internet platforms, especially those with anonymous or pseudonymous usernames, can contribute to “digital aggression” and cyberbullying.⁷ Both patients in these cases were encouraged to commit suicide or pursue admission, echoing the “Blue Whale” game that resulted in a number of cases of self-harm.⁸ Outside of bullying, mere exposure to disturbing or violent content in poorly moderated Discord groups could incite suicidal ideation in at-risk adolescents.⁹

Neither of the patients in these cases used Discord in isolation, and previous research has suggested that the use of a higher number of apps is associated with exacerbation of depression and anxiety symptoms.¹⁰ Perhaps unsurprisingly, both patients disagreed with their parents regarding the severity of their social media use and reported they found TikTok to be a source of comfort, largely contradicting reports and findings in the literature.^11–13

There are currently no validated screening instruments or treatments for problematic social media use.¹⁴ In the absence of well-validated guidelines or recommendations, we used motivational interviewing techniques to help patients and their families make decisions about patterns of technology use that minimized psychological or social distress.

Motivational interviewing, psychoeducation on behavioral addictions, and cognitive-behavioral therapy have shown efficacy in problematic social media and internet use.¹⁵ For cyberbullying, school and family-based interventions have the most empirical support.¹⁶ Small studies have suggested pharmacologic options, such as bupropion, may help with digital addiction, though further research is needed.¹⁷ Patients can also be referred to resources from the National Alliance on Mental Illness, American Academy of Pediatrics, Center for Humane Technology, and 12-step programs.^18–21

Conclusion

Although Discord lacks the feed of algorithm-driven content common among most social media platforms, it appears to share their risk of exacerbating mental health symptoms among adolescents. In addition to assessing general social media and internet use during history taking in evaluation of adolescents with behavioral health concerns, clinicians should also inquire about use and interactions on messaging platforms such as Discord.

Article Information

Published Online: December 26, 2024. https://doi.org/10.4088/PCC.24cr03797
© 2024 Physicians Postgraduate Press, Inc.
Prim Care Companion CNS Disord 2024;26(6):24cr03797
Submitted: June 26, 2024; accepted October 30, 2024.
To Cite: Thompson TJ, Munjal S. Discord and distress: cyberbullying and adolescent mental health. Prim Care Companion CNS Disord. 2025;26(6):24cr03797.
Author Affiliations: Department of Psychiatry and Behavioral Medicine, Atrium Health Wake Forest Baptist, Winston Salem, North Carolina (Thompson, Munjal).
Corresponding Author: Tyler J. Thompson, MD, Department of Psychiatry and Behavioral Medicine, Atrium Health Wake Forest Baptist, 1 Medical Center Boulevard, Winston Salem, NC 27157 ([email protected]).
Relevant Financial Relationships: None.
Funding/Support: None.
Patient Consent: Parental permission was obtained to publish the case reports, and information has been de identified to protect anonymity.