(187) Symptoms of Discord: Case Series Highlighting Mental Health Impacts of the Popular Messaging App

Abstract:
Introduction 



Previous literature has examined the relationship between mental health and various social media platforms but there is limited investigation of the messaging app Discord despite its popularity with 560 million registered users (Statista, 2024). We discuss two patients admitted for suicidal ideation for whom Discord use was cited as a significant stressor.  



Case 1 



A 12-year-old female with a history of PTSD and MDD was admitted to an inpatient psychiatric unit after a suicide attempt by overdose on venlafaxine. Patient reported she had been a victim of bullying on Discord and her family could not report the bullying at school because the users on the app were pseudonymous. Patient’s mother stated patient had received messages encouraging suicide. 



Case 2 



A 16-year-old female with a history of MDD and GAD was admitted for suicidal ideation. Patient reported being a victim of bullying on Discord and parents described these messages as “inflammatory.” Users had been encouraging patient to research criteria for psychiatric diagnoses and to endorse certain symptoms to be admitted to a psychiatric unit. Parents cited concern regarding their difficulty monitoring patient’s devices. Patient reported that they planned to continue using Discord because the app was “the only way I talk to people.”  



Discussion 



Discord differs from its contemporaries in that it blends pseudonymous messaging and content consumption; smaller groups are a facsimile of text messages whereas large groups contain a stream of posts submitted by users. The lack of accountability and deindividuation on internet platforms can contribute to “digital aggression” and cyberbullying (Kim, 2023). Both patients in this case were encouraged to commit suicide or pursue admission, echoing the “Blue Whale” game that resulted in number of cases of self-harm (Lupariello, 2019). Outside of bullying, mere exposure to disturbing or violent content in poorly moderated Discord groups could incite suicidal ideation in at-risk adolescents (Thompson, 2023). Discord has implemented parental controls; however, the limitations of these measures have drawn criticism and implementation remains unclear (Porter, 2024).  



Conclusion 



Although it lacks the infinite feed of algorithm-driven content common among most social media platforms, Discord appears to share the implications for mental health symptoms among adolescents.  In addition to assessing social media use in adolescents with behavioral health concerns, CL psychiatrists should inquire about use and interactions on messaging platforms such as Discord.  



References 

1. 
   1. Statista. (February 21, 2023). Number of registered Discord users worldwide from May 2017 to January 2023. Statista. Retrieved March 28, 2024, from https://www.statista.com/statistics/1367922/discord-registered-users-worldwide/ 
   

2. 
   Kim, M. et al. "Anonymity and its role in digital aggression: A systematic review." Aggression and violent behavior (2023): 101856.  
   

3. 
   2. Lupariello F et. al. Self-harm Risk Among Adolescents and the Phenomenon of the "Blue Whale Challenge": Case Series and Review of the Literature. J Forensic Sci. 2019;64(2):638-642.  
   

4. 
   3. Thompson TJ et al. Homicidal Ideation in Adolescents After Viewing Jeffrey Dahmer Netflix Drama. Prim Care Companion CNS Disord. 2024;26(1):23cr03577. Published 2024 Jan 23. 
   

5. 
   4. Porter S. The Many Dangers of Discord for children. National Center on Sexual Exploitation. March 4, 2024. https://endsexualexploitation.org/articles/the-many-dangers-of-discord-for-children/. 
   

Presentation Eligibility: Not previously published or presented

Diversity, Equity, and Inclusion: Technology use and access among children has historically been described using the "digital divide" model; however, as technology and social media use becomes more widespread a new gap is emerging. Families in lower socioeconomic groups may not have the bandwidth to teach healthy technology habits and higher levels of difficulty with boundaries around technology use. For further reading, see Mollborn S, Limburg A, Pace J, Fomby P. Family Socioeconomic Status and Children's Screen Time. J Marriage Fam. 2022 Aug;84(4):1129-1151. doi: 10.1111/jomf.12834. Epub 2022 Apr 22. PMID: 36211640; PMCID: PMC9541918.