The Forensic Mental Health Implications of Social Media Challenges

Risk-Taking and the Developing Brain

There is a robust literature describing differences in risk-taking behavior across childhood and adolescence compared with adults.^27,–,29 Risk-taking is an important developmental task for adolescents because it helps them to develop intimacy, form identity, and meet goals proposed by their peer group that ultimately lead to peer acceptance. Neuroscientific research indicates that developing brains are more prone to impulsive risk-taking.³⁰ Because subcortical regions mature earlier than prefrontal cortical regions, there is a biologically plausible explanation for the increased risk-taking seen in adolescence.³¹ In particular, research suggests the dorsolateral prefrontal cortex, which is thought to have an important role in inhibitory control and executive functioning, does not mature until the early 20s.³² Neurobiological immaturity alone, however, cannot fully explain adolescent risky behavior, because if it did, younger children would have similar or even more risk-taking. Instead, for adolescents, the emotional reactivity from the comparatively more developed limbic system can dominate.²⁹

In addition to maturing executive functioning abilities, adolescents tend to have increased sensation-seeking, that is, the tendency to pursue exciting, novel experiences.³³ This increased sensation-seeking, seen in adolescents across nations and cultures, peaks at about age 19, but self-regulation abilities may not fully mature until the mid-20s.^33,34 Adolescents can also have heightened activation of the ventral striatum in response to reward-related cues at a level similar to adults, even while the level of inhibitory control in prefrontal regions remains more similar to that of children.³¹ This combination of increased reward sensitivity and a still-maturing cognitive control system is known as the “dual systems model” or maturational imbalance model.³⁵

Researchers have suggested that redefining adolescence as the developmental period from age 10 to 24 may correspond more accurately to the current understanding of biological maturation and social role transitions of this population.³⁶ These neurobiological and behavioral findings are also consistent with the age-crime curve, which demonstrates that the prevalence of offending peaks in late adolescence and declines after the early 20s.³⁷ This rapid neurobiological change also appears to be linked to the emergence of psychiatric disorders during adolescence.³⁸

Psychosocial Development in Adolescence

Adolescence, beginning with the “physiologic revolution” of puberty, presents the developmental tasks of exploring identity and expanding relationships with peers.³⁹ Social media sites provide a virtual forum for social connection and comparison, identity development, and peer feedback.⁴⁰ Participating in social media can be a way to explore, construct, and manage an autobiographical narrative of identity,⁴¹ even to the point of portraying one’s character online as a type of brand.⁴²

Adolescence has been described as a sensitive period for processing social interactions among peers.⁴³ Adolescents are particularly vulnerable to peer pressure in risky situations,²⁷ have increased risk-taking when in the presence of others rather than when alone,⁴⁴ and are especially reactive to acceptance or rejection on social media.⁴⁵ These factors lead to susceptibility to participate in social media challenges.

Children and adolescents may also have difficulty appreciating the potential lethality of social media challenges because of their limited understanding of mortality. Research beginning in the 1930s explored children’s understanding of death.⁴⁶ Nagy⁴⁷ elaborated by describing three stages: children ages three to five believe that death is temporary and a fainter form of life; between ages five and nine, children understand that death is final and can picture death as a person (such as a skeletal figure); and by age nine, children recognize death as inevitable, personal, and universal. This emerging understanding of death and a sense of invulnerability can fail to temper risk-taking in the process of an adolescent’s effort to establish identity.⁴⁸

Criminal Liability

Social media challenges that involve dangerous or destructive behavior may lead to arrests, prosecution, and other legal consequences.

The Devious Lick Challenge, where participants damage or steal items from schools, has resulted in student disciplinary action, orders for restitution, and criminal charges in some cases.⁴⁹ In response to the vandalism, TikTok announced that it would redirect the associated hashtags and remove the videos from their platform.⁵⁰

The Blue Whale Challenge encouraged participants to self-harm to the point of suicide.⁵¹ The name of the challenge derives from the idea that whales strand themselves on shore either accidentally or intentionally, and if unable to return to the ocean, they die.⁵² This challenge originated in 2013 in Russia and consisted of a series of 50 tasks that involved self-harm acts such as carving “f57” onto the arm. Participants verified completion of the tasks by sending a photo to the “curator” who organized the game and who would threaten to harm the player’s family if the challenges were not performed.⁵¹ The last component of the Blue Whale Challenge is to jump off a high building and die by suicide. In India, a public interest lawsuit petitioned the High Court of Delhi to direct social media companies to remove links to the challenge.⁵³ In 2017, Philipp Budeikin, a Russian psychologist considered to be the “founder” of the challenge and who described the participants as “biological waste,” was convicted of inciting two girls, ages 16 and 17, to die by suicide.^51,54 He received a prison sentence of three years.⁵⁴

The Slender Man Challenge, initially involving photography editing, expanded to an internet mythology that led to a crime. In 2009, Creepypasta communities, which are online groups that create and disseminate horror legends, began to describe the internet-derived legend of Slender Man, a faceless human-like figure who wears a black suit and preys upon children.^55,56 The Slender Man Challenge developed, which encouraged people to take photographs and edit the images to seem to capture the paranormal.⁵⁷ Videos about the Slender Man were posted on YouTube and other sites, and popular videogames such as Minecraft included characters based on Slender Man.⁵⁶

In a highly publicized case in 2014, two girls in Wisconsin were charged with attempted homicide in connection with the Slender Man legend.⁵⁵ According to public records and media reports, the two 12-year-old girls walked into the woods and repeatedly stabbed their friend with a kitchen knife. Their plan was that following the stabbing, they would walk hundreds of miles through the Nicolet National Forest to where they believed Slender Man's mansion was located. The girls thought that their families were endangered and that their friend’s death would serve as an initiation rite to protect them from Slender Man, who they believed had the capability to read minds and at will “explode tendrils from his back and strangle his victims.”⁵⁸

Multiple forensic psychiatrists and psychologists testified about the mental health of the defendants.⁵⁸ After separate trials, in 2017 and 2018, the court found that both girls were “Guilty but Not Guilty Due to Mental Disease/Defect.”^59,60 One of the girls was diagnosed with schizophrenia,⁵⁸ and received a sentence of 40 years in a psychiatric facility for first-degree attempted homicide.⁶⁰ The other girl was given a sentence of 25 years for second-degree attempted homicide and also committed to a psychiatric facility.⁵⁹

Civil Liability

Parties affected by social media challenges have filed related civil litigation. For example, in 2022, Kia and Hyundai owners filed a class action lawsuit against the auto manufacturers based on automobile thefts arising from the Kia Challenge.⁶¹ Social media users called the Kia Boyz posted videos demonstrating a method of bypassing security systems on Kia and Hyundai cars, leading to hundreds of car thefts.⁶² As of 2023, a proposed settlement of up to $200 million was being considered by the parties in court.⁶³

Social media companies have been the primary target defendants, but they have successfully defended suits. In another class action lawsuit, Greco v. TikTok, Inc., the school districts of seven states brought a public nuisance claim that TikTok challenges, including the Devious Lick Challenge, encouraged students’ vandalism. The court dismissed that case for lack of subject matter jurisdiction.⁶⁴

The Communications Decency Act, otherwise known as Title V of the 1996 Telecommunications Act,⁶⁵ has provided protections to social networking sites from legal liability arising from user-generated content. Section 230(c)(1) separates “interactive computer services” (e.g., social media platforms) from their users, who are described as “information content providers.” Section 230(c)(2) provides that platforms may not be liable for but may restrict user-generated material that is “lewd, lascivious, filthy, excessively violent, harassing, or otherwise objectionable…”⁶⁶ Although the Act was intended to regulate indecency on the internet, the fact that it also created legal immunity may have reduced the incentive for platforms to monitor and remove harmful content.

In Anderson v. TikTok, Inc.,⁶⁷ the plaintiff alleged that TikTok knew its algorithm specifically promoted the Blackout Challenge, resulting in the death of a 10-year-old girl who died by self-strangulation. Anderson brought claims under defective design and failure to warn, but in October 2022, the U.S. District Court for the Eastern District of Pennsylvania held that TikTok was immune under the Communications Decency Act and dismissed the claim.⁶⁷

In Smith et al. v. TikTok, Inc., the plaintiffs brought a wrongful death claim in Los Angeles Superior Court after an eight-year-old and a nine-year-old died from self-strangulation also during the Blackout Challenge.⁶⁸ Instead of targeting the social media algorithms, the plaintiffs brought claims of product liability, defective design, negligence, and failure to warn. The suit alleged that TikTok was aware that minors use the site without parental consent and in fact actively marketed the site to children and promoted dangerous social media challenges. The suit alleged that TikTok knew or should have known that their product was dangerous and defective in the context of deaths across multiple countries from the Blackout Challenge and yet did not take corrective action. The plaintiffs claimed that TikTok’s product design failed to account for the psychosocial immaturity and still-developing abilities of youth to evaluate risk, regulate emotion, and control impulses. The parents who brought the lawsuit pointed out they did not enter a user agreement or other contract with TikTok. The case remains pending.^69,70

Attempts to impose liability on social media platforms continue to be strictly limited by the Communications Decency Act. In February 2023, the Act came under review by the Supreme Court of the United States in Twitter, Inc. v. Taamneh.⁷¹ The Ninth Circuit Court of Appeals had agreed with the plaintiff that Twitter had aided and abetted a terrorist organization through its recommendation algorithms; however, the Supreme Court dismissed the claim on the grounds that there was an insufficient legal basis to impose culpability.⁷¹

Subsequently, in Gonzalez v. Google LLC,⁷² the Supreme Court of the United States considered similar questions. The Court vacated the Ninth Circuit’s ruling that allowed the claim for aiding and abetting terrorists and remanded the case to the Ninth Circuit to reconsider in light of Twitter, Inc. v. Taamneh.⁷¹ Together, these rulings severely limit the likelihood that plaintiffs can successfully impose liability on social media companies in the context of terrorism-related incidents. These restrictions indicate a trend which will likely restrict the breadth of cases in which forensic psychiatry evaluation is required.

Evolving Juvenile Sentencing Standards

As the legal landscape unfolds for those involved in social media challenges, juveniles require special consideration because of influences of development. The first state juvenile court was established in 1899; since then, there has been significant expansion of those courts.⁷³ In a series of decisions beginning with Roper v. Simmons in 2005,⁷⁴ the Supreme Court of the United States has reshaped sentencing of juveniles. These decisions incorporated emerging neuroscientific research and recognized that juveniles are fundamentally different from adults.

Roper held that a court could not sentence a juvenile to capital punishment.⁷⁴ The Court’s majority opinion noted juveniles engage in reckless behavior, are vulnerable to peer pressure, and have still-developing individual identity. Five years later, in Graham v. Florida,⁷⁵ the Court held it was unconstitutional to sentence a juvenile to life imprisonment without parole for a nonhomicide offense. In reaching this conclusion, the Court emphasized that a juvenile’s brain and ability to control behavior continue to mature throughout late adolescence.

In Miller v. Alabama in 2012,⁷⁶ the Court held it was unconstitutional to impose a mandatory sentence of life without parole on a juvenile, even in the case of homicide. The ruling described juveniles as having “an unfortunate yet transient immaturity” (Ref. 76, p 479). Specifically, Miller described five aspects of immaturity: “immaturity, recklessness, and impetuosity”(Ref. 76, p 472), particularly with decision-making and the ability to appreciate future consequences; dependency on family environment; susceptibility to peer pressure; lesser capacities to participate in legal proceedings; and greater potential for rehabilitation. Together, these are known as the “Miller Factors.” In 2016, Montgomery v. Louisiana⁷⁷ held Miller applies retroactively, prompting the resentencing of those currently serving life without parole.

Understanding the Digital Context

Currently, social media challenges and their consequences are largely unknown territory for many mental health professionals. With the rise of litigation resulting from injuries related to social media challenges, forensic psychiatrists and other mental health professionals may be called upon to evaluate individuals who are participants or victims in these cases.

Evaluators should first develop familiarity with the phenomenon of social media challenges. The next step is to determine the quality and extent of an evaluee’s involvement. Social media provides extensive digital collateral that may be important for assessing the evaluee’s social relationships. The format of social media sites, which often stores a timeline of events, provides a unique opportunity to assess the individual’s longitudinal digital history.

Evaluators can benefit from learning about the language of social media, which has its own style. Social media’s spoken and written language have unique features, such as abbreviations, deviations from standard spelling and grammar, emoticons, omission of words, and capitalization. Reference lexica are available, such as the Oxford Dictionary of Social Media.⁷⁸

The linguistics of social media are rapidly evolving, sometimes in response to specific online events. In 2020, a veteran livestreamed his own suicide on Facebook, and the footage rapidly spread to Twitter, TikTok, and other platforms.⁷⁹ TikTok attempted to remove the videos.⁸⁰ A year later, TikTok released a statement that when a user searches for specific phrases, like “#suicide,” TikTok would redirect the user to a crisis line or similar resources.⁸¹ TikTok users then adopted alternative terms such as “unalive” to refer to suicide and “d3pression” to refer to depression.⁸² Forensic psychiatrists should be aware of this “algospeak,” referring to code words or emoticons designed to circumvent the social media companies’ algorithms from detecting and removing this content.⁸³

Forensic mental health professionals evaluating minors should also be aware of laws pertaining to minors’ online activity.⁸⁴ For example, the federal Children’s Online Privacy Protection Act (COPPA)⁸⁵ requires parental consent to collect personal information from children younger than 13. The California law “Privacy Rights for California Minors in the Digital World,” also known as the “eraser button law,”⁸⁶ allows children younger than 18 to remove their own postings from child-focused websites.

Forensic evaluators should keep in mind that injuries from some challenges can be misclassified as related to self-harm when the injuries are actually accidental. For instance, the Salt and Ice Challenge involves participants putting a mixture of salt and ice on their bodies, which can result in tissue damage similar to frostbite; the injury may be mistaken for self-harm by burning.⁸⁷ Likewise, overdoses inspired by social media challenges can also be mistaken for suicide attempts. One case report described a 14-year-old girl who was first admitted to the emergency department following an accidental overdose of diphenhydramine while taking part in the Benadryl Challenge. She was subsequently admitted to a psychiatric inpatient unit. Then eight months later, the girl died from diphenhydramine toxicity in the context of this same challenge. The cause of death was determined to be accidental.²⁵ Without knowing about these types of social media challenges, a forensic mental health professional tasked with opining on the circumstances of such a death may be more likely to misclassify an accidental overdose death as a suicide.

Risk Assessment

For defendants of all ages, criminal courts consider risk for future violence in assessing diversion, placement, and disposition options, including waivers for juveniles to be sentenced in adult court. Neuroscientific research about developmental trajectories has been increasingly recognized by the courts.⁸⁸ Life-course-persistent deviant behavior is much less common than the pattern of adolescence-limited deviant behavior, which is considered normative.⁸⁹ The emerging science surrounding neurobiological immaturity that extends into the early 20s and the developing understanding of behavioral trajectories contrasts with the legal distinction made between juvenile and adult at age 18.

Neuroscientific research largely derives from cohort and population-based data about neuroanatomy and cannot necessarily be extrapolated to an individual case.⁹⁰ It may be necessary to inform the courts of this risk of making a group to individual inference.⁹¹ With these caveats, forensic experts can provide general information about brain development during adolescence and its implications, including greater potential for rehabilitation.

Validated instruments can provide standardized norms and aid with assessing cognitive and emotional capacities. Standardized measures are available, such as the Youth Level of Service/Case Management Inventory 2.0, which can evaluate both general and violent offending. This actuarial tool is designed to assess risk, need, and responsivity factors that can be considered for case management.⁹² Structured professional judgment measures, such as the Early Risk Assessment List for Boys (EARL-20B) and Girls (EARL-21G) and the Structured Assessment of Violence Risk in Youth (SAVRY) may also be used.⁹²

In the future, forensic evaluators may use validated psychometric measures derived from social media to characterize an individual’s personality structure and psychological characteristics. For example, Park et al. described a reliable method of assessing Big Five personality factors drawn from Facebook language samples that was on par with more traditional self-report questionnaires.⁹³

Legal and Ethical Considerations

Evaluating the electronic footprint of an individual’s social media presence is complex.⁹⁴ Privacy rights and regulations may dictate whether social media posts are available for examination. There may be a substantial amount of information for a forensic evaluator to review if an evaluee posts extensively across multiple social media platforms. Metadata, which is information about the context of digital data, such as creation date, geolocation details, or file ownership, may be an additional layer of information to consider. For instance, metadata may reveal when a post was deleted, and the evaluator could then interpret whether that deletion might reflect remorse, general editing, or an entirely different motivation. From a practical perspective, as technologies rapidly evolve and gather massive amounts of data, reconstructing a timeline of events on social media may be difficult, if not impossible.

More generally, forensic psychiatrists may grapple with the far-reaching consequences of opining that mental health was or was not an influencing factor. Especially when juveniles are involved, forensic evaluators may consider that diagnosing a psychiatric disorder may lead to mitigation and reduced sentencing, and not making that determination could lead to long-term incarceration for young defendants. Forensic evaluators, even in the absence of a treatment relationship, may grapple with balancing nonmaleficence and beneficence when the legal context may not reflect the current understanding of the neuroscience of developmental immaturity.

Forensic evaluators should be aware of potential legal obligations arising from exploring an individual’s social media history. For example, upon discovering suicidal behavior or threats, evaluators may need to conduct careful risk assessments and consider interventions such as a referral for nonforensic mental health services or emergency psychiatric care. The scope of actionable findings is dependent on the specific circumstances of potentially dangerous behavior noted online, the judgment of the evaluator who finds this information, and jurisdictional requirements. There is currently a lack of professional guidelines surrounding mandated reporting relating to social media posts. In the internet setting, it may be unclear who is being harmed and how to ascertain who the possible intervening parties might be.⁹⁵