Social Anxiety as a Consequence of Non-consensually Disseminated Sexually Explicit Media Victimization

Abstract

The purpose of this qualitative study was to explore consequences of the non-consensual dissemination of sexually explicit media (NCDSEM) for survivors, with an emphasis on how NCDSEM may impact social relationships and social anxiety. One-on-one telephone interviews with (N = 17) self-identified survivors of NCDSEM were conducted between May and December 2019. Interviews were analyzed using a flexible coding methodology. There were five main ways in which participants described consequences of NCDSEM: (a) fear of going out in public, (b) fear of engaging in relationships, (c) fear of applying to jobs, (d) fear of seeking help, and (e) influencing depression and feelings of anxiety. These findings suggest that, for some people, NCDSEM victimization may influence whether and how they subsequently socialize with other people.

Keywords

non-consensual pornography revenge pornography social anxiety social isolation image-based sexual abuse sexually explicit media abuse sexual violence

Introduction

There is increasing recognition that the non-consensual dissemination of sexually explicit media (NCDSEM; also known as “revenge porn,” “non-consensual pornography,” and “image-based sexual abuse”) is a substantial public health, criminal justice, and social problem throughout the world (Henry & Flynn, 2019; Walker & Sleath, 2017). NCDSEM is defined as the acquisition and distribution of sexually graphic images of individuals without their consent (Cecil, 2014; Citron & Franks, 2014). This includes images obtained or distributed without consent, and the threat of obtaining or distributing images without consent (Citron & Franks, 2014; Eaton et al., 2017; Henry & Flynn, 2019). Sexual media that is shared between trusted partners consensually can subsequently be non-consensually disseminated (Cecil, 2014; McGlynn & Rackley, 2017). The material becomes NCDSEM when it is circulated online without the consent of the individual depicted, or when the images are obtained non-consensually through hidden cameras or hacking (Dodge, 2019; Henry & Flynn, 2019; Kamal & Newman, 2016; Lenhart et al., 2016; McGlynn & Rackley, 2017; Walker & Sleath, 2017). Perpetrators may digitally disseminate sexually explicit images of their ex-partner following a break-up with the intention of embarrassing or humiliating them, and sometimes with the hope of financial gain (Bates, 2017; McGlynn & Rackley, 2017; Walker & Sleath, 2017). NCDSEM may be traded between individuals, posted on social media or other public internet sites, and may be posted with extensive information about the victim, including their name, employers, and contact information. This serves to humiliate the victim and encourage others to harass the victim, both on and offline (Bates, 2017; Henry & Flynn, 2019). NCDSEM is also a form of intimate partner violence when an abusive partner disseminates the images, or threatens to disseminate the images, as a way to maintain power and control over a victim, or as retaliation if the person leaves the relationship (Beechay, 2019; Citron & Franks, 2014; Walker et al., 2019).

In 2017, the Cyber Civil Rights Initiative (CCRI), a non-profit web-based group that conducts research and advocacy aimed at combating online abuse, conducted a nation-wide survey of adult internet users in the United States and estimated that approximately 1 in 8 people living in the United States who were 18 years or older have been targets of NCDSEM at some point in their lifetimes. Results also indicated that women were 1.7 times more likely to be victims of NCDSEM than men (Eaton et al., 2017). In another nationally representative 2016 study that examined the nature and prevalence of online harassment, abuse, and cyberstalking among 3,002 internet users in the United States, researchers found that approximately 4% of men and 6% of women between the ages of 15 and 29 years old have had a nude, or nearly nude image of themselves shared on the internet without their permission (Lenhart et al., 2016).

It is important that the consequences of NCDSEM are well-understood because, reportedly, victimization can be severe and costly. Many victims describe the emotional, physical, social, and financial harm of NCDSEM as similar to that of sexual assault or rape (Bates, 2017; Citron & Franks, 2014; Eaton et al., 2017; Franks, 2019; Henry & Flynn, 2019). Although most NCDSEM research to date has utilized non-representative convenience samples, at least six studies have documented serious and potentially long-lasting mental and behavioral health effects of victimization including anxiety, panic attacks, decreased self-esteem and self-worth, paranoia, depression, anorexia nervosa, post-traumatic stress disorder, substance use, and suicidality (Bates, 2017; Beechay, 2019; Citron & Franks, 2014; Kamal & Newman, 2016; McGlynn et al., 2017; Walker & Sleath, 2017). These studies have also found that some victims disconnect from social media, and may withdraw from intimate or other supportive relationships in an attempt to minimize their risk for subsequent harm (Bates, 2017; Lenhart et al., 2016; McGlynn et al., 2017). Other possible consequences of NCDSEM include increased feelings of distrust, the loss of a job and/or an educational opportunity, and actual or threatened harassment and stalking (Beechay, 2019; Cecil, 2014; Citron & Franks, 2014; Franks, 2019; Kamal & Newman, 2016; Lenhart et al., 2016; McGlynn et al., 2017).

Two outcomes that have not yet been thoroughly investigated as possible consequences of NCDSEM victimization are the development or worsening of social anxiety and social isolation. Social anxiety is characterized as “marked fear or anxiety related to one or more social situations in which scrutiny by others is anticipated” (American Psychiatric Association, 2013). It is a subjective psychological experience in which people may fear engaging in social interactions (e.g., having a conversation, meeting unfamiliar people, going to parties or social gatherings, talking to authority figures), being observed (e.g., while eating or drinking, while shopping or out in public), and performing in front of others (e.g., talking or presenting in meetings or groups, or giving a speech); (American Psychiatric Association, 2013; Leichsenring & Leweke, 2017; National Collaborating Centre for Mental Health, 2013). Social isolation is a term used to describe a lack of people in one’s life for social interaction or social connectedness (Child & Lawton, 2019). Living alone, having few friends, and infrequent social contact are all markers of social isolation (Holt-Lunstad et al., 2015). Social isolation can be a result of social anxiety. For instance, individuals who feel intense anxiety about interactions with others may avoid social encounters, thereby reducing their opportunities to develop friendships, romantic relationships, and a sense of community (Rohde et al., 2016). For someone who is already socially isolated, a lack of exposure to social situations may increase feelings of unfamiliarity with social settings, which may cause or compound existing social anxiety and avoidance (Teo et al., 2013).

Evidence suggests that the negative health effects of social isolation are comparable to the negative health effects of excessive alcohol consumption, cigarette smoking, obesity, and high blood pressure (Holt-Lunstad et al., 2015; Ozbay et al., 2007; Pantell et al., 2013; Teo et al., 2013). In a meta-analysis of 70 studies that examined the relationship between all-cause mortality and social isolation, researchers found that individuals who reported greater social isolation had an adjusted weighted risk of premature mortality that was 29% greater than individuals who were less socially isolated. Using data from a population-based health survey, Laugesen et al. (2018) also found that after adjusting for socioeconomic status, lifestyle factors, and psychiatric and somatic morbidities associated with mortality, mortality was increased by 1.7 and 1.6 fold in men and women respectively when comparing the most socially isolated people to the least socially isolated people (Laugesen et al., 2018). Among adults 65 years of age and older, social isolation is associated with a 50% increased risk of dementia, a 29% increased risk of heart disease, and a 32% increased risk of stroke (National Academies of Sciences, Engineering, and Medicine, 2020). Furthermore, in a nationally representative study conducted in Switzerland, Hämmig (2019) found that compared to individuals with very high levels of social integration, individuals with very low levels of social integration had approximately four times the odds of self-reporting overall poor health, 2.8 times the odds of reporting poor musculoskeletal health (e.g., back pain), 11.5 times the odds of reporting moderate to severe depression, and five times the odds of reporting multiple co-morbid health problems (Hämmig, 2019).

The development of social anxiety is thought to be influenced by both genetic and environmental factors (Scaini et al., 2014). Development or exacerbation of anxiety may be associated with a particular event like exposure to childhood trauma or familial abuse (Bandelow et al., 2004; Kessler, 2003; National Collaborating Centre for Mental Health, 2013). Thus, it is possible that exposure to a traumatic event in adulthood, like NCDSEM victimization, may be an environmental factor that can trigger the onset of social anxiety, or exacerbate existing symptoms, and put people ask risk of experiencing social isolation and associated health consequences.

The purpose of this qualitative study was to explore consequences of NCDSEM for survivors, with an emphasis on how NCDSEM may impact social relationships, social anxiety, and social isolation. The specific aims were to (a) describe the experiences and context of the lives of individuals who identify as victims of NCDSEM and (b) describe the ways in which NCDSEM may influence the development and/or maintenance of social anxiety and social isolation, and the maintenance of healthy social relationships.

Methods

Study Overview

This was a qualitative study involving one-on-one telephone interviews with (N = 17) self-identified survivors of NCDSEM between May and December 2019. All materials and procedures were reviewed by the Boston University Medical Campus Internal Review Board (IRB) and determined to be exempt. Participants did not receive compensation for their participation.

Study recruitment.

The research team partnered with the non-profit organization, The Badass Army (BADASS), in order to recruit participants. Battling Abusive and Demeaning Selfie Sharing (BADASS) is a non-profit organization founded in 2017 that supports victims of image abuse nation-wide and works to eradicate NCDSEM through legislation, education, and technology development (The Badass Army, 2020). BADASS primarily operates online, with a Twitter following of approximately 3,000 individuals, and 1,500 active members on their email listserv.

IRB-approved recruitment materials were shared with prospective research participants by a BADASS staff member via the organization’s Twitter, Instagram, and Facebook accounts, as well as via email. Study staff also used their social media accounts to post recruitment advertisements. Participants were considered eligible for the study if they were 18 years or older, able to speak English, and self-identified as a victim of revenge porn. The term “revenge porn” was used because it is widely recognized by members of the public, but it was not defined on recruitment materials. It was not defined in recruitment materials because study staff assumed that potential participants would understand what the study was about, even if those individuals did not use the term “revenge porn” to describe their own experience. Interested individuals were asked to contact the research team via email to participate in a telephone-based eligibility screening, consent process, and data collection. Participation was open to individuals living in any country.

Interview procedures.

All prospective research participants were screened for eligibility over the phone by a trained research assistant with prior experience counseling survivors of trauma. Eligible individuals were then read a consent statement over the phone, and if they agreed to participate in the research, were interviewed immediately afterwards, also over the phone. Researchers used an 11-question semi-structured interview script (Table 1) and asked follow-up and clarifying questions as necessary. Participants were asked to recount the details of their experience of having sexually explicit photos or videos of themselves shared, what they did in response to the incident, what health and other consequences they experienced, and what outcomes they wish to see come from their experience. Researchers did not audio-record interviews to protect participant anonymity and instead typed verbatim as participants spoke. Interviews lasted approximately 30 minutes.

Table 1.

Semi-structured Interview Script.

1	Can you tell me a little bit about your situation, that is, what you went through?
2	How did you find out that this had happened?
3	When you found out, how did you feel?
4	What were the first things you did when you found out?
5	What else did you do in response to this incident, and how did it work out? [i.e., paid a company to take down images, but it did not work because more images popped up elsewhere]
6	What were some of the consequences for you personally, having this happen? Think both short-term and long-term about consequences in any aspect of your life, work, relationships, health, etc.
7	Were there consequences for other people in your life, such as family, friends, or intimate partners? If so, can you please describe them?
8	What consequences do you feel the person who shared your images should receive?
9	If you had to guess how much money you have spent as a result of this, how much money would you guess you have spent?
10	In a perfect world, what outcome would you like to see come from your experience?
11	What else would you like me to know?

Table 2.

Characteristics of Sample (N = 17).

% (n)

Age, in years

Mean average

Range

34.47

22–53

Ethnicity

Hispanic

Non-Hispanic

6 (1)

94 (16)

Race

Hispanic or Latino

American Indian or Alaska Native

Asian

Black/African-American

Native Hawaiian or Pacific Islander

White

Multiracial

Other

0 (0)

6 (1)

12 (2)

0 (0)

71 (12)

12 (2)

0 (0)

Sex

Female

Male

88 (15)

12 (2)

Gender identity

Female

Male

Transgender

Non-binary or genderqueer

88 (15)

12 (2)

0 (0)

Country of Residence

United States

Canada

94 (16)

6 (1)

Age of first NCP experience, in years

Mean average

Range

16–51

Number of perpetrators

More than 2

80 (12)

13 (2)

6 (1)

Relationship with perpetrator at time of incident

Former dating partner/spouse

Current dating partner/spouse

Friend/acquaintance/non-dating partner

Stranger

Other

47 (8)

18 (3)

24 (4)

0 (0)

12 (2)

Legal action taken against perpetrator

Yes

59 (10)

41 (7)

Analytic Methods

Researchers adopted a flexible coding approach (Deterding & Waters, 2018). All interviews were coded using the qualitative software analysis program NVivo. The coding process was as follows: (a) two individuals (authors JC and SMP) read through each transcript to “get a sense of the whole” (Sandelowski, 1995) (b) authors generated index codes of broad themes based on the interview script (Deterding & Waters, 2018), (b) all authors generated a coding list, where codes represented more specific, analytic themes that emerged from the interview data (Deterding & Waters, 2018), and (c) codes were applied to sections of the text by two independent coders. In order to improve the chances that the coders would make similar coding decisions on all 17 texts, at the outset of the process, they used two interview texts to harmonize coding decisions. Across all texts, the inter-rater reliability was 91%. Where discrepancies existed, the coders discussed their decisions until a consensus on a code was reached and the final corpus of text had 100% coding agreement. Next, researchers looked at each section of the text to which a particular code had been applied to get a sense of the thematic responses within that coding category. All members of the research team met to discuss the themes that emerged from the text and to select illustrative quotations that represented each.

Sample Characteristics

The 17 research participants were 88% female and 12% male. No participants identified their gender as transgender or gender non-binary. The age of participants ranged from 22 to 53 years, with an average age of 34 years. The majority of the participants were non-Hispanic (94%), with 71% White, 6% Asian, 12% Black, and 12% Multiracial. Nearly all participants (94%) were residents of the United States; 6% (n = 1) of participants were residents of Canada. The age of first NCDSEM experience ranged from 16 to 51 years old, with an average age of 30 years old at first NCDSEM experience. Approximately half (47%) of all participants identified the perpetrator as a former dating partner or spouse, 18% identified the perpetrator as their current dating partner or spouse at the time the images were posted, 24% identified the perpetrator as a friend/acquaintance or other non-dating partner whom they knew, and 12% identified a different relationship with the perpetrator. We did not ask participants to identify their sexual orientation, or the gender of the person who perpetrated NCDSEM against them, and thus do not know the proportion that identifies as lesbian, gay, bisexual, or queer. Most participants (80%) identified one perpetrator that initially shared their images, and three participants (20%) reported that more than one perpetrator shared their images. About half (59%) of participants reported that they had ever taken legal action against the perpetrator (Table 2).

Findings

There were 5 main ways in which participants described consequences of NCDSEM: (1) fear of going out in public, (2) fear of engaging in relationships, (3) fear of applying to jobs, (4) fear of seeking help, and (5) feelings of depression and generalized anxiety.

Fear of going out in public.

Many participants described the development of intense fears and anxieties resulting from NCDSEM. These often manifested as a fear of going out in public. It was typical for participants to worry that “everyone” had seen their photos, and were unfavorably judging them, which felt humiliating. For example, a 22-year-old woman told researchers:

I live in fear and despair every single day. I constantly worry about how many people saw my naked pictures and how I’m being made fun of for it.

Similarly, a 53-year-old woman described feeling so afraid of potential humiliation and harassment that she had trouble leaving her house:

For the first two months, I was afraid to leave the house. I was scared to death. Anytime anyone talked about sex or porn, I would cringe. I felt like maybe they had seen me.

A 30-year-old man reported that after sexually explicit photos of him were posted online, he didn’t leave the house for a week; he said that he “couldn’t even touch the door handle.” A 38-year-old woman explained that she became averse to going out at all because she lives in a small town where most people know each other, and she worried that they might have seen her sexually explicit photos:

I hate going in public. I hate going to the store. I think someone is looking at me, and I have horrible thoughts.

This participant described that worrying about how people will perceive her was the single most distressing component of her NCDSEM experience. She compared her experience to sexual assault and commented that the public nature of revenge porn perpetration was uniquely devastating:

I was raped when I was 15 years old, but at least no one knew about it.

For one 31-year-old woman who experienced NCDSEM on two separate occasions, the experience of NCDSEM intensified existing symptoms of social anxiety to the point that it disrupted her ability to complete normal, daily tasks:

When I was 17, I was officially diagnosed with social anxiety disorder. When the photos were released at age 21, it exacerbated the social anxiety to the point that I didn’t leave the house for months. It affected my ability to just show up normally in my life. I was unemployed and depressed and didn’t leave the house except to go to therapy. I couldn’t even go to the bank or the grocery store because I was afraid that somebody in there had seen the photos.

Another 30-year-old woman reported a similar experience noting that:

I always had some social anxiety, but now it’s significantly worse. Even if a stranger made eye contact with me, I just wonder, “Did you see me on the internet?”

Fear of engaging in relationships.

Nearly all participants described problems with relationships. A number of participants explained that they became isolated and withdrawn following their NCDSEM experience, or that they stopped trying to meet new people and make new friends. For example, a 36-year-old woman said:

Every single relationship I have with any person has been impacted. I don’t want to meet people, I don’t want to give away my name or my identity. Even the people I love, I don’t want to talk to them because they don’t understand it. It did me more harm having to explain what happened to me.

A 38-year-old woman also noticed that only after the pictures of her were posted online, her friendships suffered:

I’m definitely withdrawn more, don’t like to go out anymore. I don’t like to go out drinking or socializing with my girlfriends.

This participant also commented that she did not want to attend important social events, like friend’s weddings, as a direct result of NCDSEM. Other participants described isolating themselves from their families because they feared family members would not understand or would blame them for the incident. For example, a different 38-year-old woman explained that she was so afraid of telling her mother about the incident that she stopped communicating with her completely. It wasn’t until her mother called her worried and joked that she almost searched her online to “make sure that [she] was still alive” that the participant told her what happened.

Participants also described being hesitant to engage in romantic relationships. One 22-year-old woman’s description of her experience summarizes how the experience caused romantic relationship problems her life:

I isolate myself. I stay home all day afraid to go out. I lost most of my ability to trust people. I don’t think I deserve to have any friends or a romantic partner. The people who spread my naked pictures said so many awful things about me and I sometimes believe it. It’s so hard to trust people I’m just so scared of being hurt and betrayed again. I feel worthless like nobody cares about me.… I overanalyze and overthink everything and everyone and their intentions/how they truly feel versus how they say they feel. [I am] just always on high alert and scared of being backstabbed again.… I’m so broken from bullying and isolating myself that I can’t imagine being in a romantic relationship anymore.

Fear of applying to jobs.

Research participants described losing their jobs after employers saw explicit images of them online, as well as significant challenges specifically related to applying for new jobs after job loss. One 34-year-old woman explained that her anxiety stems from a fear of employers searching her on the internet before the interview, which is a common practice, and finding explicit images of her:

If I try to get a job, I’m afraid that they’ll just Google my name and the images will come up.… It’s just going to be a while before anything gets better. I’m looking for a job right now and I’m afraid of what they’ll find.

A 41-year-old woman echoed this sentiment, explaining that the experience holds her back from doing anything in public, especially applying to jobs, because she often thinks, “what if I’m successful and this comes back to haunt me?” Finally, a 38-year-old woman whose partner at the time secretly recorded and posted hours of videos of her without her consent said:

I couldn’t walk into any job interview without it just painted on my face, “Should I just tell them? Should I not?” Every interview was so painful and awkward. I would just crumble.… Still even the thought of looking for jobs just melts me down to the core. Just thinking about it now, it makes my heart skip a beat. I don’t have words to describe what a fucked-up place it puts me in.

Fear of seeking help.

Consistent with research that suggests that about half of individuals with social anxiety do not seek help (Stein & Stein, 2008) some individuals who experience NCDSEM are also hesitant to seek social support from family and friends, or legal aid from police officers or attorneys. Some participants, like a 31-year-old woman who experienced multiple NCDSEM victimizations, explained that embarrassment and shame deterred her from seeking support and pursuing legal recourse:

The first time it happened, I felt completely alone. There was no word for [NCDSEM], there was no community of support. I didn’t know what to do. I knew what was happening wasn’t right, but I had a feeling that if I went to the police nothing would get dealt with.

A 38-year-old woman explained that she sent explicit photos of herself to friends online after being pressured to do so. When the pictures were sent to her boyfriend, she explained why she did not seek help for the relationship problems, decreased work productivity, and sense of powerlessness that ensued:

I’ve seen hotlines, but I just haven’t sought any kind of therapy or help because, sad as it is, my guilt is still there. Reaching out for help would just evoke those same feelings again.

Other participants described being blamed by friends, family, police officers, and attorneys for consensually taking or sharing the photos with trusted partners in the first place. Participants described feeling judged for their actions, which decreased their willingness to seek support. For example, one 38-year-old woman who described experiencing homelessness and unemployment resulting from NCDSEM by her abusive ex-partner explained:

Some people say, “you shouldn’t have let the pictures be taken in the first place.” Which makes me feel worse, and even more shame because of the victim blaming.

A 31-year-old woman said that fear of victim blaming deterred her from seeking legal support:

In some ways, I’m kind of grateful I didn’t go to law enforcement, because if I had the trauma of not being believed by law enforcement it would have been really traumatizing and it would have “leveled” me. If I had gone to police and been victim shamed, or not believed, I don’t think I would be able to talk about it today.

Feeling depressed and anxious.

Survivors of NCDSEM in our sample described feeling depressed and anxious because of the NCDSEM incident(s). One 36-year-old woman described how feeling depressed was closely tied to her fears of going out in public:

I was struggling on a daily basis with suicidal ideation. I was trying to leave to drive back home, but I couldn’t. I don’t think I came out of my apartment for two days. I think the scary thing about this, is that it’s been done in little intervals, so I don’t know if it’s done or if it’ll start up again. I feel like he murdered my spirit, my soul.

Another 53-year-old woman, whose husband at the time took secret screenshots of her via video chat, explained that she believed her depression stemmed from a deep disappointment that someone she once loved would betray and endanger her. She confided to interviewers that “It was to the point that I was contemplating suicide. I could not take it anymore.” A 22-year-old woman echoed this sentiment, admitting that, “this is so hard. I’m sad, depressed, anxious, stressed out. Every negative emotion I can think of I have, and yet I’m always alone and I feel like nobody cares.” This participant also told researchers that she, “[has] extreme depression and post-traumatic stress disorder,” and, “had a panic attack” that required hospitalization following NCDSEM.

Discussion

To our knowledge, this is the first study to describe the ways in which NCDSEM may influence social anxiety and social isolation in survivors. Participants in this sample reported that the experience of NCDSEM victimization made them fear going out in public, engaging in social relationships, applying to jobs, and seeking help. Additionally, they described experiencing depression and anxiety that made it more difficult for them to socialize with others, and exacerbated social isolation.

There are at least three practical implications of recognizing that social anxiety and social isolation may be consequences of NCDSEM. First, friends and family members of NCDSEM survivors should be alerted that social withdrawal can be a sign that a survivor is suffering from social anxiety, and should educate themselves about how to reduce social anxiety and social isolation for a loved one. Second, clinicians to whom an individual may disclose their experience of NCDSEM should be prepared to evaluate clients for possible social anxiety disorder. However, many symptoms of social anxiety, like avoidance of select places, people, and activities, dysthymia, and depression overlap with symptoms of trauma-related mental illnesses and phobia-related disorders that are a subset of generalized anxiety disorder (National Institute of Mental Health, 2018, 2019). Thus, comprehensive evaluations are warranted in order to make any conclusive diagnostic decisions regarding the presentation of symptoms, and courses of treatment. Techniques such as one-on-one cognitive behavioral therapy, psychodynamic therapy, stress reduction mindfulness therapy, and when appropriate, medications including selective serotonin and norepinephrine-reuptake inhibitors have been shown to be effective for use with individuals experiencing social anxiety (Leichsenring & Leweke, 2017; National Collaborating Centre for Mental Health, 2013; Stein & Stein, 2008). Third, advocates and attorneys who work closely with victims of NCDSEM could provide information and handouts about social anxiety and isolation to victims that might increase the likelihood that they will engage in self-care or clinical care to alleviate those symptoms if they experience them.

Efforts to bolster social support and social networks for survivors are also crucial to mitigating the harms of social anxiety and isolation following NCDSEM. Increasing survivors’ access to networks of family, friends, and community members that can provide psychological, physical, and financial help, and the perception of being care for, loved, and esteemed can enhance resilience to stress and increase functionality by facilitating efficient coping with crises and stressful life situations, like NCDSEM (Cobb, 1976; Ozbay et al., 2007; Rohde et al., 2016). Providing clinical psychoeducation to survivors about how to recognize feelings of anxiety and isolating behaviors, and teaching them to counter these reactions with increased social networking, as opposed to increased isolation, could have substantial implications for reducing the risk of morbidity and mortality associated with social anxiety and isolation. Furthermore, it may encourage organizations that work with survivors to bolster initiatives and programs that facilitate connectivity among members, in order to develop survivors’ sense of community.

There are also implications for advocacy organizations such as the CCRI, BADASS, and others that work with survivors to provide assistance, information, and support following NCDSEM incidents. For example, the CCRI works with tech industries such as Google, Facebook, and Twitter, where NCDSEM is often perpetrated, to help them develop and address the shortcomings of existing policies. It also provides public education and awareness about NCDSEM and conducts legal research to support legislators in drafting effective NCDSEM legislation (Cyber Civil Rights Initiative, 2020). BADASS focuses on victim-centered advocacy and empowering survivors to access the tools and resources they need to regain control of their images and get justice for crimes committed against them (The Badass Army, 2020). A deeper understanding of the social consequences of NCDSEM victimization may assist advocacy organizations in effectively collaborating with technology industries, legislators, and health care professionals to reduce the burden NCDSEM has on survivors.

Limitations

This study faced at least four limitations. First, as with all qualitative, exploratory research, this study was not designed to generate representative or generalizable data, but rather to gather rich and detailed data that may give meaning to quantitative findings in other studies and generate hypotheses for future research (Myers, 2000; Suter, 2012). Themes presented here do not reflect an exhaustive list of health outcomes for individuals who experience NCDSEM victimization, nor are they generalizable to all individuals who experienced NCDSEM victimization. Nevertheless, findings contribute to valuable knowledge regarding the phenomenon of NCDSEM and may be useful to stakeholders seeking to gain an in-depth understanding of the experiences of NCDSEM survivors (Myers, 2000). Symptoms of social anxiety and isolation may also overlap with symptoms of trauma-related disorders and/or mood disorders. A closer examination of the relationships between NCDSEM and other trauma and mood-related outcomes is warranted. Any formal clinical evaluation of NCDSEM survivors should consider a broad scope of potential mental health consequences.

Second, researchers specifically used the term “revenge porn” in recruitment materials. This term was used because it is widely recognized by members of the public. However, it is also widely cited as a misnomer by researchers and legal experts because it fails to capture commonly reported motivations for perpetrating NCDSEM beyond that of revenge, and inappropriately implies the victim has done something wrong to warrant vengeful behavior (Cecil, 2014; Citron & Franks, 2014; Henry & Flynn, 2019; Kamal & Newman, 2016; Velez, 2019; Walker et al., 2019). After conducting interviews, it became evident that some victims of NCDSEM may not identify what happened to them as “revenge porn.” Therefore, the experiences of our sample may have been disproportionately those with a particular type of NCDSEM experience.

Third, we did not inquire about the gender of the perpetrators, nor the sexual orientation of survivors. However, research suggests that LGBTQ+ individuals experience prejudice in the form of sexual assault, dating violence, and online harassment more often than cis-gender, heterosexual individuals (Edwards et al., 2015; Meyer, 2007; Powell et al., 2020; Rothman et al., 2011). Research also suggests that LGBTQ+ individuals, particularly transgender and people who identify as gender-non-conforming, report significantly higher rates of depression, anxiety, and perceived stress (Borgogna et al., 2019; K. I. Fredriksen-Goldsen et al., 2014; Meyer, 2007) and lower levels of social support (K. Fredriksen-Goldsen, 2018; Perone et al., 2020) as a result of prejudice and discrimination than their cisgender peers. Taken together, it is reasonable to hypothesize that LGBTQ+ individuals, especially transgender and gender-non-conforming individuals, may be at increased risk of experiencing social anxiety and isolation following NCDSEM victimization, and may be less likely to have robust social support networks to mitigate associated health consequences. Future research should consider the interaction between sexual orientation and gender identity, social anxiety, and NCDSEM victimization.

Finally, we did not examine the intersection of NCDSEM, race, and social anxiety and isolation. In a 2017 nationally representative study of 4,248 U.S. adults, the Pew Research Center found that 25% of Black participants and 10% of Hispanic participants reported being targeted for online harassment because of their race or ethnicity, compared to only 3% of White participants (Pew Research Center, 2017). There is also robust evidence to suggest that non-white racial and ethnic minority groups experience significant and persistent stress and adverse health outcomes as a result of racial prejudice, discrimination, and harassment at individual, internalized, structural and institutional levels (Clark et al., 1999; Jones, 2000; Paradies et al., 2015). Future research should consider whether or not there are disparate impacts of NCDSEM on the social and overall health of racial and ethnic minorities, as well as consider the intersections between NCDSEM, social anxiety, race, ethnicity, gender identity, and sexual orientation.

Conclusions

This qualitative study aimed to explore how NCDSEM impacts survivors’ social relationships, social anxiety, and social isolation. We found that participants in this study experienced social anxiety related to going out in public, engaging in relationships, applying to jobs, and engaging in help-seeking behaviors and that these experiences overlapped with feelings of depression and generalized anxiety. While the development of effective strategies and legislation aimed at preventing NCDSEM is in nascent stages, social anxiety and social isolation are well-understood. Increased social support and existing clinical strategies used to treat individuals with social anxiety may be effective in mitigating the consequences of social anxiety and isolation for survivors of NCDSEM. Moreover, given that the impacts of NCDSEM have enduring consequences for survivors, the expansion of prevention efforts and victim-centered legislation is imperative to protect survivors’ health and well-being. Future research should seek to understand how different specific consequences of NCDSEM are related to other mental illnesses and health conditions, and how the intersection of race, ethnicity, gender identity, and sexual orientation impact the social and mental health of people who experience NCDSEM.

Footnotes

Acknowledgments

The authors wish to acknowledge each survivor whose story was used in this analysis. We gratefully acknowledge recruitment help from The Badass Army (Battling Abusive and Demeaning Selfie Sharing), a non-profit dedicated to providing support to victims of revenge porn and image abuse without whom this study would not have been possible.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Julia K. Campbell

Emily F. Rothman

Author Biographies

Julia K. Campbell, MPH, is the center coordinator for the Injury Prevention Center at Boston Medical Center, and a Research Coordinator at the Boston University School of Public Health. She is interested in research that focuses on intimate partner and sexual violence, and preventable injuries including mild traumatic brain injury.

Sydney McCartin Poage, MPH, is a graduate of the Boston University School of Public Health and is currently working as a Health Educator in the Greater Boston area. Sydney’s areas of interest include adolescent sexual health and substance use, developing inclusive health education programs, and working with youth to become peer health educators.

Sophie Godley, DrPH, MPH, is a clinical assistant professor in the Department of Community Health Sciences & Director of Undergraduate Education for the Boston University School of Public Health. Sophie’s areas of interest include adolescent sexual health, effective public health education, and adopting a race equity framework in public health programs.

Emily F. Rothman, ScD, is a professor of Community Health Sciences at the Boston University School of Public Health. Her research focuses on the prevention of adolescent dating violence, sexual violence, and commercial sexual exploitation. She also studies pornography from a public health perspective. She is interested in improving evidence-based program options for autistic adolescents.

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