Psychopathic personality traits and cyberbullying among adolescents: The moderating role of online disinhibition


Published: Mar 13, 2026
Keywords:
cyber-bullying, psychopathic traits, online disinhibition, adolescence, gender differences
Nafsika Antoniadou
https://orcid.org/0000-0002-8881-2235
Abstract

The rapid integration of Information and Communication Technologies (ICT) into adolescents’ daily lives has reshaped social interaction while simultaneously creating new forms of aggression, with cyber-bullying representing the most pervasive and harmful form. Cyber-bullying is defined as intentional, repetitive aggression conducted through digital media, typically involving a perceived power imbalance between the perpetrator and the victim (Smith et al., 2008). Compared to traditional bullying, cyber-bullying is amplified by the characteristics of computer-mediated communication, such as anonymity, asynchronous interaction, and the absence of direct feedback, which facilitate continuous harassment and emotional detachment from the victim’s suffering (Antoniadou et al., 2019; Suler, 2004). A growing body of research highlights the role of individual traits, particularly psychopathic personality characteristics, in explaining aggressive online behaviour (Hudon et al., 2025; Kowalski et al., 2014). Psychopathic traits, typically conceptualized along the dimensions of grandiose-manipulative, callous-unemotional, and impulsive-irresponsible, are characterized by superficial charm, egocentricity, lack of empathy, and emotional detachment (Fanti & Kimonis, 2012; Hare, 2003). These traits have been linked to both traditional and cyber forms of bullying, suggesting that individuals high in psychopathic features may be particularly prone to online aggression due to reduced empathy and moral inhibition. Moreover, the online context itself may amplify the expression of these traits through the online disinhibition effect (Suler, 2004). This phenomenon refers to the loosening of social or moral constraints that typically inhibit antisocial acts, enabled by perceived anonymity, invisibility, and diminished accountability. The combination of dispositional risk factors (psychopathic traits) and situational affordances (online disinhibition) may therefore provide a compelling framework for understanding cyber-bullying perpetration. This study aimed to examine the predictive role of psychopathic personality traits (grandiose-manipulative, callous-unemotional, and impulsive-irresponsible) in adolescents’ engagement in cyber-bullying behaviours, and to explore the moderating effect of online disinhibition on these associations. Additionally, gender was included as a covariate, given consistent findings showing higher involvement of males in aggressive online behaviours. The sample consisted of 1,097 middle school students (558 girls, 531 boys) aged 12-15 years, attending public junior high schools in Central and Eastern Macedonia, Greece. Schools were selected through proportional stratified sampling to represent urban, semi-urban, and rural areas. The research employed a correlational quantitative design based on self-report questionnaires. Psychopathic traits were assessed with the Youth Psychopathic Inventory-Short Version (YPI-S; Van Baardewijk et al., 2010), which includes 18 items measuring grandiose-manipulative, callous-unemotional, and impulsive-irresponsible traits. Online disinhibition was measured through the Internet Behaviours and Attitudes Questionnaire (Morahan-Martin & Schumacher, 2000), validated in Greek samples (Αντωνιάδου & Κόκκινος, 2013). Cyber-bullying was assessed with the Cyber-Bullying and Victimization Experiences Questionnaire (CBVEQ˙ Antoniadou et al., 2016). Reliability coefficients were satisfactory.Preliminary analyses indicated that boys reported significantly higher levels of cyber-bullying (M = 1.26) compared to girls (M = 1.14), t(1085) = 5.31, p < .001, and higher scores in grandiose-manipulative and callous-unemotional traits. Correlations among study variables were positive and significant, suggesting that higher psychopathic traits were associated with higher online disinhibition and greater engagement in cyber-bullying.  Moderation analyses were conducted using PROCESS v4.1 (Hayes, 2022). Results revealed significant interaction effects for the grandiose-manipulative and callous-unemotional traits with online disinhibition on cyber-bullying perpetration. Specifically, the relationship between grandiose-manipulative traits and cyber-bullying was stronger at higher levels of online disinhibition (b = .15, SE = .04, p < .001), while a similar pattern emerged for callous-unemotional traits (b = .14, SE = .04, p < .01). Gender was controlled for in all models, showing that boys remained significantly more likely to engage in cyber-bullying (p < .05). No significant moderating effect emerged for impulsive-irresponsible traits. Findings underscore that psychopathic traits, particularly the grandiose-manipulative and callous-unemotional dimensions, constitute key dispositional predictors of cyber-bullying among adolescents. Importantly, these effects were intensified under conditions of high online disinhibition, confirming the moderating influence of digital environments in amplifying antisocial behaviours. The results suggest that prevention and intervention programs should not only address moral reasoning and empathy deficits but also focus on developing adolescents’ digital self-regulation skills and awareness of online accountability.

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References
Anderson, C. A. & Bushman, B. J. (2002). Human aggression. Annual Review of Psychology, 53, 27-51. https://doi.org/10.1146/annurev.psych.53.100901.135231
Andreou, E., Didaskalou, E., & Vlachou, A. (2007). Evaluating the effectiveness of a curriculum‐based anti‐bullying intervention program in Greek primary schools. Educational Psychology, 27, 693-711. https://doi.org/10.1080/01443410601159993
Andreou, E., Didaskalou, E., & Vlachou, A. (2008). Outcomes of a curriculum‐based anti‐bullying intervention program on students' attitudes and behavior. Emotional and Behavioural Difficulties, 13, 235-248. https://doi.org/10.1080/13632750802442110
Αντωνιάδου, Ν. (2016). Το ψυχοκοινωνικό και συναισθηματικό προφίλ των Ελλήνων μαθητών γυμνασίου που εμπλέκονται σε περιστατικά κυβερνο-εκφοβισμού (cyber-bullying) και παραδοσιακού εκφοβισμού: συγκριτική μελέτη [Διδακτορική διατριβή, Δημοκρίτειο Πανεπιστήμιο Θράκης]. https://www.didaktorika.gr/eadd/handle/10442/39829
Αντωνιάδου, Ν., & Κόκκινος, Κ. Μ. (2013). Κυβερνοεκφοβισμός και κυβερνοθυματοποίηση σε παιδιά και εφήβους: Συχνότητα εμφάνισης και παράγοντες επικινδυνότητας. Προσχολική & Σχολική Εκπαίδευση, 1, 138-169. https://doi.org/10.12681/ppej.42
Antoniadou, N., Kokkinos, C. M., & Markos, A. (2016a). Possible common correlates between bullying and cyber-bullying among adolescents. Psicología Educativa, 22, 27-38. https://doi.org/10.1016/j.pse.2016.01.003
Antoniadou, N., Kokkinos, C. M., & Markos, A. (2016b). Development, construct validation and measurement invariance of the Greek cyber-bullying/victimization experiences questionnaire (CBVEQ-G). Computers in Human Behavior, 65, 380-390. https://doi.org/10.1016/j.chb.2016.08.032
Antoniadou, N., Kokkinos, C. M., & Markos, A. (2019). Psychopathic traits and social anxiety in cyber-space: A context-dependent theoretical framework explaining online disinhibition. Computers in Human Behavior, 99, 228-234. https://doi.org/10.1016/j.chb.2019.05.025
Baldry, A. C., Farrington, D. P., & Sorrentino, A. (2015). “Am I at risk of cyberbullying”? A narrative review and conceptual framework for research on risk of cyberbullying and cybervictimization: The risk and needs assessment approach. Aggression and Violent Behavior, 23, 36-51. https://doi.org/10.1016/j.avb.2015.05.014
Barlett, C. P., Seyfert, L. W., Simmers, M. M., Chen, V. H. H., Cavalcanti, J. G., Krahé, B., Suzuki, K., Warburton, W. A., Wong, R. Y. M., Pimentel, C. E., & Skowronski, M. (2021). Cross-cultural similarities and differences in the theoretical predictors of cyberbullying perpetration: Results from a seven-country study. Aggressive Behavior, 47(1), 111–119. https://doi.org/10.1002/ab.21923
Bauman, S. (2013). Cyberbullying: What does research tell us? Theory Into Practice, 52, 249-256. https://doi.org/10.1080/00405841.2013.829727
Bobadilla, L., Wampler, M., & Taylor, J. (2012). Proactive and reactive aggression are associated with different physiological and personality profiles. Journal of Social and Clinical Psychology, 31(5), 458-487. https://doi.org/10.1521/jscp.2012.31.5.458
Camacho, A., Runions, K., Ortega-Ruiz, R., & Romera, E. M. (2023). Bullying and cyberbullying perpetration and victimization: Prospective within-person associations. Journal of Youth and Adolescence, 52(2), 406-418. https://doi.org/10.1007/s10964-022-01704-3
Chan, H. C. O., & Wong, D. S. (2015). Traditional school bullying and cyberbullying in Chinese societies: Prevalence and a review of the whole-school intervention approach. Aggression and Violent Behavior, 23, 98-108. https://doi.org/10.1016/j.avb.2015.05.010
Ciucci, E., & Baroncelli, A. (2014). The emotional core of bullying: Further evidence of the role of callous-unemotional traits and empathy. Personality and Individual Differences, 67, 69-74. https://doi.org/10.1016/j.paid.2013.09.033
Deng, J., Shou, Y., Wang, M.-C., Allen, J. L., Gao, Y., & Hawes, D. J. (2024). Core features of callous-unemotional traits: A cross-cultural comparison of youth in four countries. European Child & Adolescent Psychiatry, 33(8), 2681–2693. https://doi.org/10.1007/s00787-023-02357-8
Elsaesser, C., Russell, B., Ohannessian, C. M., & Patton, D. U. (2017). Parenting in a digital age: A review of parents’ role in preventing adolescent cyberbullying. Aggression and Violent Behavior, 35, 62–72. https://doi.org/10.1016/j.avb.2017.06.004
Fanti, K. A., & Kimonis, E. R. (2012). Bullying and victimization: The role of conduct problems and psychopathic traits. Journal of Research on Adolescence, 22, 617-631. https://doi.org/10.1111/j.1532-7795.2012.00809.x
Fanti, K. A., Frick, P. J., & Georgiou, S. (2009). Linking callous-unemotional traits to instrumental and non-instrumental forms of aggression. Journal of Psychopathology and Behavioral Assessment, 31, 285-298. https:doi.org/10.1007/s10862-008-9111-3
Fanti, K. A., & Kimonis, E. R. (2013). Dimensions of juvenile psychopathy distinguish «bullies» «bully-victims», and «victims». Psychology of Violence, 3, 396-409. https://doi.org/10.1037/a0033951
Festl, R. (2016). Perpetrators on the internet: Analyzing individual and structural explanation factors of cyberbullying in school context. Computers in Human Behavior, 59, 237-248. http://doi.org/10.1016/j.chb.2016.02.017
Gaffney, H., Farrington, D. P., Espelage, D. L., & Ttofi, M. M. (2019). Are cyberbullying intervention and prevention programs effective? A systematic and meta-analytical review. Aggression and Violent Behavior, 45, 134–153. https://doi.org/10.1016/j.avb.2018.07.002
Gradinger, P., Yanagida, T., Strohmeier, D., & Spiel, C. (2016). Effectiveness and sustainability of the ViSC Social Competence Program to prevent cyberbullying and cyber‐victimization: Class and individual level moderators. Aggressive Behavior, 42, 181-193. https://doi.org/10.1002/ab.21631
Hare, R. D. (2003). The Hare psychopathy diagnostic checklist-revised (2nd ed.). Multi-Health Systems.
Hayes, A. F. (2022). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (Vol. 3). The Guilford Press.
Hu, W., & Zhao, B. (2025). The relationship between dark traits and cyberbullying behavior among vocational school students: a moderated mediation model. BMC Psychology, 13(1), 833. https://doi.org/10.1186/s40359-025-03188-9
Hudon, A., Harvey, E., Nicolas, S., Dufour, M., Guérin-Thériault, C., Bérubé-Fortin, J., ... & MacDermott, V. (2025). Cyberpsychopathy: A multidimensional framework for understanding psychopathic traits in digital environments. European Journal of Investigation in Health, Psychology and Education, 15(6), 107. https://doi.org/10.3390/ejihpe15060107
Joinson, A. N. (2003). Understanding the psychology of internet behaviour: Virtual worlds, real lives. Nalgrave Macmillan.
Kokkinos, C. M., & Antoniadou, N. (2019). Cyber-bullying and cyber-victimization among undergraduate student teachers through the lens of the General Aggression Model. Computers in Human Behavior, 98, 59–68. https://doi.org/10.1016/j.chb.2019.04.007
Kokkinos, C. M., Antoniadou, N., Asdre, A., & Voulgaridou, K. (2016). Parenting and Internet behavior predictors of cyber-bullying and cyber-victimization among preadolescents. Deviant Behavior, 37, 439-455. https://doi.org/10.1080/01639625.2015.1060087
Kokkinos, C. M., Antoniadou, N., Dalara, E., Koufogazou, A., & Papatziki, A. (2013). Cyber-bullying, personality traits and coping strategies in pre-adolescent students. International Journal of Cyber Behavior, Psychology and Learning, 3, 55-69. https://psycnet.apa.org/doi/10.4018/ijcbpl.2013100104
Kokkinos, C. M., Antoniadou, N., & Markos, A. (2014). Cyber-bullying: An investigation of the psychological profile of university student participants. Journal of Applied Developmental Psychology, 35, 204–214. https://doi.org/10.1016/j.appdev.2014.04.001
Kowalski, R. M., Giumetti, G. W., Schroeder, A. N., & Lattanner, M. R. (2014). Bullying in the digital age: A critical review and meta-analysis of cyberbullying research among youth. Psychological Bulletin, 140, 1073-1137. https://doi.org/10.1037/a0035618
Krueger, R. F., Caspi, A., Moffitt, T. E., White, J., & Stouthamer-Loeber, M. (1996). Delay of gratification, personality and psychopathology: Is low self-control specific to externalizing problems? Journal of Personality, 64, 107-129. https://doi.org/10.1111/j.1467-6494.1996.tb00816.x
Lee, Y., Harris, M. N., & Kim, J. (2022). Gender differences in cyberbullying victimization from a developmental perspective: An examination of risk and protective factors. Crime & Delinquency, 68(13-14), 2422-2451. https://doi.org/10.1177/00111287221081025
Leistico, A. R., Salekin, R. T., DeCoster, J., & Rogers, R. (2008). A large-scale meta-analysis relating the Hare measures of psychopathy to antisocial conduct. Law and Human Behavior, 32, 28-45. https://doi.org/10.1007/s10979-007-9096-6
Li, Q. (2006). Cyberbullying in Schools: A research of gender differences. School Psychology International, 27, 1-14. https://doi.org/10.1177/0143034306064547
López-Larrañaga, M., & Orue, I. (2019). Interaction of psychopathic traits in the prediction of cyberbullying behavior. Revista de Psicopatología y Psicología Clínica, 24(1). https://doi.org/10.5944/rppc.23932
Lyons, M. (2019). The dark triad of personality: Narcissism, machiavellianism, and psychopathy in everyday life. Academic Press.
Marciano, L., Schulz, P. J., & Camerini, A. L. (2020). Cyberbullying perpetration and victimization in youth: A meta-analysis of longitudinal studies. Journal of Computer-Mediated Communication, 25(2), 163-181. https://doi.org/10.1093/jcmc/zmz031
Morahan-Martin, J., & Schumacher, P. (2000). Incidence and correlates of pathological Internet use among college students. Computers in Human Behavior, 16, 13-29. https://doi.org/10.1016/S0747-5632(99)00049-7
Moreno, M. A., Binger, K., Zhao, Q., Eickhoff, J., Minich, M., & Uhls, Y. T. (2022). Digital technology and media use by adolescents: Latent class analysis. JMIR Pediatrics and Parenting, 5(2), e35540. https://doi.org/10.2196/35540
Navarro, R., Serna, C., Martínez, V., & Ruiz-Olivares, R. (2013). The role of Internet use and parental mediation on cyberbullying victimization among Spanish children from rural public schools. European Journal of Psychology of Education, 28(3), 725–745. https://doi.org/10.1007/s10212-012-0137-2
Nevin, A. D. (2015). Cyber-Psychopathy: Examining the relationship between dark e-personality and online misconduct (Master’s thesis). Retrieved from https://ir.lib.uwo.ca/cgi/viewcontent.cgi?article=4531&context=etd
Niemz, K., Griffiths, M. D., & Banyard, P. (2005). Prevalence of pathological Internet use among university students and correlations with self-esteem, GHQ and disinhibition. CyberPsychology and Behavior, 8, 562-570. https://doi.org/10.1089/cpb.2005.8.562
Ortega- Ruiz, R., Calmaestra, J., & Merchán, J. M. (2008). Cyberbullying. International Journal of Psychology and Psychological Therapy, 8, 183-192.
Orue, I., & Andershed, H. (2015). The youth psychopathic traits inventory-short version in Spanish adolescents-factor structure, reliability, and relation with aggression, bullying, and cyber bullying. Journal of Psychopathology and Behavioral Assessment, 7, 563-575. https://doi.org/10.1007/s10862-015-9489-7
Orue, I., & Calvete, E. (2019). Psychopathic traits and moral disengagement interact to predict bullying and cyberbullying among adolescents. Journal of Interpersonal Violence, 34(11), 2313-2332. https://doi.org/10.1177/0886260516660302
Palladino, B. E., Nocentini, A., & Menesini, E. (2016). Evidence‐based intervention against bullying and cyberbullying: Evaluation of the NoTrap! program in two independent trials. Aggressive Behavior, 42, 194-206. https://doi.org/10.1002/ab.21636
Perenc, L., & Radochoński, M. (2014). Psychopathic traits and reactive–proactive aggression in a large community sample of Polish adolescents. Child Psychiatry & Human Development, 45, 464–471. https://doi.org/10.1007/s10578-013-0432-4
Phillips-Shyrock, S. (2014). A mixed methods study of cyberbullying: Student, educator, and parent/guardian perspectives and implications for prevention and intervention (Unpublished doctoral dissertation). Indiana University, Pennsylvania.
Podsakoff, P. M., MacKenzie, S. B., Lee, J.-Y., & Podsakoff, N. P. (2003). Common method biases in behavioral research: A critical review of the literature and recommended remedies. Journal of Applied Psychology, 88(5), 879–903. https://doi.org/10.1037/0021-9010.88.5.879
Rigby, K (2004). Why do some children bully at school? The contributions of negative attitudes towards victims and perceived expectations of friends, parents and teachers. School Psychology International, 26, 147-161. https://doi.org/10.1177/0143034305052910
Slonje, R., Smith, P. K., & Frisen, A. (2012). Processes of cyberbullying, and feelings of remorse by bullies. European Journal of Developmental Psychology, 9, 244-259. https://doi.org/10.1080/17405629.2011.643670
Smith, P. K., Mahdavi, J., Carvalho, M., Fisher, S., Russell, S., & Tippett, N. (2008). Cyberbullying: Its nature and impact in secondary school pupils. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 49, 376-385. https://doi.org/10.1111/j.1469-7610.2007.01846.x
Stellwagen, K. K. (2011). Psychopathy, narcissism, and machiavellianism: Distinct yet intertwinning personality constructs. In C. T. Barry, P. K. Kerig, K. K. Stellwagen, & T. D. Barry (Eds.), Narcissim and machiavellianism in youth (pp. 25-46). Washington: American Psychological Association.
Suler, J. (2004). The online disinhibition effect. CyberPsychology & Behavior, 7, 321-326. https://doi.org/10.1089/1094931041291295
Sun, S., Fan, X., & Du, J. (2016). Cyberbullying perpetration: A meta-analysis of gender differences. International Journal of Internet Science, 11(1), 61-81. https://www.scirp.org/reference/referencespapers?referenceid=3756352
Swearer, S. M., Espelage, D. L., Koenig, B., Berry, B., Collins, A., & Lembeck, P. (2012). A social-ecological model of bullying prevention and intervention in early adolescence. In S. R. Jimerson, A. B. Nickerson, M. J. Mayer, & M. J. Furlong (Eds.), The handbook of school violence and school safety: International research and practice (pp. 333-355). Routledge.
Tackett, J. L., & Mackrell, S. (2011). Emerging personality in childhood and adolescence: Implications for the development of narcissism and machiavellianism. In C. T. Barry, P. K. Kerig, K. K. Stellwagen, & T. D. Barry (Eds.), Narcissism and machiavellianism in youth (pp. 11-23). American Psychological Association.
Thomaes, S., Brummelman, E., Miller, J. D., & Lilienfeld, S. O. (2017). The dark personality and psychopathology: Toward a brighter future. Journal of Abnormal Psychology, 126(7), 835- 842. https://doi.org/10.1037/abn0000305
Thornton, L. C., Frick, P. J., Crapanzano, A. M., & Terranova, A. M. (2013). The incremental utility of callous-unemotional traits and conduct problems in predicting aggression and bullying in a community sample of boys and girls. Psychological Assessment, 25, 366-378. https://doi.org/10.1037/a0031153
Van Baardewijk, Y. Andershed, H., Stegge, H., Nilsson, K., Scholte, E., & Vermeiren, R. (2010). The development of parallel short versions of the YPI and YPI-Child Version. The European Journal of Psychological Assessment, 26, 122-126. https://doi.org/10.1027/1015-5759/a000017
Van Baardewijk, Y., Stegge, H., Bushman, B. J., & Vermeiren, R. (2009). Psychopathic traits, victim distress and aggression in children. Journal of Child Psychology and Psychiatry, 50, 718–725. https://doi.org/10.1111/j.1469-7610.2008.02023
Van Geel, M., Goemans, A., Toprak, F., & Vedder, P. (2017). Which personality traits are related to traditional bullying and cyberbullying? A study with the Big Five, Dark Triad and sadism. Personality and Individual Differences, 106, 231-235. https://doi.org/10.1016/j.paid.2016.10.063
Vandebosch, H., & Van Cleemput, K. (2008). Defining cyberbullying: A qualitative research into the perceptions of youngsters. Cyberpsychology & Behavior, 11, 499-503. https://doi.org/10.1089/cpb.2007.0042
Varjas, K., Talley, J., Meyers, J., Parris, L. & Cutts, H. (2010). High school students’ perceptions of motivations for cyberbullying: An exploratory study. Western Journal of Emergency Medicine, 11, 269-273. https://pubmed.ncbi.nlm.nih.gov/20882148/
Vrselja, I., Lacković, D., & Lotar Rihtarić, M. (2023). Perceived anonymity and cyberbullying: what happens when there is a lack of social influence? Hrvatska Revija za Rehabilitacijska Istraživanja, 59(2), 31-42. https://doi.org/10.31299/hrri.59.2.3
Veen, V. C. V., Stevens, G. W. J. M., Andershed, H., Raaijmakers, Q. A. W., Doreleijers, T. A. H., & Vollebergh, W. A. M. (2011). Cross-ethnic generalizability of the three-factor model of psychopathy: The Youth Psychopathic Traits Inventory in an incarcerated sample of native Dutch and Moroccan immigrant boys. International Journal of Law and Psychiatry, 34(2), 127–130. https://doi.org/10.1016/j.ijlp.2011.02.007
Wang, L., Jiang, S., Zhou, Z., Fei, W., & Wang, W. (2024). Online disinhibition and adolescent cyberbullying: A systematic review. Children and Youth Services Review, 156, 107352. https://doi.org/10.1016/j.childyouth.2023.107352
Wong, R. Y., Cheung, C. M., & Xiao, B. (2018). Does gender matter in cyberbullying perpetration? An empirical investigation. Computers in Human Behavior, 79, 247-257. https://doi.org/10.1016/j.chb.2017.10.022
Wright, M. F. (2017). Parental mediation, cyberbullying, and cybertrolling: The role of gender. Computers in Human Behavior, 71, 189–195. https://doi.org/10.1016/j.chb.2017.01.059
Wright, M. F., Harper, B. D., & Wachs, S. (2019). The associations between cyberbullying and callous-unemotional traits among adolescents: The moderating effect of online disinhibition. Personality and Individual Differences, 140, 41-45. https://doi.org/10.1016/j.paid.2018.04.001
Wright, M. F., Huang, Z., Wachs, S., Aoyama, I., Kamble, S., Soudi, S., Li, Z, L., Lei, L. & Shu, C. (2020). Associations between cyberbullying perpetration and the dark triad of personality traits: The moderating effect of country of origin and gender. Asia Pacific Journal of Social Work and Development, 30(3), 242-256. https://doi.org/10.1080/02185385.2020.1788979
Zhao, Z. (2024). The effect of perceived anonymity on cyberbullying. In 2024 8th international seminar on education, management and social sciences (ISEMSS 2024) (pp. 859-868). Atlantis Press.
Zhu, C., Huang, S., Evans, R., & Zhang, W. (2021). Cyberbullying among adolescents and children: A comprehensive review of the global situation, risk factors, and preventive measures. Frontiers in Public Health, 9, 634909. https://doi.org/10.3389/fpubh.2021.634909.