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Mar 2018 ( Volume -12 Number -3)

Article 2
Attempted ‘Blue Whale Challenge’–A Case report
Salendra Mohan Tripathi, MD; Junaid Nabi, MD; Manjunadh M, MD and Anil Kumar, MD
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Attempted ‘Blue Whale Challenge’–A Case report

Salendra Mohan Tripathi, MD; Junaid Nabi, MD; Manjunadh M, MD and Anil Kumar, MD

Abstract:

The Blue Whale Game also known as "Blue Whale Challenge", is a 21st-century social network phenomenon existing in several countries. The blue whale game was launched in Russia in the year 2013. Blue whale game is known by many different ways like “Wake up at 4:20 am”, “F 57”. The game “Blue Whale Challenge” gives a player 50 days, with one mission for each day, with total of 50 levels. After completing all 49 tasks, the 50th task is to kill his own self. We at King George Medical University (KGMU), report a case of a young boy who indulged in this game.

Case Report:

A 14 years old boy was brought to OPD with history of playing the “Blue Whale Challenge”. Though he had started playing this game from last one month, his family noticed change in his behavior from the last three months. His performance in school had deteriorated along with anger control issues. There was also history of frequent quarrels and externalizing tendency like breaking stuff at home. He would get angry on issues which could otherwise be solved in a peaceful way.

The child does not have any close friends around his home or in school. His parents noted that he would sit alone and had been seen interacting less with family members. He got details of the Blue Whale Challenge from the internet and had completed up to stage 11. He reportedly was not in contact with any administrator for the challenge but was rather doing it himself.

He carved the diagram of a blue whale on his forearm using a broken glass and was later caught by his mother finding the same on his hand and was brought to hospital. Patient had no regrets for the damage caused to himself and was waiting for even harder steps in the game. He added that it is difficult to get away from the challenges as one feels under influence of it. On further enquiring, his father said that patient wants things to be done the way he wants and that he is rigid. If anyone messes up with his things, he becomes irritable and restless. He would also demand things and would try to blackmail his family member on the pretext of getting good treatment. It was perplexing to see a child of 14 years carving a blue whale on his forearm with a piece of glass, one can imagine the pain he must have gone through. His father said he demanded for a mobile phone for seeking treatment from a doctor. Patient said he becomes sad which lead to his anger because of non-congenial environment in his family.

Mental Status examination at the time of presentation in OPD revealed a sad looking boy who would speak less in a low tone. Patient was restless with anxious features. Physical Examination was within normal limits. Local examination revealed a self-mutilating mark on his left forearm which resembled a whale. He described it clearly as a whale with fins, tail and a head. He did it with a broken glass.

Fig 1. Partially healed outline of a whale drawn by using a broken piece of glass.

The possibility of obsessive compulsive and related disorder (unspecified obsessive-compulsive and related disorder) was kept in mind with personality issues. In view of the rarity of the cases reports, patient was told to undergo investigations, which included complete blood count, kidney function, liver function tests. All investigations were within normal limits. Magnetic resonance imaging (MRI) was done which was normal. On the basis of diagnosis as per DSM-5 (Diagnostic and Statistical Manual of Mental Disorders 5), Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) was administered on the patient to validate the severity1. On administrating the scale, patient fell in the range of moderate case of OCD with the score of 22.

Patient was started on fluoxetine 20mg once a day after breakfast along with clomipramine 25mg at bed time on outpatient department basis. Patient was advised to take medications regularly and his parents were directed to ensure compliance. A follow up after 10 days was scheduled. On enquiring, the patient reported good improvement. His father was also happy with the improvement. Patient started interacting more and was able to handle his anger better. Intensity of anger also came down. The repeated thought of playing the deadly game had also decreased. Overall improvement was remarkable. On administered Y-BOCS, this also showed marked improvement where score had got reduced to the range of 14. Treatment was continued (Tablet Fluoxetine 40 mg and Tablet Clomipramine 25 mg per day). Regular follow up was stressed.

Discussion:

The Blue Whale Game also known as "Blue Whale Challenge", is a 21st-century social network phenomenon that is claimed to exist in several countries, beginning in 2016. The game reportedly consists of a series of tasks assigned to players by administrators over a 50-day period, with the final challenge requiring the player to commit suicide2.

The term "blue whale" comes from the phenomenon of beached whales, which is linked to suicide. Beaching is a phenomenon in which cetaceans strand themselves on land, usually on a beach. Beached whales die due to dehydration, collapsing under their own weight or drowning when high tide covers the blowhole.

"Blue Whale" came to prominence in May 2016 through an article in a Russian newspaper, Novaya Gazeta, that linked many unrelated child suicides to membership of group "F57" on the Russian-based V Kontakte social network. The game is said to run on different social media platforms and is described as a relationship between an administrator and participant. Over a period of fifty days the administrator sets one task per day; the tasks seem innocuous to begin with (get up at 4:30 am, watch a horror movie), and move on to self-harm, body mutilation and leading to the participant committing suicide on the final day. Claims of suicides connected to the game have been reported worldwide2,3,4. The challenge has allegedly claimed over 130 deaths so far, with multiple teens its reported victims from around the world.

In 2016, Philipp Budeikin, a 21-year-old former psychology student who was expelled from his university, claimed that he invented the game in 2013. He said his intention was to cleanse society by pushing persons to suicide whom he deemed as having no value5.

The first case of alleged Blue Whale suicide in India was reported on July 30, when a 14 old boy jumped to death from the seventh floor of a building in Mumbai. There are many suspected cases in India.

Our patient presented with history of playing blue whale game which according to parents was difficult to get away from it. Patient explained as if he was under some spell which was hard to get off. During completing first steps, he made a whale which is 11th step of the game. His mother came to know about this and this is how it came to his parents knowledge. We treated this patient on the line of obsessive compulsive and related disorder (unspecified obsessive-compulsive and related disorder) and was started on SSRI’S(Selective serotonin reuptake inhibitors). Patient showed marked improvement.

India's Ministry of Electronics and IT has directed internet platforms like Google, Facebook, WhatsApp, Instagram and Yahoo to remove the links to the online game. This follows a petition

from the Ministry of Women and Child Development, demanding a ban on the game.

The other dangerous games which are potentially fatal are The Ghost Pepper Challenge, The Cinnamon Challenge, The Choking Challenge, Ice & Salt Challenge, and Car Surfing Challenge. Scientific and systematic research in this area is highly required to formulate effective management strategy in adolescent population.

Conclusion:

This case has different dimensions. First, the personality characteristics of the child. Second, the family set up and constant fights. Third, resorting to such an extreme measure like playing blue whale challenge and mutilating oneself as part of an attempt to manipulate and also to generate sadistic pleasure. Once the diagnosis was confirmed, patient was managed on the lines of obsessive compulsive and related disorder (unspecified obsessive-compulsive and related disorder). The dosage of the drugs used should be kept at minimum effective dose since this problem is found mostly in adolescents and it may affect their studies. Parental guidance may be utilized to prevent children jumping into this deadly game.

References:

1.    Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., Charney, D. S. The Yale-Brown Obsessive-Compulsive Scale. I. Development, Use, and Reliability. 1989. Archives of General Psychiatry, 46(11), 1006-1011.

2.    Khazov-Cassia, Sergei.  "Teen 'Suicide Games' Send Shudders Through Russian-Speaking World". (21 February 2017). Radio Free Europe/Radio Liberty.

3.    Alluri A. (19 September 2017). "Why is 'Blue Whale' hysteria gripping India?"bbc.com

4.    Trincadi G; Salvia M. "The Truth About 'Blue Whale,' an Online Game That Tells Teens to Self Harm"vice.com

5.    Blue whale challenge administrator pleads guilty to inciting suicide - BBC Newsbeat. BBC Newsbeat. 2017-11-05.

Author Information: Dr. Salendra Mohan Tripathi, is Assistant Professor, Dr. Junaid Nabi, is Fellow; Dr. Manjunadh M, is DM Resident, and Dr. Anil Kumar, is Senior Resident. All are working in the Department of Geriatric Mental Health, King George Medical University, Lucknow, UP, India.

Corresponding Author: Dr. Junaid Nabi, Geriatric Mental Health, Department of Geriatric Mental Health, King George Medical University, Lucknow, UP, India. Email: mohammedsarwarmir@gmail.com

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