How the 764 network pushes kids to self-harm, and the signs doctors miss [PODCAST]

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An online network is coercing children into hurting themselves, and the warning signs are easy to miss. Matthew Turner is an emergency medicine physician, and Dana Grueser is a parent advocate. This episode is based on their article “The 764 network warning signs clinicians miss,” published on KevinMD. You will hear what the 764 network is, how it reaches children through gaming and social media, and why ritualistic or numeric self-harm should prompt questions about a young patient’s online life. Dana describes nearly losing her son, whose viewing of gore content got past her parental controls and whose warning signs were missed. Matthew shares the open-ended questions he now asks in the emergency department, and why a family that says their child is getting worse should be believed. They also discuss flip phones, gaming in shared spaces, and banding together with other parents. Press play to hear why they urge clinicians to spend two or three extra minutes asking about a young patient’s online life.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Matthew Turner, an emergency medicine physician, and we introduce Dana Grueser, a parent advocate. Both of them cowrote the KevinMD article “The 764 network warning signs clinicians miss.” Matthew and Dana, welcome to the show.

Dana Grueser: Thank you for having me.

Matthew Turner: Thanks. It’s great to be back.

Kevin Pho: All right. I’m just going to ask each of you to briefly introduce yourselves, and then we’ll jump right into the article. Matthew, why don’t you go first?

Matthew Turner: It’s great to be back on the show. I’m Dr. Matthew Turner, currently an EM physician at Womack Army Medical Center down in Fayetteville, North Carolina. One of my interests is online extremism and the impact it has on youth, and that’s what led me to this material.

Kevin Pho: All right. And Dana, a brief introduction to share your story.

Dana Grueser: Yes. I’m a speaker and writer about online harm and online radicalization, specifically about nihilistic violent extremist networks. I’m also a parent advocate for children’s online safety. I lead the Mothers Against Media Addiction chapter here in Denver, and I write at Slow Tech Revolution on Substack.

Kevin Pho: All right. So both of you cowrote this article, “The 764 network warning signs clinicians miss.” Matthew, for those who didn’t get a chance to read it, tell us what it’s about.

Matthew Turner: Absolutely. Fundamentally, 764 is an online sextortion network that’s focused on children and teenagers. To go into a little more detail, 764 is a decentralized, transnational online extremist network that targets children and teenagers, usually through social media and gaming platforms. The goal is to coerce them into self-harm, animal abuse, and ultimately the production of child sexual abuse material. Unfortunately, it’s highly effective. The members often share educational material with each other on how to quickly and efficiently earn trust, isolate their victims, and then extort them.

It was originally founded by Bradley Cadenhead, a teenager in Texas, in 2021, and named after his area code. Cadenhead is currently in prison, but unfortunately, 764 has persisted. In the past couple of years and months, we’ve seen it grow exponentially across the globe, from the U.S. to Europe, with increasing cases in Asia and Latin America. For example, the FBI is currently investigating over five hundred cases of 764 involving every single one of its field offices. Canada and New Zealand have both identified it as a terrorist organization.

We’re also seeing multiple offshoots of it in the online ecosystem known as the Com, which includes the true crime community, splinter groups like 8884 and CVLT, and pretty significant connections to a lot of neo-Nazi extremism online, such as the Order of Nine Angles. It’s highly active on Discord and Telegram, and unfortunately, as someone who works with a pediatric patient population, I’m starting to see more and more of it, which is why I reached out to Dana to help cowrite this article.

Kevin Pho: Before I get to Dana, Matthew, what examples of the 764 network are you seeing in your emergency department?

Matthew Turner: Often what you’ll see in the emergency department is kids coming in with self-harm and depression. Self-harm is typically the big one. A big thing to look out for is children coming in with ritualistic or numeric self-harm on their bodies. In cases like this, it’s very important to screen for their internet behaviors.

Literally two days ago, I had a teenager come in with increasing depression over a couple of months. I ended up talking with him about his internet usage, and I straight up asked him, “Are you familiar with 764?” He was shocked that I even knew what it was, because he had been in contact with multiple people affiliated with this network. Fortunately, he had cut them off a couple of months ago, but not before several of them had tried to dox him. So it’s really spreading and becoming very pervasive. I’d say if you have any minor or adolescent come in with any sort of mental health issue, definitely screen for this, as well as their internet usage.

Kevin Pho: Dana, you are a parent advocate. Tell us about your story.

Dana Grueser: I came into this advocacy work because I nearly lost my son to 764 back in 2024. At that time, there had been some FBI bulletins about 764 and QAnon, but it unfortunately was not widely known among mental health and emergency room physicians. So many of the warning signs were missed, even though I was raising alarm bells for many months before he was eventually hospitalized with suicidal ideation.

And I had to fight to keep him hospitalized. They tried to send him home that evening, even though they noted that he had self-harm on his body. They called them anarchy symbols, which we now know were call signs for 764. He told staff that he didn’t have intent to commit suicide, but that he was terrified he might end up doing so because of the repetitive thoughts he was having about suicide, and because the ritualistic self-harm he was carrying out had gone too far on more than one occasion. He said specifically, “I do not feel safe going home. I’m afraid of what I might do.”

I also told them that we had found he had purchased a large hunting knife, that he had escalating mental health issues, and that he was saying things that sounded extremist. I called them extremist at the time because I didn’t know about nihilism and 764 until a few days later. I raised all these alarm bells, but the basic screening question was, “Does he have immediate intent to kill himself or somebody else?” That is a screening question that can miss this type of emergency, because these kids are being coerced, and they’ve been desensitized through watching gore content.

My son was watching this content between his school Chromebook and his smartphone, bypassing both school safety measures and my parental controls. He was watching it for twelve to fourteen hours a day. A lot of parents are aware that there can be violent content online, but they may think that their parental controls are sufficient. I’m here to tell you that they are not. Teenagers are smarter than middle-aged parents about getting around these controls, and these content creators are smarter than the content moderators at making sure their videos are not flagged. So again, he was able to watch this content for twelve hours a day, even though he wasn’t allowed on any social media websites. I had them all blocked.

At that point, they get so desensitized to this type of violence that they’re not considering the impacts of it, or that they’re taking it too far, or that it’s even really a problem. My son did a complete 180 in his personality, mental health, and beliefs in a period of just a few months, to where he was talking about widespread anarchy and the fall of governments, that blood needs to be shed, that violence is OK, and stuff that sounded really crazy and very unlike him.

So I think our standard screening questions need to be taken a step further, to really look at online content. A lot of times, kids are going to hide this stuff. They don’t want to get caught, or they may be threatened if they’re in direct contact with somebody, so they may not come out with it right away. We really need to be asking a lot of questions and looking at the totality of the picture that’s being painted, not just the standard screening questions.

Kevin Pho: Dana, you mentioned gore content. Can you give us an example of exactly what we’re talking about, and what kind of 764 content your son may have been exposed to?

Dana Grueser: My son told me just a few months ago that his first exposure to gore content was when he was seven years old, on Roblox. That was ten years ago. This is marketed as a safe game for children, right? It has a parental rating that shows that it is a safe game for children. It is not. He was playing a normal, run-of-the-mill game on Roblox, and some game mechanic dragged him toward a button. He thought something was wrong with the game, so he tried to close out of it, and it still drags you toward the button and starts showing you a gore video. There were games on there where the object of the game is to dismember yourself.

Gore content is against community standards on platforms like YouTube, TikTok, and Reddit, but it’s rampant on there. It’s all over the place. So when we’re talking about gore content, we’re not talking about violent R-rated content. We’re talking about cartel torture videos. We’re talking about AI-generated murders. My son told a Bloomberg reporter that the scariest video he saw was of a man being skinned alive by a cartel, and he saw that when he was about twelve or thirteen years old.

And this is the thing I want to point out too: I had been checking his phone specifically. Not only did I have websites like TikTok, Reddit, YouTube, Facebook, and Instagram all blocked, I was also checking his phone periodically to make sure that he was not direct messaging with people or seeing harmful content. So again, this stuff is very rampant online and often flies under the radar of both parental controls and content moderation.

Kevin Pho: So Dana, how does 764 present itself? How does one know that this is 764-related content?

Dana Grueser: Generally, the way I’ve seen it play out is that the child is somehow exposed to gore content, and the way these algorithms work, if you even hover your eyeballs over it for more than a few seconds, and most teenage boys are going to look at this stuff because they’re curious, your feed starts getting flooded with it. Then a specific 764 creator might reach out. Often that’s not done on platforms like YouTube. They’ll try to move them off-platform into more private spaces, like Discord or something else, where they can private message them.

That may happen in the comments section. My son followed one creator who did reaction videos to gore content to bypass content moderation, and he encouraged people to sign up for his Patreon and pay a dollar a month. So sometimes it can be a direct reach-out. Sometimes it may be in the comments section, trying to get them off-platform. At that point, somebody from the 764 network can reach out to your child, and that’s when the coercion and extortion start to happen.

In my son’s case, he actually never had any direct messages with anybody, so this is something we parents also need to be screening for. It’s not just, “Has somebody direct messaged your child?” We know that these algorithms are addictive and that this content can become addictive, and just watching the content is often enough to desensitize your child and to get them to start these self-harm behaviors. My son had lost his friend group, had some social difficulties, and was getting bullied at school. He wasn’t looking for any particular ideology. This type of ideology was actually completely against all of his beliefs. He was looking for belonging and a new social circle, and this is what they prey upon.

Kevin Pho: Matthew, Dana said the standard screening questions for suicide simply aren’t enough. Now that you know this and have studied it, tell us the type of questions you now ask in potential cases you see in the emergency department.

Matthew Turner: Ultimately, it’s very important to be open-ended with these questions. I would highly emphasize that. As I alluded to earlier, sometimes being direct is also very effective. I don’t know if I’d recommend that for a twelve-year-old or a thirteen-year-old, but for someone who’s a little older and a little more mature, just saying, “Hey, are you familiar with these online networks?” can be quite effective.

But a lot of times, if a kid’s coming in with self-harm or the telltale signs of these networks, just ask them about it: “Hey, can you walk me through what this symbol represents? Have you ever taken a photo of the self-harm or been asked to? Tell me about your friends online. Is there someone online that you feel like you’re doing this for? What types of things have you been watching online? Are there people online that are important to you? Are there places or groups that you go to online that feel important to you?” Anything like that.

One thing to definitely look out for is any recent or sudden change. If the family believes that the child is getting worse, believe them. They’ll know the kid way better than you ever could in a limited setting in the emergency department. If the kid seems more flat or hopeless, that could be a sign that this nihilistic worldview is really getting to them, and they could be in a very dangerous place. So I’d encourage physicians to look out for that as well. It can be difficult to screen for these things, but I think it’s very important to take your time and dig a little deeper. Just go open-ended with it.

Kevin Pho: Matthew, last time you were on, you talked about the concept of proverbially immunizing teenagers against these types of groups. It sounds like a lot of the entry points are online games and gaming platforms. So when we talk about, quote unquote, “healthy gaming,” versus being exposed to gore content or being led down that path, what questions should parents ask, and what should they be looking for? Because, as Dana said, even going through these platforms and looking at their phone, you can sometimes miss this kind of stuff. As parents, what can they do to make sure that whatever online sites and gaming platforms their kids use are indeed safe?

Matthew Turner: This is actually a question I think I’ll refer to Dana. We discussed this ourselves a couple of months ago, the question of, quote unquote, “safe online consumption for children and minors,” and I think Dana’s got a really good answer for it.

Kevin Pho: All right, Dana.

Dana Grueser: I know this is probably not the most popular take, but through my work in advocacy, speaking with a lot of survivor parents, and through our own experience, I do not believe that most of these gaming platforms are safe for children, especially if there is some online component with direct messaging or any type of friending people, and social media included. And YouTube is social media. They are not safe for children, period, end of story.

There are too many ways that kids can get around this stuff. Like I said before, there are too many ways that content can start with a drip, drip, drip of something just a little violent, and then it becomes outright gore in 764. It’s just too easy. And there have been settlements recently that Meta has made, that TikTok has made, and that Snapchat has made, where internal documents have come out showing that these companies know what’s happening. They have designed these platforms to be addictive, especially for children, and they let it happen anyway because it makes them money.

I have never given my children a pack of cigarettes and said, “Here, figure out a way to use this safely, or start using it now so that when you’re older, you know how to moderate it.” I have a hard time moderating my own smartphone use and not checking my email six hundred times a day.

So I really think a lot of parents feel like they’re taking something away if they either roll back technology that they have allowed or don’t hand their child a smartphone. My son has had a flip phone for two and a half years now, and he says he does not ever want a smartphone again. It was the best thing that ever happened for his mental health. He is allowed to play some video games, never Roblox again, but they are on the main TV where I can see them, and it only happens if I’m in the house and downstairs where I can see it. My kids are just not allowed on social media anymore. Every time they’ve gone back to using it, there have ended up being problems within a matter of days, either with excessive use or with the content they’re seeing.

Kevin Pho: Dana, first off, let me say I do agree with you. I know that a lot of these platforms are engineered to be addictive, and whatever safeguards they have or propose can easily be worked around. So I agree with that premise. But there’s a lot of peer pressure. How do you navigate that if you have a teenage boy and all his friends are playing these games and are on social media? How do you lock that down, not only when they’re teenagers being pressured by their peers, but going forward? Because eventually they’re going to be exposed to some type of social media as they grow up. Social media, online gaming, and YouTube are probably not going away.

Dana Grueser: I think one thing that did help my son was that I talked to him a lot about not direct messaging people online, watching out for content, and “If you see something, say something. I won’t be upset with you if you come to me and say, ‘Hey, I’m in trouble.'” Unfortunately, he did not come to me and tell me about it until later, but he did tell me, “You drilled into my head not to direct message people unless I was 100 percent sure that I knew the person, and even then to be cautious.” That’s a big thing that saved his life.

For the peer pressure, the tide is turning, and for parents this is definitely a collective action problem, as Jonathan Haidt says. So band together with other parents, especially your children’s closer friends’ parents, and just say, “Hey, look, I have these concerns. I don’t think I want to give my child a smartphone until they’re a little older. Could we join together and agree that we’re going to do flip phones and send our kids outside instead of having them do online gaming? Or if they are gaming online, we’re going to make sure they’re doing it in a place where parents can hear and see what’s going on.”

It is a lot on parents, and the peer pressure is there. Fortunately for us, this was a life-or-death situation, so it was a pretty clear-cut point. But my daughter has not been as on board with not doing social media. So it also helps to talk to the kids about how these companies are trying to take advantage of them, so it’s not just me as a parent saying no to something. I’m not just saying no; I’m giving you another freedom and another opportunity. You can go to your friend’s house. You can ride your bike to the store, right? You can do these other things that are probably actually safer, even though we consider them not to be. And explain to them that these companies are trying to take advantage of you.

As for when they’re older, I’ll go back to things like smoking and drinking, right? We don’t allow teenagers to do these things. Their brains are still developing. They’re very impulsive, and they just don’t have the same ability to moderate this stuff that adults do. So I think it’s the same thing. Give them that time to grow up, right? Give them that time for their brains to develop, and then if they decide they want to do it later, sometimes you’re not going to be able to control that. They’re eighteen, they’re twenty-five, whatever, they’re out of the house. But hopefully by that point, they’ve had enough time for their brains to mature, and they can start to pick out, “OK, my algorithm is now showing me this. Why is it showing me this? What’s the end game here?”

Kevin Pho: We’re talking to Matthew Turner and Dana Grueser. Matthew is an emergency physician, and Dana is a parent advocate. They wrote the KevinMD article “The 764 network warning signs clinicians miss.” Now I’m going to end by asking each of you for your take-home messages to the KevinMD audience. Matthew, why don’t you go first?

Matthew Turner: My take-home message is for physicians, specifically emergency medicine physicians. If you’re dealing with minors and adolescents, even if they’re not coming in for anything mental health related, I would highly encourage taking an extra two or three minutes just to ask them about their online content consumption.

Kevin Pho: And Dana, we’ll end with you and your take-home messages.

Dana Grueser: I would say try as a family to prioritize real-world experiences over online experiences. That’s a great way to keep your kids safe. And if you have an intuition that something is going wrong, if you see your kid really escalating in mental health behaviors or declining, believe what you’re seeing.

Kevin Pho: Dana and Matthew, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.

Dana Grueser: Thanks for having us.

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