When most of us went to school, we knew who the bullies were, and we knew who got bullied, but the problem was not discussed much. Things have changed since then. With media coverage of suicides attributable to bullying, we now realize that the phenomenon is potentially deadly.
Bullying is generally defined as an aggressive, intentional act carried out by an individual or a group, repeatedly over time, and aimed at a victim who can’t easily defend him or herself. It can take various forms. It can be physical (an assault), verbal (a threat), relational (socially isolating the victim), indirect (spreading rumors), or cyber (via social media, texting, etc).
Bullying is common, with half of all children experiencing it at some point during their school years, peaking in middle school years (Pergolizzi F et al, Int J Adolesc Med Health 2011;23(1):11—18). The National Education Association has estimated that each day, more than 160,000 children stay home from school because of bullying.
The Impact of Bullying
There have been a number of studies on the psychological effects of bullying. They have consistently shown a correlation between being frequently bullied and being more likely—by about two-fold—to experience anxiety, depression, lowered self-esteem, loneliness, self-harm, and suicidality (Kaltiala-Heino R et al, J Adolesc 2000;23(6):661–674; Wolke D & Lereya St, Arch Dis Child 2015;Epub ahead of print). And while we tend to have little sympathy for the bullies, they suffer high rates of depression, are often victims of abuse or bullying themselves, and are at risk for substance abuse.
Asking about bullying should be an explicit part of your routine history since many children will not spontaneously report these experiences. In one survey, up to 50% of kids said they would never or only rarely tell their parents or teachers, likely because of shame or fear of retaliation (Radford L et al, Child Abuse Negl 2013;37(10):801–813). Kids with developmental problems, such as autism, are at particularly high risk to be bullied. See “Types of Bullying and Questions to Ask Victims” below for more on specific types of bullying and questions you may ask children if you suspect they are a victim. You’ll want to probe for more details in kids who tell you that bullying is a significant problem.
Table 1: Types of Bullying and Questions to Ask Victims
How do you “treat” bullying? Clearly, it is not an individual disorder but is a problem in the child’s environment. While you can treat secondary symptoms of depression and anxiety using your usual combinations of medications and therapy, in order to stop the bullying you will have to understand the context and work with the parents and the school.
In some situations, decisive action by the school, such as disciplining the perpetrator, may essentially solve the problem. But in more subtle bullying situations, the child may need training in social skills. These can include basic interaction skills (smiling, making eye contact, listening), and coaching on how to join a group activity, how to take turns or share, how to problem-solve when disagreements come up, and how to stand up for oneself. Social skills training has been shown to have a positive impact, particularly in middle and high school kids (Braddock BA et al, Clin Pediatr (Phila) 2015;Epub ahead of print). Having a few close friends can improve self-esteem and decrease anxiety and depressive symptoms, so learning these skills to help form connections with peers can be effective.
Dr. Carlat's Verdict: Bullying is common, takes many forms, and can have a significant mental health impact for the bully as well as for the victim. Ask about bullying as an explicit part of your routine history since many children will not spontaneously report these experiences. In your work with schools, be clear to school staff that the most effective way to create a healthy school environment for all is not based upon what the principal or teacher says, but, much more importantly, what is done about bullying, once it is reported to the school.