Bullying

Epidemiology

Incidence of Bullying in school children
1. Up to 20% of children reported Bullying in prior year at school
2. Up to 16% of children reported Cyberbullying in prior year
3. Kann (2016) MMWR Surveill Summ 65(6): 1-174 [PubMed]
Bullying associated with weapons in school Grades 6-10
1. Bullies: 500% more likely to bring weapon to school
2. Victims: 60% more likely to bring weapon to school
3. Nansel (2003) Arch Pediatr Adolesc Med 157:348-53 [PubMed]
School violent deaths often caused by Bullying victim
1. Anderson (2001) JAMA 286:2695-702 [PubMed]

Definition

Aggressor repeatedly, intentionally attacks or intimidates victim to cause fear, distress or harm
1. Based on an imbalance of power between the bully and the victim
Common forms of Bullying
1. Harassment or threatening behavior
2. Name calling, teasing, racist or sexual remarks
3. Bully circulates rumors
4. Bully takes victims belonginings
5. Physical harm (hitting, kicking, slapping)
6. Isolation from group or manipulation of friends
7. Cyberbullying (even a single instance of Bullying via electronic means)

Characteristics
Bully

Bully characteristics
1. Aggressive behavior with teachers, parents, siblings
2. Impulsive and easily frustrated
3. Dominant personality
4. May witness Violence as used at home
5. May lack parental nurturing and supervision
6. Normal or over-inflated self-esteem
7. Misperceives threats
No anxiety or insecurity over behavior
1. Does not relate to emotional experiences of others
2. Uses Violence as a tool of power and domination
3. Reinforcement: Control, prestige, material goods
Associated psychiatric illnesses
1. Antisocial Personality disorder
2. Oppositional Defiant Disorder
3. Attention Deficit Hyperactivity Disorder (ADHD)
4. Major Depression and Suicidal Ideation
5. Substance Abuse
6. Truancy
7. Criminality (shoplifting, vandalism, assault)

Characteristics
Bullying victim

Victim characteristics
1. Victim perceived as unassertive and unable to defend self
2. Victims sense weaker, helpless position
3. Physically smaller and weaker than peers
4. Sensitive, quiet children who are socially isolated
5. React to Bullying with crying and withdrawal
6. Child feels like a failure and are ashamed
7. Poor self worth: Believe they are stupid or ugly, and may feel they deserve to be teased or harassed
Provocative victim (Bully Victim) characteristics
1. Victim as above, but are more aggressive
2. Tease bully to incite more Bullying
3. Irritate others and incite social tension

Risk factors (victim of Bullying)

Chronic illness (e.g. Asthma, Diabetes Mellitus)
Physical deformity
Outlier body habitus (e.g. Obesity or underweight)
Learning Disorder
Behavioral disorder
Children in special education classes
Children with difficult social skills
Clumsy children
LGBT (lesbian, gay, bisexual, Transgender)

Symptoms (victim of Bullying)

Insomnia
Depressed mood
Nocturnal Enuresis
Eating Disorder
Somatic symptoms
1. Recurrent Abdominal Pain
2. Chronic Headache
3. Dizziness

Associated conditions (victim of Bullying)

Low self esteem
Social isolation and loss of friends
School avoidance or Truancy
Decreased school performance and poor grades
Anxiety Disorder
Major Depression
Violent retaliation by victim

Prevention

Screen for Bullying at routine clinic visits (start at 6 years old)
1. Are you ever teased at school?
2. What have you been teased about?
3. What do you do when you are teased?
4. Have you told anyone about this? What happened?
Other screening questions
1. Do you feel safe at school?
2. Do you get along well with teachers and other students?
3. Have you ever been bullied at school or on Social Media?
4. Is there someone at home or school you can talk to if you are bullied or feel unsafe?
Victims and their families
1. Reinforce supportive environment
  1. Caring adults with close family relationships (optimize parent-child relationship)
  2. Foster connections to healthy school environment
2. Role play on projecting sense of confidence
  1. Stand straight and make eye contact
  2. Arms and hands should appear relaxed
  3. Use strong voice to sound secure
3. Participate in activities that promote confidence
  1. Activity should be free of Bullying
  2. Child should have interest in activity
  3. Examples of positive peer groups
    1. Drama club (may also learn to act confident)
    2. Sports participation
4. Respond to Bullying event: Talk, Walk, Squawk
  1. Talk briefly to bully with confidence
    1. Example: "You don't scare me"
    2. Do not provoke further Bullying
  2. Walk (not run) away from the scene
  3. Squawk to an adult about event
    1. Adult should be pre-identified to speak with
    2. Tell about event when it happens
5. Parental response
  1. Parents of the victim should not confront the parents of the bully
    1. Associated with worsening the situation
    2. Freeman (2012) Psychiatr Clin North Am 35(4): 877-900 [PubMed]
  2. Respond with support and involve the school and mental health resources
  3. Parents should not minimize the Bullying
Bullies and their families
1. No tolerance policy
2. Eliminate reinforcements (power and social influence)
3. Consider school psychologist involvement
4. Provide strong role models with positive attitudes
School-wide program development
1. Olweus Bullying Prevention Program (Norway program)

Resources

U.S. Dept Health and Human Services StopBullying.gov
1. http://www.stopbullying.gov
National Education Association on Bullying
1. http://www.nea.org/home/neabullyfree.html
PACERs National Bullying Prevention Center
1. http://www.pacer.org/bullying/
AACAP Bullying
1. https://www.aacap.org/aacap/Families_and_Youth/Resource_Centers/Bullying_Resource_Center/Home.aspx
Secondstep Bullying Prevention Unit
1. http://www.secondstep.org/bullying-prevention

References