What is Identifying and Addressing Bullying?
Bullying is a serious yet preventable problem that threatens the physical and emotional health of children. Bullying typically involves a more powerful individual or group repeatedly behaving aggressively towards those they see as weak.
According to the CDC, bullying is any undesired aggressive behavior by another child or group who are not siblings or current dating partners, that involves a power imbalance and is repeated or is very likely to happen again. The National Center Against Bullying in Australia defines it as a continuous misuse of power in relationships that repeatedly brings verbal, physical, or social harm.
In the past, people often looked at bullying as a normal part of growing up. However, we now know that it can have long-term physical and mental health consequences. Bullying often targets children who are somehow “different,” such as racial, religious, or ethnic minorities, immigrants, refugees, people with visible physical features or disabilities, or younger or more vulnerable children. Bullies often act violently without provocation and are usually seeking attention or notoriety.
Healthcare professionals play a crucial part in preventing bullying and helping victims overcome its negative effects. They can recognize and act on instances of bullying early. The goal is to improve the lives of young people affected by bullying, including victims, bullies, and those who witness the bullying.
Bullying, especially verbal bullying like name-calling and taunting, often happens in unstructured and unsupervised places, such as playgrounds, cafeterias, or buses. Cyberbullying, bullying that occurs over digital devices like cell phones, computers, and tablets, has become more common with access to technology increasing. Increased online activity during COVID-19 lockdowns has only intensified this trend, with name-calling being the most common form of online bullying.
The misuse of artificial intelligence (AI) has even led to the creation of fake explicit content to intimidate victims. However, victims of cyberbullying often stay silent. Cyberbullying can be harder to recognize because it might not be as repetitive as physical or verbal bullying, and bullies can often remain anonymous online. Since hurtful messages online can be easily saved and shared, victims can continue to suffer even after the bullying stops. Victims of cyberbullying often feel like there’s no escape because the bullying can occur anytime and anywhere, even at home.
Other forms of bullying, like social bullying, involve manipulation of social relationships to hurt the victim. This can include spreading rumors, excluding victims from social groups, or manipulating social dynamics to damage reputations or relationships. While less direct, this form of bullying can lead to emotional harm and can often occur online as well.
Doctors play a key role in spotting and treating bullying’s harmful effects. They can help identify at-risk patients, teach families how to deal with bullying, and push for anti-bullying measures in schools and the community. In the end, the goal is to improve children’s well-being and reduce the damage caused by bullying.
What Causes Identifying and Addressing Bullying?
Bullying is not a simple issue; it’s the result of a mix of individual characteristics, social situations, and environmental factors. Some kids who bully have a specific background and behave in certain ways. Likewise, the kids they bully often share similar qualities.
Children who have had difficult experiences early in life are more likely to become bullies. Some traits associated with these kids include being aggressive, easily frustrated, not being able to control impulses, blaming others for their problems, and not taking responsibility for their actions. They often want power, believe others are against them, and tend to hang out with friends who are also bullies. Bullies often act out more and use marijuana and alcohol more than kids who don’t bully. It’s important to note that bullies don’t have to be physically stronger than the kids they bully. They just need to seem more powerful, which could be due to being popular, having money, being part of a certain group, or being very smart. Some kids who bully use it as a way to be popular with their friends. Also, some kids who bully have been bullied themselves and may not think of themselves as bullies.
Bullying happens among kids from all walks of life. Kids from less wealthy families tend to be bullied more, but being wealthier doesn’t guarantee that a kid won’t be bullied. Kids from troubled families or who see violence at home are more likely to be bullied. However, having a supportive family or a caring adult in their life, having good friends, and the ability to deal with their feelings can help protect kids from the impacts of bullying.
Kids who are seen as “different” from their peers are more prone to bullying. This includes kids from different racial and ethnic groups, who might also be affected by other factors that go hand in hand with bullying, like living in tough communities or going to challenging schools. A strong connection to their ethnicity and family can help protect these kids from the harms of bullying. Similarly, kids who are part of religious minorities or are immigrants or refugees are more likely to be targeted. This also includes kids who look different, like having birthmarks, being very tall or short, having disabilities, or chronic health conditions. These conditions can include severe acne, seizures, changes in skin color, autism, attention deficit disorder (ADHD), and obesity. Research has shown that teens with obesity are twice as likely to be bullied as their normal-weight pals. Kids who don’t have many friends or have trouble socializing are also often targeted.
Bullying often happens to enforce certain norms among peers, such as traditional relationships and gender roles. Students who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) are more likely to experience bullying based on their sexuality or identity. They face more verbal and physical bullying, as well as online bullying, which can lead to emotional harm, injuries, and even suicide.
Some kids who bully others have been bullied or hurt themselves. These are called “bully victims” and they’re at a higher risk of mental, emotional, and behavioral problems compared to other kids. They’re also more likely to think about or try to commit suicide.
Risk Factors and Frequency for Identifying and Addressing Bullying
According to statistics, bullying is a widespread issue among students aged 12 to 18. The National Center for Educational Statistics notes that 22% of these students report being bullied in school frequently. Teachers and academic administrators confirm this as a regular discipline problem, with 14% dealing with it every day or at least weekly.
Different forms of bullying reported include:
- Spreading rumors (15% of cases)
- Verbal taunting (14% of cases)
- Exclusion from activities (6% of cases)
- Physical aggression (being pushed, shoved, tripped, or spit on) (5% of cases)
- Physical threats (4% of cases)
- Coerce students into unwanted actions or destruction of their possessions (2% of cases)
Also, approximately 20% of US high school students have reported being bullied at school. Among this group, around 30% of girls have reported cyberbullying. This form of bullying is deemed a “major problem” by half of the victims.
Observing bullying is also common, with approximately 40% of children admitting to witnessing it at their school. Bullying proves to be a global issue with a reported prevalence rate between 5% and 45%. It happens more frequently among boys, especially those in middle school. Boys mostly experience physical and verbal bullying, while girls often face verbal and social bullying.
Racial, religious, and ethnic minority youths are significantly affected by bullying. Black teenagers tend to experience bullying more than their peers from other racial groups. Further, they’re twice as likely to feel that their race made them a target compared to White or Hispanic teens.
Finally, lesbian, gay, bisexual, or youth unsure about their sexual identity also face a higher risk of bullying. Around 40% of these high school students report being bullied, with bisexual students reporting 22% of the total number. Worryingly, LGBTQ students are bullied twice as much as their heterosexual and cisgender peers and are less likely to report it.
Signs and Symptoms of Identifying and Addressing Bullying
Bullying can be a hidden issue in children, as many won’t readily admit it. If a child seems to be showing signs of stress, like difficulties sleeping or nightmares, changes in eating habits, frequent headaches or stomachaches, mood swings, lack of self-esteem, or suicidal thoughts, it can be a red flag. Additionally, evidence of anxiety or depression, school absences, slipping grades, loss of friends, or missing or damaged belongings can suggest bullying.
To help identify and support victims of bullying early on, clinicians can use various screening tools like the HEADDS assessment or the Bright Futures questionnaires. It’s important to create a comfortable environment in the healthcare setting where children feel safe discussing their experiences. This is even more crucial for LGBTQ+ children who may not have supportive environments at home or school.
- Difficulty sleeping or nightmares
- Change in appetite
- Headaches or stomachaches
- Mood swings
- Low self-esteem
- Suicidal thoughts
- Anxiety or depression
- School absences
- Falling grades
- Loss of friends
- Missing or damaged belongings
Most victims of bullying don’t want to admit to it, so indirectly asking about their school life or friendships can provide greater insight into bullying situations. Physical examinations typically don’t reveal much, but unexpected weight changes or unexplained bruises or cuts could hint at physical bullying or self-harm.
To illustrate, consider a teenage boy who was previously a good student and active in sports and music, now struggling with his grades. His teacher suspects ADHD because he isn’t completing homework, but upon further examination, it’s revealed that he’s being bullied, leading to his declining performance. Similarly, a teenage immigrant girl suffering from weight loss isn’t unhappy with American school lunches; she’s being bullied for her lack of English language skills, leading to her refusing to eat at school and self-harming.
Bullying falls under ongoing traumatic childhood experiences. The American Academy of Pediatrics suggests using trauma-informed care, a method of medical care recognizing the impact of stress on children and their families. It’s the responsibility of clinicians to respond sensitively, maintaining the child’s safety and privacy, using respectful language, and supporting their autonomy.
Testing for Identifying and Addressing Bullying
If you’re a doctor suspects that a child might be facing bullying, the first step is to talk directly and privately with the child to understand just how serious the problem is. Bullying can be quite a sensitive topic, so the doctor will take steps to create a safe and comfortable environment for the child. This includes asking open-ended questions, active listening, being empathetic, and assuring the child that what they share will remain private unless there’s a need to inform authorities for the child’s safety.
The doctor might ask the child these three basic questions to get started:
1. Is someone bullying you?
2. How often does it happen?
3. How long has this been happening?
Knowing just what kind of bullying the child is facing and how severe it is will be crucial when deciding how to help. The doctor needs to know if it’s physical, verbal, social, or cyberbullying, as different types of bullying need different ways to handle them. The doctor will also try to find out whether or not the bullying is so serious that it’s putting the child in danger and if child protective services needs to get involved.
The doctor might also ask if the child is facing other harmful situations, like child abuse or domestic violence, while they’re interviewing them confidentially.
The steps to help the child and deal with the situation usually happen alongside the assessment and more detailed evaluation process.
Treatment Options for Identifying and Addressing Bullying
When a healthcare provider thinks a child is being bullied, they usually gather more information from the child, their parents or caregivers, and occasionally their teachers. After that, the healthcare provider may give advice for future situations, direct the family to helpful resources, or recommend speaking to a specialist in mental health. They might also suggest contacting the child’s school or, in more serious cases, law enforcement authorities. The first priority is to ensure the child’s safety. If the child is in extreme danger, has been physically or sexually abused, or is having suicidal thoughts, the healthcare provider will arrange immediate transport to the nearest emergency facility.
In the doctor’s office, healthcare providers who are treating victims of bullying always make sure the children feel safe and understand that the bullying is not their fault. These healthcare providers can help the children learn techniques to handle bullies, such as telling the bully to stop, walking away, and then telling a grown up they trust about the incident. They should also tell another adult if they’ve already reported the bullying and nothing has been done. The healthcare provider might practice these techniques with the patient and encourage the parents to do the same at home. Parents often need guidance from healthcare providers on how to recognize signs of bullying and how to talk about it with their children’s teachers. The parents might be directed to resources like stopbullying.org and marccenter.org, which can help them address these issues.
When dealing with cyberbullying, children should never engage, but rather hold onto any hurtful messages as evidence, block the person sending them, and tell a trusted adult about it. If necessary, the healthcare provider can provide counseling and ensure appropriate steps are taken at school or elsewhere to prevent further harm.
In the community, healthcare providers should work with schools and others to tackle bullying. All US states require schools to develop plans to address bullying, and successful ones often emphasize empathy, improve social skills, educate school staff and families about the problem, and build a school culture that does not tolerate bullying. They also encourage students who see bullying to step in and stop it. Still, more comprehensive programs that involve families, schools, and communities can have the most significant impact, reducing bullying by up to 20%.
In addition to their practice, healthcare providers can also advocate locally and nationally to support anti-bullying initiatives. They can improve community education and services, work on strengthening anti-bullying laws, and create policies that fought bullying based on racial, ethnic, or sexual stereotypes.
Sometimes, healthcare providers may also treat bullying perpetrators. It’s crucial to make it clear that the bullying is wrong without condemning them personally. Bullies may also have been victims themselves and might need to share their experiences. Listening and understanding these children’s backgrounds can provide insights into the reasons behind the bullying. The healthcare provider could recommend necessary disciplinary actions and connect with the child’s school to advocate for non-punitive measures. They can also provide mental health counseling if needed. Some children might stop the bullying behavior when they understand the damage they have done and learn other ways to cope with their feelings.
What else can Identifying and Addressing Bullying be?
Doctors can often find out if a patient is being bullied if they take the time to ask the right questions and pay close attention to the patient’s answers. However, the signs commonly linked to bullying can be vague and might be due to other worrying situations. These could include:
- Problems with peers
- Dating violence
- Problems at home
- Harassment
- Hazing
It’s crucial to address and handle these issues properly. If bullying turns out to be the problem, doctors should check the victim for mental health issues that might have resulted from the bullying. This could include:
- Posttraumatic stress disorder
- Anxiety
- Depression
- Thoughts about suicide
Keep in mind that the patient’s physical and emotional health might get worse if they’re dealing with more than one of these problems at the same time.
What to expect with Identifying and Addressing Bullying
In medicine, doctors use the term ‘prognosis’ to predict the outcome of a disease. This could be recovery, disease recurrence, or even death. However, bullying isn’t a disease, so we look at the consequences and complications instead.
Despite this, we often use ‘prognosis’ in a broader sense to predict a likely outcome. Now, both medical and educational studies suggest that unless we take effective steps to prevent and address it, the future impact of bullying could be severe. This means it will continue to harm children and young people all around the world.
Possible Complications When Diagnosed with Identifying and Addressing Bullying
Bullying can lead to both physical and mental health problems in the short term and over time. These harmful effects can persist even after treatment for physical injuries, which might continue to hinder the victim. Bullied children often struggle academically, with lower grades and difficulty focusing. Both those who are bullied and the bullies themselves can end up feeling isolated, harassed, and depressed. This can escalate to substance abuse and suicidal thoughts, and these issues can continue into their adult lives. In fact, bullying focused on stigma around personal characteristics can lead to even more significant health problems than general bullying.
- Short-term and long-term physical and mental health problems
- Trouble in schoolwork like lower grades and difficulty focusing
- Social isolation, anxiety, depression, suicidality, substance abuse
- These issues can continue into their adult lives
The victims of severe bullying can feel threatened and depressed and may develop post-traumatic stress disorder. As adults, they may carry weapons for self-defense and are more likely to try to take their own lives compared to those who were not bullied. They also show poor social adjustment. One study revealed that children who were bullied in 5th grade were more likely to consume substances like tobacco, marijuana, and alcohol by 10th grade to cope with the emotional pain. Indeed, there’s a clear link between being bullied and suffering from depression, anxiety, relationship difficulties, failing health, struggling academically, harboring suicidal thoughts, and having sleep problems.
The rates of substance abuse among bullied LGBTQ youth are noticeably higher. Bullying can also lead to psychological distress and increase suicide rates among this group. Teens who have been threatened or involved in fights are more likely to carry weapons at school and show violent behavior, creating an unsafe environment for all students.
Those who engage in bullying too can meet with negative outcomes. If they engage in anti-social behaviors or face expulsion, they might drop out of school. Criminal activities and domestic violence are frequent issues they face later in life. These problems can be even more severe for ‘bully-victims’, those who are both victims and perpetrators of bullying.
Higher rates of mental health issues, thoughts of self-harm and suicidality, and substance abuse are seen with such individuals. While supportive adult figures can help mitigate the effects of bullying and potential substance use in the future, it is still complex to separate bullying from other factors like anxiety or other traumatic childhood events that can all contribute to substance use.
Preventing Identifying and Addressing Bullying
School programs aimed at preventing bullying can help to lessen the acts of bullying and the negative effects it can have. The success of these programs isn’t easy to measure, as there are very few detailed studies evaluating how effective they truly are. Further, what works in one school or community may not work in another. What is generally considered successful is a program that fosters a school environment where bullying is not tolerated, engages students who witness bullying to take action, promotes classroom discussions and role-playing activities, increases adult supervision in areas like playgrounds, and provides learning resources for parents and caregivers.
It has been observed that programs targeting only one aspect of the school environment or just addressing bullying in the curriculum are less effective than programs that involve everyone in the school – including teachers, cafeteria workers, administrators, custodians, and bus drivers. Some schools even use focus groups to shape the program content and strategize, ensuring they understand the perspectives of their students.
Schools that have clubs that promote equality and friendship between gay and straight students have seen increased levels of happiness and confidence among their LGBTQ students. The Massachusetts Safe Schools Program for LGBTQ Students is a good example of a statewide effort. This program, a joint effort between the Department of Elementary and Secondary Education and the Massachusetts Commission on LGBTQ Youth, includes classroom lessons, student activities, teacher training workshops, and offers opportunities to develop new policies. Doctors often recommend that communities and schools use ideas from these and similar programs to create their own guidelines to prevent bullying.
