TAKING A STAND AGAINST BULLYING
BULLYING : A GUIDE TO DETECTION AND PREVENTION AUTHOR Julia Richerson , MD , FAAP
“ Rather than hoping a child is tough enough to endure the insurmountable , we must build resilient places — healthier , safer , more nurturing and just — where all children can thrive . This is where prevention and healing begin .”
-Mona Hanna-Attisha , pediatrician and professor at Michigan State University College of Human Medicine and Director of the Pediatric Public Health Initiative .
My first patient of the day ( hypothetical , based on a sampling of usual presentations ) is here for her 12-year-old checkup . She is a healthy seventh grader , is doing well in school and lives with her parents and younger brother . During the visit , her father mentions that she has been having stomachaches over the last six months , getting progressively worse , and now almost daily . After a complete history and exam shows no evidence of physical illness , I ask about any changes in her life or anything that makes her feel sad , scared or bad . She denies all .
After three more months of frequent follow up visits and a negative medical workup , at last she discloses that she is afraid to go out in public , to the grocery , to see family and friends and to school . She states her final grades this year were failing in all but two subjects . But it takes several more visits before she feels comfortable disclosing to me and her family that she is being bullied in person and on Snapchat .
Bullying and cyberbullying in youth are international public health crises . They are very common : 1 in 5 high school students reported being bullied at school in the last year . 1 Additionally , 33 % of middle school students and 30 % of high school students report they have been targets of cyberbullying . 1
Bullying and cyberbullying must be viewed in the larger context of violence , specifically youth violence . More accurate terms like “ perpetrator ” and “ target ” instead of “ bully ” and “ victim ,” highlight that these are true acts of violence and force us to consider the short term and long term negative consequences .
The Centers for Disease Control and Prevention defines bullying as “ Any unwanted aggressive behaviors by another youth or group
of youths , who are not siblings or current dating partners , that involves an observed or perceived power imbalance and is repeated multiple times or is highly likely to be repeated .” 1
Bullying through the use of technology is called cyberbullying and has important differences . Cyberbullying can be more intense and prolonged because of the use of technology , with pictures and posts viewed by an unlimited audience and stored electronically for long periods of time . 2 Cyberbullying can be nearly invisible to adults who might intervene . The perpetrators do not see their targets , so are less likely to feel the impact on their target and stop bullying because of feelings of empathy and remorse . 2 In addition , half of all targets have reported that they did not know the identity of the perpetrator , 2 which may contribute to increased fear by the target .
Bullying involves a target , a perpetrator and often a bystander . Bullying negatively impacts each person involved . The impacts of bullying vary from person to person , with many personal and societal factors that mitigate and intensify the negative impacts .
Typically , we first consider the mental health of the target of the violence . Issues such as unhealthy sleep patterns , worry , fear , sadness , social withdrawal and loneliness are often experienced by the target . Anxiety and depression may be diagnosed . Suicidality , both thoughts and attempts , are more common among targets when compared to same aged peers . 2
There is also a clear association between being bullied and poor physical health . 3 Youth who are bullied at school have twice the likelihood of having somatic problems compared to their nonbullied peers of the same age . 3 Long term health issues such as headaches , abdominal pain , shortness of breath , musculoskeletal complaints ,
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