Definition of Bullying:
Bullying, scourge of all times, is defined as ‘aggressive, intentional acts carried out by a group or an individual repeatedly and over time against a victim who cannot easily defend him- or herself’. Three criteria are relevant to define aggressive behavior as bullying(1): repetition(2), intentionality(3) and an imbalance of power(91). Bullying is then the systematic abuse of power and is defined as aggressive behavior or intentional harmdoing by peers that is carried out repeatedly and involves an imbalance of power, either actual or perceived, between the victim and the bully(1).
Forms of Bullying:
Bullying can take the form of
- Direct bullying, which includes physical and verbal acts of aggression such as hitting, stealing or name calling,
- Or indirect bullying, which is characterized by social exclusion (eg, you cannot play with us, you are not invited, etc.) and rumor spreading(2-4).
Bullies, victims, bully/victims, and cyberbullying:
Children can be involved in bullying as victims and bullies, and also as bully/victims, a subgroup of victims who also display bullying behaviour(5,6). Recently there has been much interest in cyberbullying, which can be broadly defined as any bullying which is performed via electronic means, such as mobile phones or the internet.
Bullying in numbers:
One in three children report having been bullied at some point in their lives, and 10–14% experience chronic bullying lasting for more than 6 months(7,8). Between 2% and 5% are bullies and a similar number are bully/victims in childhood/adolescence(9).
Rates of cyberbullying are substantially lower at around 4.5% for victims and 2.8% for perpetrators (bullies and bully/victims), with up to 90% of the cyber-bullying victims also being traditionally (face to face) bullied10. Being bullied by peers is the most frequent form of abuse encountered by children, much higher than abuse by parents or other adult perpetrators(11).
Bullies profile:
Bullying is found in all societies, the purpose of which is to gain high status and dominance(14), get access to resources, secure survival, reduce stress and allow for more mating oportunities(15). Pure bullies (but not bully/victims or victims) have been found to be strong, highly popular and to have good social and emotional understanding(17). Hence, bullies most likely do not have a conduct disorder. Moreover, unlike conduct disorder, bullies are found in all socioeconomic(18) and ethnic groups(12).
Victims & bully/victims’ profile:
In contrast, victims have been described as withdrawn, unassertive, easily emotionally upset, and as having poor emotional or social understanding(17,19), while bully/victims tend to be aggressive, easily angered, low on popularity, frequently bullied by their siblings(20) and come from families with lower socioeconomic status (SES)(18), similar to children with conduct disorder.
Consequences:
Until fairly recently, most studies on the effects of bullying just included brief follow-up periods, making it impossible to identify whether bullying is the cause or consequence of health problems. We will try to review new studies that were able to control for pre-existing health conditions, family situation and other exposures to violence (eg, family violence) in investigating the effects of being involved in bullying on subsequent health, self-harm and suicide, schooling, employment and social relationships.
Children who were victims of bullying have been consistently found to be at higher risk for common somatic problems such as colds, or psychosomatic problems such as headaches, stomach aches or sleeping problems, and are more likely to take up smoking(39,40). Victims have also been reported to more often develop internalizing problems(90) and anxiety disorder or depression disorder(31). Victims of bullying are at significantly increased risk of self-harm or thinking about suicide in adolescence(43,44). Furthermore, being bullied in primary school has been found to both predict borderline personality symptoms(30) and psychotic experiences, such as hallucinations or delusions, by adolescence(37). Where investigated, those who were either exposed to several forms of bullying or were bullied over long periods of time (chronic bullying) tended to show more adverse effects(31,37). In contrast to the consistently moderate to strong relationships with somatic and mental health outcomes, the association between being bullied and poor academic functioning has not been as strong as expected(51). A meta-analysis only indicated a small negative effect of victimization on mostly concurrent academic performance and the effects differed whether bullying was self-reported or by peers or teachers(47).
We know little about the mental health outcomes of bullies in childhood, but there are some suggestions that they may also be at slightly increased risk of depression or self-harm(33,45), however, less so than victims. Bullies were also more likely to display delinquent behavior and perpetrate dating violence by eighth grade(50). Children who were victims of bullying have been consistently found to be at higher risk for internalizing problems, in particular diagnoses of anxiety disorder(55) and depression(9) in young adulthood and middle adulthood (18–50 years of age)(56). Furthermore, victims were at increased risk for displaying psychotic experiences at age 18 and having suicidal ideation, attempts and completed suicides(56). Victims were also reported to have poor general health(65), including more bodily pain, headaches and slower recovery from illnesses(57). Moreover, victimized children were found to have lower educational qualifications, be worse at financial management(57) and to earn less than their peers even at age 50(56,69). Victims were also reported to have more trouble making or keeping friends and to be less likely to live with a partner and have social support. No association between substance use, anti-social behavior and victimization was found. Victims were at increased risk for displaying anti-social behavior and were more likely to become a young parent(62,70,71).
Pure bullies may be more deviant and more likely to be less educated and to be unemployed(65). They have also been reported to be more likely to display anti-social behavior, and be charged with serious crime, burglary or illegal drug use(58,59,66). However, many of these effects on delinquency may disappear when other adverse family circumstances are controlled for(57). Victims of bullying used lethal force in retaliation. And, while deadly violence is a relatively improbable event for most youth, the consequences (i.e., death and serious injury) represent a high cost to individuals, families, and communities(99). Bullying consequences last well into adulthood in terms of impaired functioning, such as problems with doing housework and managing money(92), reduced levels of education(93), and problems with work(95). These are important findings as we need to understand the impact of bullying on a diverse range of adult adjustment outcomes.
Bullying victimization may also influence social relationships. In childhood, victims of bullying are more likely to report loneliness, social avoidance, and self-blame(96). They experience more rejection and feel less accepted by peers(97). Not surprisingly, they may have trouble forming new social relationships during the transition to young adulthood and experience more loneliness, less social support, a lower likelihood of having a live-in partner, and poorer family functioning in adulthood(98) found that victims of bullying were at increased risk for problems with finances, health, and social relationships in adulthood, even when controlling for other adversity, including childhood violence.
Being bullied may alter physiological responses to stress(74), interact with a genetic vulnerability such as variation in the serotonin transporter (5-HTT) gene(75), or affect telomere length (ageing) or the epigenome(76). Altered HPA-axis activity and altered cortisol responses may increase the risk for developing mental health problems(77) and also increase susceptibility to illness by interfering with immune responses(78). Both altered stress responses and altered social cognition (eg, being hypervigilant to hostile cues(38)) and neurocircuitry(83) related to bullying exposure may affect social relationships with parents, friends and co-workers. Finally, victimization, in particular of bully/victims, affects schooling and has been found to be associated with school absenteeism.
Conclusion:
There is growing research documenting the long-term consequences of bullying victimization, reaching beyond health problems. The developmental phases of childhood and adolescence may create a particular vulnerability to shame after bullying victimization, which may influence psychosocial adjustment during the transition from adolescence to young adulthood. The unique effect of bullying victimization, over and above the effect of violence, calls for an integration of the two research fields to include bullying victimization and integrate it into trauma research, along with other forms of violence.
Bullying is a strong predictor of nearly all anti-social outcomes. Physical bullying was more predictive than verbal/indirect bullying. Controlling for family risks and externalizing/ internalizing problems reduced effect sizes, but bullying remained a sound predictor. Bullying seems to be a key risk marker for anti-social development.
We have to invest into more studies, trying to prevent and convert bullying effects on individuals and then societies, aiming for better life.
Dr. Antoine YAZBECK
M.D, Head of Pediatrics Department Serhal Hospital
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