Bullying

Impact / effects / consequences, age groups impacted, risk factors / warning signs, need for a public health response, strategies to address, assisting bullies and victims, screening for bullying, resources for parents

This page has three sections:

  1. Background Material that provides the context for the topic

  2. A suggested Practice Approach

  3. A list of Supporting Material / References

Feedback welcome!

Background Material


What is bullying?

Bullying is an ongoing and deliberate misuse of power in relationships through repeated verbal, physical and/ or social behaviour that intends to cause physical, social and/or psychological harm with immediate, medium and long-term effects on those involved, including bystanders. The three main features of bullying are

  • Misuse of power in a relationship.

  • Ongoing and repeated behaviour.

  • Behaviour that causes harm (Robinson, 2020).

Childhood bullying can adversely impact on one’s whole life both for bully and victim. It can have short- and long-term effects on physical health, mental health and society in general.


The association between bullying in childhood and later mental health problems, including depression, anxiety and suicidality is well established. Children may also become withdrawn at school or at home, which in turn affects their confidence and ability to develop friendships and trusting relationships, further diminishing their sense of connection and belonging. Bullying not only remains a serious threat to children’s physical wellbeing during the time they are involved or experience it, it also can persist for many years into adulthood (McClowry et al., 2017; Prosser, 2020; Robinson, 2020)


To reduce the mental illness burden in the adult population, effective prevention of and responses to bullying behaviours in childhood are needed. Furthermore, with increasing use of the Internet and social media by children and young people, bullying behaviours in childhood are less confined to school hours. Yet, there continues to be an emphasis on school-based solutions when a wider public health prevention and early intervention response is warranted (Robinson, 2020).


Characteristics and Effects of Childhood Bullying (Stephens et al., 2018)

Characteristics

Short-term effects

Long-term effects

The Bully

Easily frustrated

Has positive attitude toward violence

Impulsive

Sees threats where none exist

The Bully

Antisocial personality disorders

Conduct problems and school disengagement

Depression

Increased risk of suicidal ideation, suicide attempts, and completed suicide

Involvement in vandalism, shoplifting, fighting

Substance abuse (tobacco, alcohol, drugs) Underachievement in school

The Bully

Aggression

Antisocial behaviour

Criminal acts

Increased substance abuse

Performing below potential in employee role

Severe relationship problems

The Victim

Insecure

May believe that he or she deserves to be teased/taunted and harassed

Perceived as weak or different Socially isolated Unassertive

The Victim

Anxiety (social phobia, obsessive-compulsive disorder, panic disorder)

Chronic absenteeism

Depression

Difficulty sleeping

Increased risk of suicidal ideation, suicide attempts, and completed suicide

More likely to carry weapons to school for safety or retaliation

Nightmares/bed wetting

Poor academic performance

Posttraumatic stress disorder

Psychosomatic problems (e.g., headache, abdominal pain), especially in the morning

Self-harm

The Victim

Depression and anxiety

High levels of stress and feeling isolated

Increased risk of suicidal ideation, suicide attempts, and completed suicide

Low self-esteem

Poor academic achievement

Poor psychosocial adjustment

Posttraumatic stress disorder

Bully-victim*

Prone to irritating others and creating tension socially

Quick tempered and emotionally reactive

Reacts to being bullied with provocation (fighting back) and then may claim self-defence


* A victim of bullying who reactively bullies others, typically younger children

Bully-victim

Conduct problems and school disengagement

Depression and anxiety

Fighting

Increased risk of suicidal ideation, suicide attempts, and completed suicide

More likely to carry weapons to school

Psychosomatic problems

Self-harm

Social ostracization by peers

Substance abuse

Bully-victim

Depression

Increased risk of suicidal ideation, suicide attempts, and completed suicide

Increased substance abuse

Moderate to severe impairment in social functioning and intimate relationships

Posttraumatic stress disorder Psychiatric illnesses

Recognised consequences of childhood bullying (Dale, et al., 2014; Vaillancourt, 2017)

Physical health

Mental health

Societal problems

Headaches

Poor appetite

Abdominal pain

Sleeping problems

Enuresis

Depression

Self-harm

Suicide

Psychosis

Anxiety

Personality disorder

School absenteeism

Elective home education

Poor employability

Lowered income

Drug use

Offending behaviour

Bullying is relatively common among pre-teens. Australian research indicates it peaks in the middle primary years and gradually declines through the teenage years.

Bullying behaviours are traditionally thought of as occurring in the teenage years, and many resources addressing bullying are targeted at this age group. Evidence suggests, however, that bullying is common in the pre-teen years (e.g. one-third of year 5 students are affected by frequent bullying), and that there is a fairly steady downwards trend from the pre-teen years through the remainder of the school years (Robinson, 2020). Recent data from the Government of South Australia (2019) reveals that approximately 27% of year 4 to year 9 Australian students report being bullied every few weeks or more. Cyberbullying is less common than face-to-face bullying, with approximately one in five children experiencing online bullying in any year. Australian research indicates that bullying tends to peak during the early to middle primary years, and again just prior to the transition to secondary school.


Bullying is no longer confined to school. Therefore some bullying goes undetected leaving those involved unsupported.


There is a growing awareness that bullying is best addressed as a public health problem requiring a collaborative, community-based solution, and that prevention and early intervention approaches in the pre-teen years (and earlier) are needed for this purpose. The World Health Organisation have identified bullying as existing beyond schools. For example, cyberbullying means bullying can occur anytime and outside of a physical setting. Therefore, it is important to identifying key social and community touchpoints for pre-teens other than schools. One of these is health services (Robinson, 2020; Government of South Australia, 2019).


Pre-teens with peer problems are more likely to see a GP, paediatrician, or allied health worker than those not experiencing peer problems. One-third of parents say their GP could be a potential source of help if their child was being bullied. Furthermore, research indicated that 40% of children being bullied don’t disclose to parents. Therefore, primary health care professionals should be an option for children to disclose to because of:

  • the widespread prevalence of bullying.

  • the adverse consequences of bullying.

  • reluctance of some victims to seek help from parents or school authorities.

  • the limited effectiveness of school prevention programs (Robinson, 2020).

There are identifiable risk factors and warning signs for children who either engage in bullying or become a victim.


Understanding and addressing risk factors while building protective factors are important in early intervention to prevent bullying behaviours. Several risk factors are proposed in the literature, but caution is needed given the limitations of the quality of the evidence available (Robinson, 2020). Risk factors for bullying victimisation include (McClowry, 2017; Robinson, 2020):

  • Conduct problems, e.g. engaging in externalising behaviour

  • Social problems, e.g. lack adequate social skills, experiencing difficulty in solving social problems, being noticeably rejected and isolated by peers

  • Prior victimisation

  • Internalising problems, e.g. internalising symptoms, possessing negative self-related thinking

  • Coming from a negative community, family, and school environment

  • Vulnerability, e.g. have a disability, be overweight or obese, be sexually diverse

  • Behavioural problems

  • Learning disability

  • Identifying as lesbian, gay, bisexual, transgender, queer, questioning, asexual, intersex, or as any other not defined by society’s labels

Children are more likely to engage in bullying if they experience strains or pressures in different settings, e.g. bullying might increase if there is:

  • Family conflict

  • Punishment by adults

  • Poor peer relationships

  • Experiences of development trauma or victimisation (Government of South Australia, 2019)

Warning signs for bullying

  • Mood disorders, psychosomatic or behavioral symptoms, substance abuse, self-harm behaviors, suicidal ideation or a suicide attempt, a decline in academic performance, and reports of school truancy.

  • Parental concerns, e.g. when a child suddenly needs more money for lunch, is having aggressive outbursts, or is exhibiting unexplained physical injuries.

Strategies exist to effectively address bullying, at both an individual and community level.

  1. Strengthen children’s involvement in community programs so they learn social skills, conflict resolution and problem solving.

  2. Strengthen community knowledge and awareness about bullying through

  • Educating parents around children’s behaviour, cyberbullying and cybersafety

  • Community education programs

  • Provision of children’s mental health services

  • Applying a public health approach to address children’s peer-to-peer bullying at a population level (Government of South Australia, 2019).

Practice Approach


At a community level health practitioners can advocate for and support programs to address bullying, e.g. by liaising with schools, sports organisations, and other community agencies (McClowry et al., 2017).


At a direct practice level practitioners can:

1. Educate themselves in the risk factors and warning signs for bullying.

Refer to the Background Material section above

2. Screen for bullying (for both perpetrator and victim) if flagged by risk factors / warning signs.

Stephens et al. (2018) suggest the following questions:

  • Do you feel safe at school? (Critical question)

  • How do you get along with teachers and other students?

  • Have your grades changed recently?

  • Many young people experience bullying at school or via social media. Have you ever had this happen to you or anyone you know? Or are you or is anyone you know being bullied through social media or other electronic means?

  • Follow-up questions: Is there anyone at school or at home you can talk to about your concerns? How could your parents help you with this problem?

McClowry et al. (2017) suggest a simple screening instrument could be used if children don’t wish to discuss bullying openly.

Statements/questions

Responses

  1. I feel safe at school

Never | Sometimes | Always

2. I feel I belong at school

Never | Sometimes | Always

3. Students at school make fun of, bother, or hurt me

Never | Sometimes | Always

4. How often have you made fun of, bothered, or hurt another student at school?

I haven't | 1-2 times | 2-3 times | Several times a week

5. Where have you been made fun of, bothered, or hurt?

At school | Online | At home | Going to and from school | Other

6. Have you told anyone that you've been made fun of, bothered, or hurt?

Not applicable | Yes | No

McClowry also suggests parents be included in screening: ask them about any changes in behaviours or attitude their children have had at school and if they have talked to their children about bullying or witnessed their children being picked on.


3. Treat mental health issues that may arise because of bullying.


Once bullying has been identified, family physicians have an important role in screening for comorbid disorders, such a depression and anxiety, and in providing appropriate treatment (McClowry et al. (2017). Dale et al. (2014), Stephens er al. (2018) and Villiancourt et al. (2017) outline potential impacts of bullying on both perpetrator and victim in the Background Material above.


4. If necessary, be an effective referral point to other appropriate services.


Where it is relevant, a multidisciplinary collaboration between physician, the patient, the family, the clinical social worker or psychologist, or other school personnel can assist in creating a safe network of empathy for the patient and bring about social change (McClowry et al., 2017).


5. Provide resources for parents and children to use to address the bullying.

Quality resources are available on the internet and in print form in many countries. The Raising Children Network has several easy-to-read articles on how to support those children who are bullied or a bullying others. See https://raisingchildren.net.a/search?query=Bullying. The following are a selection of titles:

The Australian Institute of Family Studies focuses on children who bully and how parents and health professionals can approach the issue. See https://aifs.gov.au/search/site/Bullying. The following are a selection of titles:

6. Work with children and parents to address the bullying.


There is generally a lack of quality guidance around best practice in identifying and responding to bullying in primary health care, and what little exists is usually heavily focused on victims of bullying, with little attention paid to children who engage in bullying behaviours or who are victim/bullies (Robinson, 2020). Prosser (2020) suggests an approach for prejudice-based bullying that is helpful. Prosser suggests health professionals choose from the following approaches:

  • Validate the child’s experience by talking about and naming the bullying. Gather details.

o “How often are you bullied?”

o “How long have you been bullied?”

o “Where are you bullied?” (E.g. school, sports, home, neighbourhood)

o “How are you bullied?” (E.g. hitting, insults, gossiping, text messaging)

o “How do you feel when you are bullied?”

o McClowry et al. (2017) suggest some children and adolescents may be reluctant to admit they are being cyberbullied out of frear that their online time will be restricted or their electronics confiscated.

  • If appropriate, openly discuss discrimination

o Name the issue and discuss with the child how they feel about it. You should ask directly whether the child is experiencing bullying because of a particular attribute. This may be a relief for the child as it can provide a safe space for them to open up about their experiences.

o Don’t ignore it or tell the child to ignore it, as this may reinforce the discrimination.

o Affirm that discrimination is never okay.

  • Encourage reporting of the bullying (but don’t leave this all up to the child)

o Make a plan with the child about how they will tell their teacher or coach about the bullying

o Help the child write a letter to their teacher or coach asking for support

o Work on a list about what the child would like to see changed, to share with the adults in charge at their club or school

o Some bullied children will fear identification of the abuser or fear they will be treated unfavourably by their peers. Explain that revealing the bully may help end the cycle, not only for them, but for others as well.

  • Discuss with the parents and carers the impact of bullying on their child; encourage them to report bullying. As McClowry et al. (2017) point out, it is important to provide the parents with direct, clear information about bullying and its impact so that they are better able to engage in shared decision making and to appropriately participate in the plan to improve their child’s overall health.


  • Reframe negative messages they will have heard

o Help the child understand that it is the stereotypes and biases associated with these characteristics that are the problem, not the child or behaviour

o Ask some questions and help the child make a list of things they can be proud of

o Help them to integrate these positive aspects into their sense of self so that the bullying doesn’t define them

o Remind the child that their identity is something that they can celebrate, and that the cause of the problem lies with other people’s misperceptions and prejudices

  • Ensure the child maintains agency and control over their experience by supporting them to develop coping strategies


  • Facilitate connection and belonging by linking the child and their family to peer support groups and identifying positive role models

6a. What approaches are suggested for those who bully others?


The articles in point 5 above from the Australian Institute of Family Studies are quite comprehensive, especially Working with families whose child is bullying at https://aifs.gov.au/cfca/publications/working-families-whose-child-bullying. The Raising Children Network also addresses this issue at https://raisingchildren.net.au/school-age/behaviour/bullying/your-child-bullying. The Raising Children Network article suggests (in brief) the following strategies that may be useful when working with children and parents:

  • Tell the child their bullying behaviour is not okay.

  • Work with the school or organisation, that should have guidelines around bullying. Support the organisation’s decisions. Check in with the organisation regularly.

  • Look for reasons for the bullying. This may uncover something that can be changed to stop it.

o Is the child being bullied?

o Is the child joining in bullying to avoid being bullied?

o Is the child seeing bullying at home or in other settings such as TV or videos?

o Does the child bully to feel more in control or because he or she has low self-esteem?

o Is the child misunderstanding messages about ‘standing up for themselves’?

  • If bullying continues other strategies could be to (i) implement a behaviour contract between parents, organisation/school and child, (ii) organising counselling, (iii) be a role model for the child by treating others with respect and kindness, (iv) work on raising your child’s self-esteem, (iv) give the child plenty of positive attention, (v) set limits and consequences for behaviour, (vi) manage parental conflicts constructively.

Supporting Material / References

(Available on request)


Dale, J., Russell, R., & Wolke, D. (2014). Intervening in primary care against childhood bullying: An increasingly pressing public health need. Jlournal of the Royal Society of Medicine, 107(6), 219-223. doi: 0.1177/0141076814525071


Government of South Australia. (2019). Connected, A community approach to bullying prevention within the school gates and beyond. Retrieved from https://www.education.sa.gov.au/sites/default/files/connected-community-approach-bullying-prevention.pdf


McClowry, R. J., Miller, M. N., & Mills, G. D. (2017). What family physicians can do to combat bullying. The Journal of Family Practice, 66(2), 82-89.


Prosser, S. (2020). Prejudice-motivated bullying and its impact on child mental health and wellbeing. Emerging Minds. Retrieved from https://emergingminds.com.au/resources/prejudice-motivated-bullying-and-its-impact-on-child-mental-health-and-wellbeing/


Robinson, E. (2020). Identifying and responding to bullying in the pre-teen years: The role of primary health practitioners. Emerging Minds. Retrieved from https://emergingminds.com.au/resources/identifying-and-responding-to-bullying-in-the-pre-teen-years-the-role-of-primary-health-care-practitioners/


Stephens, M. M., Cook-Fasano, H. T., & Sibbaluca, K. (2018). Childhood bullying: Implications for physicians. American Family Physician, 97(3), 187-192. Retrieved from https://www.aafp.org/afp/2018/0201/p187.html


Vaillancourt, T., Faris, R., & Mishna, F. (2017). Cyberbullying in children and youth: Implications for health and clinical practice. The Canadian Journal of Psychiatry, 62(6), 368-373. doi: 10.1177/0706743716684791