Bullying and psychiatry

Dr. AHNAF KARIMPHASE B, RESIDENT

Department of Psychiatry, BSMMU

What is bullying?

Repeated and deliberate use of physical or psychological means to hurt another child, without adequate provocation and in the knowledge that the victim is unlikely to retaliate effectively

(Goodman and Scott,2005)

“Bullying is psychological violence”

Dr. Gary Namie,

Director of the Workplace Bullying Institute (WBI) in Bellingham, WA

and author of “The Bully at Work.”

Washington state anti bullying law (SHB 1444)

An intentional written, verbal or physical act, including but not limited to one shown to be motivated by any characteristic such as race, color, religion, ancestry, national origin, gender, sexual orientation, mental or physical disability, or other distinguishing characteristics, when the intentional act:

(a) Physically harms a student or damages his/her property; or

(b) Substantially interferes with the student’s education; or (c) Is so severe, persistent or pervasive that it creates an

intimidating or threatening educational environment; or (d) Substantially disrupts the orderly operation of a school

• Bullying can be overt (i.e., teasing, hitting, or stealing); boys are most often overt bullies

• Bullying can be covert (i.e., spreading rumors); girls are most often covert bullies

Bullying Happens in Four Ways

Verbal Teasing, jokes, ignoring/isolation, gossip, threats Physical Blocking someone’s path, physical restraint,

pushing/kicking, hazing Sexual Teasing, touching, slapping, pictures, emails, sexual

assault Property Hiding belongings, theft, arson, extortion, vandalism,

destruction

Victim Profile

• Generally tend to lack friends and social support

• Cautious, sensitive, quiet and non-aggressive

• Lack confidence in their abilities

• If a boy –tend to be smaller and physically weaker

• Considered by others as ‘different’

Effects of Bullying onthe Target

Physical Effects• Stomach aches• Weight loss/gain• Headaches• Drop in grades• Drug or alcohol use• Sexual activity• Physical aggression

Emotional Effects• Low self-esteem• Insecurity• Fear• Depression• Withdrawn• Aggression• Anger• Suicidal• Homicidal

Possible signs of bullying• Not wanting to go to school• Cuts and bruises• Asking for stolen possessions to be

replaced• ‘Losing’ lunch money• Being bad tempered• Being quiet and withdrawn• Refusing to talk about what happens

at school• Loss of appetite, bedwetting• Aggression with brothers and sisters• Doing less well at school work• Insomnia, anxiety• Talking about not having friends

A typical bully is a person who:

• Has a desire to hurt • Lacks compassion and empathy for others• Lacks guilt for his or her actions• Believes it is OK to treat others in a cruel fashion• Likes to dominate and be in charge• Avoids adults and plays/spends time out of adult

sight• Is verbally convincing

Impact on the Bully

• Learned behavior• Limited social skills• Poor relationships• Higher chance of

juvenile delinquency• More likely to turn to

criminal activity as adult

• Suffer higher rates of

depression• As adults, treat their

own children in a dominating and emotionally abusive manner

Why do children bully?

Individual model:• Skill deficits or differences • Come from homes that

use physical punishment to discipline

• Caregivers of bullies are typically uninvolved and lack warmth

• Children who bully are often defiant toward authority figures

• Peer group or behavior reinforcement model

-- peer group reinforcement--- responses of the

victimized children

High Risk Environments

• Poverty

• Dysfunctional families

• Childhood abuse

• Failure to bond with adults or develop positive relationships with adults

• Exposure to media violence

• School failure and school problems

Role of the Family

• Children increasingly live in dysfunctional families• Abused children grow up impulsive, aggressive,

antisocial, and lacking in empathy to the people and world around them

• Over half of today’s teenagers have lived through their parents’ divorce and reside with a single parent or divide their time between two households

• 60% teenagers live in households where both parents work outside the home

(Stevenson & Schneider)

Role of the Family

• Family history with problem behavior

• Family conflict

• Family members don't spend much time together

• Lack of parental supervision

Role of the Media

• By the time children start school, they will have seen over 8,000 murders on television and over 100,000 violent acts. By the time they graduate from high school, these numbers will double

American Academy of Child and Adolescents

Psychiatry, 1995

Role of the Media

• Increased aggressiveness and antisocial behavior

• Teenage life is defined by the media

Role of the Community

• Alcohol and other drugs readily available

• Norms are unclear

• Neighborhood disorganization

• Extreme economic deprivation

• Lack of strong social institutions

• Lack of monitoring youths' activities

Role of the School

• Lack of clear expectations, both academic and behavioral

• Lack of commitment or sense of belonging at school

• Academic failure

• Parents and community members not actively involved

Participants role

• Bullying – 8%• Victimized- 12%• Assistant- 7% (join bullying)• Reinforcers- 20% (encourage bullying)• Onlookers- 24% (watch bullying)• Defenders-17% (try to stop bullying)• No clear role- 13%

(salmivalli,1999)

Family Bullying

Occurs when a person in a family uses theirpower to control those with less power in ways that

are threatening and abusive

• spouse/partner abuse• child abuse and neglect• sibling threats and aggression• abuse of older adults by caregivers

Why is defending uncommon?

• Fear of children who bully

• Negative perceptions of children who are victimized

• Brief appearance of some bullying incidents

• Diffusion of responsibility

(salmivalli,1999)

Workplace bullying

Surveys of bullying in the UK indicate that between 12-50% of the workforce experience bullying.

UK National Workplace Bullying

Workplace bullying (contd.)

20% Education sector

12% Healthcare

10% Social services

06% Charity / non profit sector.

Advice Line

Workplace bullying (contd.)

Study of Finnish workers examined the link between sleep disorders and bullying

Prevalence 5%

Sleep problems were reported by 21% of women and 17% of men.

http://www.workplacebullying.org/2011/03/12/lallukka/

CYBER BULLYING

An individual or group that uses information and communication involving electronic technologies to facilitate deliberate and repeated harassment or threat to an individual or group

‘Electronic Bullying’ & ‘Online Social Cruelty’

CYBER BULLIES’ TECHNOLOGY

E-mailCell phonesPager text messagesInstant messagingDefamatory personal web sitesChat rooms

DIFFERENCES

BULLYING

• DIRECT

• Occurs on school property

• Poor relationships with teachers

www.stopbullyingnow.hrsa.gov

CYBERBULLYING

• ANONYMOUS

• Occurs offschool property

• Good relationships with teachers

{McKenna & Bargh, 2004; Ybarra & Mitchell, 2004}

CYBER BULLYING PREVALENCE

• 35% of kids have been threatened online. Nearly 1 in 5 have had it happen more than once.

• 21% of kids have received mean or threatening e-mail or other messages

• 42% of kids have been bullied while online. 1 in 4 have had it happen more than once.

Based on 2004 i-SAFE survey of 1,500 students http://www.isafe.org

*Taken from an i-SAFE America survey of students nationwide

Statistics

As many as half of all children are bullied at some time in their school years, and at least 10% are bullied on a regular basis.

American Academy of Child & Adolescent Psychiatry, May 2008

Childhood trauma and children's emerging psychotic symptoms: A genetically sensitive longitudinal

cohort study.

Children who experienced bullying by peers or adults were more likely to report psychotic symptoms at age 12 than children who did not experience such traumatic events. The higher risk for psychotic symptoms was observed whether these events occurred early in life or later in childhood

Am J Psychiatry. 2011 Jan;168(1):7-8.

• At young ages, ADHD and depression, as well as anxiety are prevalent concurrently with bullying among the children involved.

• In young adulthood, Male victims are at risk for anxiety and personality

disorder Male bullies for personality disorders The risk is especially increased if the child is

disturbed when involved in bullying at school age.

Int J Adolesc Med Health. 2008 Apr-Jun;20(2):121-32.

Consequences of bullying in schools

Peer victimization is a significant causal factor in school children's lowered health and well-being and that the effects can be long-lasting. Further evidence from longitudinal studies indicates that the tendency to bully others at school significantly predicts subsequent antisocial and violent behaviour

Can J Psychiatry. 2003 Oct;48(9):575.

A nationally representative study of 15,686 students in grades six through U.S. schools

• Males> females • Bullies are more likely to smoke and drink

alcohol, and to be poorer students• Bully-victims--students who are both bullies and

recipients of bullying--tend to experience social isolation, to do poorly in school

Journal of the American Medical Association (Vol. 285, No. 16)

Cyber and traditional bullying: differential association with

depression

• Cyber victims reported higher depression than bullies or bully-victims.

• For physical, verbal, and relational bullies, the frequently-involved group of victims and bully victims reported a significantly higher level of depression than the corresponding occasionally involved group.

J Adolesc Health. 2011 Apr;48(4):415-7. Epub 2010 Sep 22.

• 100,000 students carry a gun to school.

• 28% of youths who carry weapons have witnessed violence at home.

• Playground statistics - Every 7 minutes a child is bullied.

THE BUREAU OF JUSTICE STATISTICS - School Crime and Safety’09

• Early experience as a bully in school is a significant predictor of juvenile delinquency.

Bullies also evidence increased spousal abuse and child abuse in adult life.

• Hazler, R.J. (1994). Bullying breeds violence: You can stop it.

Learning, 22, 38-41

• 44% of suicides among 10- to 14-year-olds may be bullying-related.

At least 14% were clearly linked by the press to bullying.

http://www.bbc.co.uk/news/10302550

• Yale professor Young-Shin Kim has done research on what's been termed "bullycide" and has found that victims of bullying are 5.6 times more at risk of attempting or thinking about suicide

Bullies are five times more likely to end up with a serious criminal record by age 30.

National Association of School Psychologists

• 6,437 children from birth to 13 years. At the age of 13, the children were interviewed about their experiences of psychotic symptoms in the previous six months

• Bullying can increase the risk of children suffering from psychotic symptoms by up to four times

• Effects included hallucinations, paranoid delusions

• Children who experienced sustained bullying over a number of years could be four times more at risk.

http://www.independent.co.uk/news/education/education-news/bullying-can-lead-to-mental-illness-says-study-1677108.html

In Bangladesh

• Bullying is a serious problem in Bangladesh with more than 30% of students admitting to bullying someone at least once over the past year.

http://www.savethechildren.org.au/resources/position-papers/bullying

In Bangladesh

• Teenage suicides – 22 (‘10) dozens of high-profile attacks on

teenage girls have highlighted Bangladesh's sexual bullying problem

Ain O Salish Kendra (ASK)

Eve-teasing

The south Asian term for sexual harassment -- is an everyday reality in Bangladesh

• Plain-clothed policemen have been on patrol outside top girls' schools in Dhaka, and female police officers have gone undercover inside school grounds across the country -- arresting more than 500 bullies so far this year.

• Traditional attitudes and new technology like mobile phones have combined.

AFP news- july’10

• Burka bullying banned by Bangladesh court

Bangladesh's high court has banned educational institutions from bullying female employees into wearing headscarves or veils

Telegraph---09 Apr 2010

Bangladeshi school girls learn karate to fight bullying

The Tangail district's measures follow the deaths of three people across Bangladesh this week in bullying-related incidents, bringing the total number of deaths to 36 this year, according to police statistics.

http://www.thehimalayantimes.com/fullNews.php?headline=Bangladeshi+school+girls+learn+karate+to+fight+bullying&NewsID=264145 ; 2010-11-

02

Best Practices in Prevention and Intervention

Behavioral Ecological Model

Adapted from “The Behavioral Ecological Model: Integrating public health and behavioral science.” by Hovell, Wahlgren, & Gehrman, 2002. In R.J. DiClemente, R. Crosby, & M. Kegler, (Eds.), New and emerging theories in health promotion practice & research (pp.347-385). San Francisco: Jossey-Bass

Faulty beliefs/ attitudes to change

• I’m not good enough• Being different is bad• I am to blame• I can’t accept the truth• I can do it my own way• Nothing works• No-one can help• I think it is a waste of time

Behaviour (Actions)

Feeling(Emotions)

Thinking

School programs

• Review of 48 studies –

• 48% reduction in bullying

• 33% reduction in victimization

(craig et al..,2010)

Creating Caring,Connected and Safe Homes

Conclusion

• What is required is a commitment by everyone for cultural change that no longer accepts or tolerates violence in our schools, neighborhoods, and broader society

• ‘PEAS’ PROGRAMPsychological-Educational-And-Social

‘He who passively accepts evil is as much involved in it as he who helps to perpetrate it’

(Martin Luther King Jr.)

Cyber bullying victim Amanda Todd left her mum a 'goodbye' video message before she hanged herself.

Together we can make a difference