Bullying’s brutal impact

Physical pain, depression, anxiety, even suicide: the effects of bullying are profound. How academic medicine can — and must — help those who suffer.
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Editor’s note: The opinions expressed by the author do not necessarily reflect the opinions of the AAMC or its members.

Going to school each day should be about learning, fun, and friends, but for many youngsters, the school day is filled with worry about repeated harassment, physical attacks, and painful social ostracism.

In fact, 1 in 3 sixth-graders and 1 in 5 tenth-graders report being bullied at school, according to the U.S. Department of Education. And the numbers are much higher for certain vulnerable groups: For example, nearly 85% of LGBTQ students say they’ve experienced verbal harassment.

Given that bullying is so common, one might ask, “What’s all the fuss? Isn’t this just kids being kids?” As a pediatrician who has written extensively about the issue, I’m often asked that question.

My answer is simple: Bullying has many short- and long-term physical and emotional effects that we in the medical community have an obligation to work to prevent and heal.

Being bullied is associated with physical health problems, reduced academic achievement, and sometimes even violent retaliation. And research on adverse childhood experiences (ACEs) implicates childhood traumas not only in poor health outcomes later in life but in negative intergenerational epigenetic impacts as well.

Perhaps most worrisome are behavioral health outcomes, such as depression and suicidal ideation, that may not appear immediately but can have crippling effects even into adulthood. Such consequences are more often associated with ostracism, rumor-mongering, and other relational forms of bullying that can be difficult to detect.

Bullying has many short- and long-term physical and emotional effects that we in the medical community have an obligation to work to prevent and heal.

What’s more, the modern development of cyberbullying is a complex and dangerous phenomenon — as some tragic cases of related suicides highlight — because of its potential for viral proliferation, near-constant presence, and tempting cloak of anonymity.

Most physicians are well aware that bullying affects their patients. In periodic American Academy of Pediatrics surveys, most respondents say they have an important role to play in bullying prevention, and parents believe that physicians have a key role as well. The question, then, is, “What’s a physician to do?”

Those hoping to address the issue can start by deepening their understanding of bullying. In fact, several organizations, including the American Medical Association, the American Association of Child and Adolescent Psychiatry, and the American Academy of Pediatrics, have passed resolutions emphasizing member education on bullying prevention.

Fortunately, the National Academies of Sciences, Engineering, and Medicine (NAM) has produced a valuable and comprehensive report, Preventing Bullying Through Science, Policy, and Practice. This document can serve as a one-stop-shop for health professionals looking to learn the state-of-the-art science on bullying.

Continuing medical education (CME) is another great way to expand knowledge about bullying. I’ve personally spent the better part of the last decade engaging colleagues in various CME trainings. In-person options range from 90-minute workshops to day-long summits, while web-based resources such as webinars, including those offered by stopbullying.gov, are also available.

In addition, though, we have a duty to learn about the real-world context of the patients, families, and communities with whom we work and live. One way to do this is to make sure to ask children and parents about local instances of bullying. Such conversations also offer opportunities to provide anticipatory guidance on how to handle being bullied and how to stop bullying others.

Another way to engage with local communities is to work with schools and other institutions to create anti-bullying programs. Among the NAM report's recommendations is implementing evidence-informed training on bullying prevention for those who work regularly with children and teens. As providers, we should be urging local leaders to create programs that support youth and increase awareness among educators and similar professionals.

Lastly, and with the greatest potential for indelible impact, would be to introduce bullying-related content in undergraduate medical education. We have many options for teaching future physicians about bullying, from including the topic in basic health and society courses to more complex instruction on how life experiences can alter DNA activity.

The time is right to integrate bullying content fully into medical school curricula. Today, as we are increasingly aware of the role of social determinants of health, it would be a mistake to omit a social behavior that has such potentially powerful health outcomes. What's more, a great deal of the intellectual awakening around bullying emanates from millennial learners, so it makes sense to leverage their energy and insights as we work to weave bullying into medical education.

We owe it to our learners — and to those who suffer from bullying — to act boldly before yet another generation bears the scars.

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Joseph Wright, MD, MPH, is senior vice president and chief medical officer of the University of Maryland Capital Region Health and the University of Maryland Medical System, as well as an adjunct research professor at the University of Maryland School of Public Health. He has worked extensively on bullying, including as lead author of an American Academy of Pediatrics policy statement on the role of the pediatrician in bullying and violence prevention.