Adolescent bullying: etiology, pathophysiology, and clinical manifestations

Adolescent Bullying Fact Sheet

Nursing

Etiology/Pathophysiology/Incidence/Prevalence

Opinions regarding the etiology of bullying vary. As with many behaviors, there are those that contend that bullies learn and practice behaviors of aggression and violence in the home environment. Some argue that bullies hurt others because they experience abuse in their own lives and manifest their feelings of disgust & horror at their own weakness or vulnerability by hurting others. There are also arguments that some people become bullies because they lack sufficient social intelligence, awareness and skill. They may perceive aggression or hostility in others, including in their words & behaviors, when the person victimized by the bully, truly shows no signs nor has no intentions of violence or conflict. The pathophysiology of bullies includes higher blood pressure, subpar impulse control, and other physical indicators of stress, anger, rage, and even confusion. Those who are victimized may sweat excessively, have anxiety attacks, higher blood pressure, headaches, problems controlling their bladders & bowels, and more. Adolescent boys are far more likely to become bullies than girls, yet the frequency and intensity of female bullying continues to warrant attention & research as it is on the rise. (NYVPRC, 2002) There is also research that argues that males are likely to be more physically violent that females with regard to bullying, but as more research is performed, these figures and assumptions change. The home environment is a key factor in the incidence and prevalence of bullying. Where there is little emotional support, where there are forms of abuse (physical, substance, etc.), where the parents are not involved in the lives of their children -- these are just some of the factors that contribute to the prevalence and incidence of easily angered, pro-violence, impulsive adolescent bullies with low tolerances for frustration. (NYVRPC, 2002) Statistics vary across countries regarding teen bullying. The percentages of those bullied does not typically exceed a third of the population survey or studied.

2. Differential Diagnosis

Whether we consider the bully or the victim of the bully, on both sides of the conflict, there will be stress, anxiety, and often fear that is experienced. Victims of bullies may not want to attend school. They may be skipping classes or have higher than usual rates of absenteeism or truancy. The same may be said for the bullies. As bullies often have unstable and scary home lives, the bullies may be worried or anxious about the people at home. This may be a parent who abuses drugs and is home alone with a younger, more vulnerable sibling while the adolescent sibling attends school and shows his/her fears by bullying others. Adolescent bullying may refer to bullying that occurs during the stage of development that is adolescents and it can refer to bullying that is specifically performed by adolescents. Adolescents may experience bullying from their peers and from teachers or other staff members they encounter as part of their regular school day schedule. This is yet another reason why bullies and victims of bullies may be quite reluctant to attend school or specific classes with regularity.

4. Diagnostic Studies

a. Laboratory Evaluation -- In the study by Cooper et al. (2012) their research supported other findings in that bullying is serious and prevalent. Schools need to implement prevention strategies, interventions, and screening for bullying and victimization. (281, 2012)

5. Treatment -- Emotional support is necessary for victims as well as for bullies. It is important for parents and other people to whom victims or bullies seek out remain calm and supportive. Try to see the situation from the youth's perspective. Victims and bullies need to be instilled with confidence to either stand up to the bully or to feel confident in other ways instead of hurting others. Parents should not approach the adolescent victim or bully independently. Parents should also seek assistance from the school or other professional organizations or agencies that specialize in the treatment of bullying. Increased involvement in outside activities, therapy, and other solutions can support youth are bullied and who are bullies.

6. Expected Outcome/Follow-up Needs -- The long-term expected outcome is for the bullying and victimization to end. Depending on the situation and the people involved, the short-term outcomes and follow up needs will vary. Each situation will seek unique progress on an independent timeline or schedule. What is most important is progress. (AACAP, 2011) Victims need help as early as possible so that they do not internalize their victimization and remain in that state into adulthood. Bullies need early intervention as well so that they do not end up becoming violent criminals, which is a likely path for a bully.

7. Patient Education -- The patient in this case would like be the victim of the bully and/or the parents of the victim. There is information online, local medical facilities, and at the youth's school. Parents and other supporting figures in the youth's life can also relate their experiences with bullies, as nearly every single person has encountered a bully in at least one instance of his/her life. What is important is to educate the victim in every way possible and/or available to the parent. Even simply explaining that bullies hurt others because they are hurt by others can help the victim gain perspective and confidence to stand up, fight back, or otherwise not be afraid.

References:

Coopers, G.D., Clements, T.C., & Holt, K.E. (2012). Examining Childhood Bullying and Adolescent Suicide: Implications for School Nurses. The Journal of School Nursing, 28(4), 275 -- 283.

National Youth Violence Prevention Resource Center. (2002). Facts for Teens: Bullying. Rockville, MD. Available from: www.safeyouth.org. 2013 January 16.

The American Academy of Child and Adolescent Psychiatry. (2011). Facts for Families -- Bullying. The American Academy of Child and Adolescent Psychiatry Journal, 80(2011), 1 -- 3.