Bullying refers to repeated negative activity or aggression intended to harm or bother someone that the aggressor perceives as less powerful. In many cases, bullying victims are harassed because of certain characteristics others perceive as “different”—for instance, physical or learning disabilities, race, ethnicity, or sexual orientation. (See the box below.)
Sexual orientation: A trigger for bullying
Teen bullying based on sexual orientation has become pervasive. In a recent survey of lesbian, gay, bisexual, and transgender teens, 85% reported they’d been verbally harassed and 44% said they’d been physically harrassed because of their sexual orientation.
Boys are more likely to bully than girls. Physical fighting is more common among African American and Hispanic boys. Studies show boys’ bullying is more physical, whereas girls tend to bully psychologically, as by spreading rumors. Bullying is more prevalent in schools than anywhere else, but studies show an increase in after-school bullying through the Internet, social media, and texting. A child may become a bully after being a victim of bullying or child abuse when younger or after witnessing domestic violence.
Consequences of bullying
Bullying victims are more likely to report thoughts of suicide and engage in suicidal behavior. Other consequences include:
- mental distress
- physical distress
- poor academic performance
- increased absenteeism
- compromised emotional health (a leading cause of suicide among teens)
- increased physical complaints, such as headache, stomachache, or sleeplessness (both as a result of stress and as a way to avoid going to school).
Bullied boys are at increased risk for physical victimization, which has been linked to substance abuse, delinquency, and aggression. Bullying motivated by racial or ethnic prejudice is likely to cause greater consequences than bullying for other reasons; in victims of such bullying, school grades are likely to suffer and attendance is likely to decrease.
Health risks of being bullied include depression and an increase in risky health and sexual behaviors, which can lead to sexually transmitted diseases, unwanted pregnancy, and suicide. These risks provide a clear public health rationale for implementing policies and programs aimed at prevention and intervention.
Prevention and intervention
Because schools are the primary socializing institutions where children and teens spend most of their time, school is a crucial environment for implementing prevention and intervention strategies. Even modest reductions in bullying in middle and high schools would bring significant long-term health gains. Schools can offer safer environments by developing and enforcing comprehensive antidiscrimination and anti-harassment policies that incorporate input from administrators, educators, parents, students, and outside clinicians who see students after school. These policies should include LGBT identity and gender expression. School curricula should integrate racial and ethnic diversity and LGBT issues; when these become a routine part of learning, all students will be perceived as “normal.”
Education on bullying should be tailored to students’ age and ethnic group. Messages must be personalized at the individual level and should be based on bully, victim, or bystander status. Students should be taught how bullying affects others, what its consequences are, and where to go for information and support. Bullies must be assessed properly to determine why they bully and what interventions can be used to help them.
School administrators and educators must advocate for and implement policies and programs that promote safe, supportive learning environments where all students are protected from victimization. Prevention and intervention strategies must incorporate input from students themselves. After all, students absorb the experiences of various bullying situations. (In fact, in most bullying situations, only students are present.) They know what’s being done to stop bullying and can see how effective various anti-bullying strategies are.
Teachers are in a prime position to notice and respond to bullying situations and should learn how to identify potential victims and how to intervene. Improving the classroom climate and raising awareness among students about bullying may decrease the problem.
Comprehensive school-wide anti-bullying programs should include strategies that aim to change peer dynamics by raising awareness of how bystanders contribute to the problem. Also, when bullying occurs, parents of both victim and bully need to be involved. In addition, increasing acceptance of differences among students, improving class spirit, and celebrating ethnic differences will help students learn about and understand cultural differences.
Implications for nursing practice
School nurses are in the best position to identify student bullying victims through physical and psychosocial assessment. What’s more, they can take immediate steps to intervene in suspected or actual bullying. They’re an important resource for students because they don’t grade students on performance as teachers do or discipline students as parents do. Their neutral position can foster a relationship of trust with adolescents.
Also, school nurses may be the first to notice increased absenteeism and increased complaints of such physical ailments as headache or stomachache, which can indicate stress or avoidance of bullying. With their comprehensive training and skills, nurses can educate school administrators, teachers, coaches, and other staff, as well as parents, about the characteristics of bullies and victims and the health risks and long-term effects of victimization, thereby increasing awareness of bullying and its warning signs. Nurses can provide support and guidance to parents in creating a supportive environment that helps children talk about the situation, their feelings, and possible solutions. What’s more, nurses can teach others to watch for warning signs of victimization. (See the box below.)
Warning signs that a child has been bullied
School nurses, teachers, and parents should stay alert for:
As nurses, we can help stop the cycle of bullying. We’re natural leaders in developing appropriate policies and prevention programs that address teen bullying, as well as intervention strategies that can help eliminate or reduce bullying. And by conducting research on bullying and examining the nature of ethnic differences (such as varying cultural norms, social contexts, and coping skills), we can identify and sharpen intervention strategies and propose more specific recommendations to help end the bullying cycle.
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Frisen A, Holmqvist K. Adolescents’ own suggestions for bullying interventions at age 13 and 16. Scand J Psychol. 2010;51(2);123-31.
Glew GM, Fan MY, Katon W, Rivara FP. Bullying and school safety. J Pediatr. 2008;152(1):123-8.
Russell ST, Ryan C, Toomey RB, Diaz RM, Sanchez J. Lesbian, gay, bisexual, and transgender adolescent school victimization: implications for young adult health and adjustment. J Sch Health. 2011;81(5):223-30.
Wang J, Iannotti RJ, Luk JW, Nansel TR. Co-occurrence of victimization from five subtypes of bullying: physical, verbal, social exclusion, spreading rumors, and cyber. J Pediatr Psychol. 2010;35(10):1103-12.
Toni Loftus is a candidate for a doctorate in nursing practice at Wilkes University in Wilkes-Barre, Pennsylvania.
Thank you for your kind words!
An excellent, well thought out and most useful article! We should hope for more articles from this author.