články -patopsychologie

How bullies operate

Bullying occurs in settings where individuals do not have a say concerning the group they want to be in. This is the situation for children in school classrooms or at home with siblings, and has been compared to being ‘caged’ with others. In an effort to establish a social network or hierarchy, bullies will try to exert their power with all children. Those who have an emotional reaction (eg, cry, run away, are upset) and have nobody or few to stand up for them, are the repeated targets of bullies. Bullies may get others to join in (laugh, tease, hit, spread rumours) as bystanders or even as henchmen (bully/victims). It has been shown that conditions that foster higher density and greater hierarchies in classrooms (inegalitarian conditions),21 at home22 or even in nations,23 increase bullying24 and the stability of bullying victimisation over time.25

Adverse consequences of being bullied

Until fairly recently, most studies on the effects of bullying were cross-sectional or just included brief follow-up periods, making it impossible to identify whether bullying is the cause or consequence of health problems. Thus, this review focuses mostly on prospective studies that were able to control for pre-existing health conditions, family situation and other exposures to violence (eg, family violence) in investigating the effects of being involved in bullying on subsequent health, self-harm and suicide, schooling, employment and social relationships.

Childhood and adolescence (6–17 years)

A fully referenced summary of the consequences of bullying during childhood and adolescence on prospectively studied outcomes up to the age of 17 years is shown in table 1. Children who were victims of bullying have been consistently found to be at higher risk for common somatic problems such as colds, or psychosomatic problems such as headaches, stomach aches or sleeping problems, and are more likely to take up smoking.39 ,40 Victims have also been reported to more often develop internalising problems and anxiety disorder or depression disorder.31 Genetically sensitive designs allowed comparison of monozygotic twins who are genetically identical and live in the same households but were discordant for experiences of bullying. Internalising problems was found to have increased over time only in those who were bullied,32 providing strong evidence that bullying rather than other factors explains increases in internalising problems. Furthermore, victims of bullying are at significantly increased risk of self-harm or thinking about suicide in adolescence.43 ,44 Furthermore, being bullied in primary school has been found to both predict borderline personality symptoms30 and psychotic experiences, such as hallucinations or delusions, by adolescence.37 Where investigated, those who were either exposed to several forms of bullying or were bullied over long periods of time (chronic bullying) tended to show more adverse effects.31 ,37 In contrast to the consistently moderate to strong relationships with somatic and mental health outcomes, the association between being bullied and poor academic functioning has not been as strong as expected.51 A meta-analysis only indicated a small negative effect of victimisation on mostly concurrent academic performance and the effects differed whether bullying was self-reported or by peers or teachers.47 Those studies that distinguished between victims and bully/victims usually reported that bully/victims had a slightly higher risk for somatic and mental health problems than pure victims.41 ,52 Furthermore, most studies considered bullies and bully/victims together; however, as outlined above, the two roles are quite different with bullies often highly competent manipulators and ringleaders, while bully/victims are described as impulsive and poor in regulating their emotions.53 We know little about the mental health outcomes of bullies in childhood, but there are some suggestions that they may also be at slightly increased risk of depression or self-harm,33 ,45 however, less so than victims. Similarly, the relationship between being a bully and somatic health is weaker than in bully/victims,39 or bullies have even been found to be healthier and stronger than children not involved in bullying.41 Bullying perpetration has been found to increase the risk of offending in adolescence;54 however, the analysis did not distinguish between bullies and bully/victims and did not include information about poly-victimisation (eg, being maltreated by parents). Bullies were also more likely to display delinquent behaviour and perpetrate dating violence by eighth grade.50