The All-American sport of football has a dark side. Much has been written of late about locker-room bullying by the pros. Who knows how far down the ladder of football players a bullying ethic prevails: in colleges? in high schools? in junior high locker rooms?. And alas, bullying is by no means a phenomenon just of football players. It may be going on in your own life at home, with a person who you thought was your friend, or, far too often, with a difficult boss or colleague at work.
Bullies can be any age. One of my grandsons suffered initial anxiety and then serious difficulties learning to read from having been bullied by a mean three-year-old in his preschool class. We have all heard of elementary school and teenage playground bullies. Less frequently acknowledged as bullies are parents such as borderline mothers who rage at their kids and dads who are verbally, physically or sexually abusive to their children. In addition, adults with borderline or abusive personality disorders (which may be one and the same disorder) tend to bully not only their children but also their adult loved ones, resulting in a marriage in deep trouble. Employers, police officers, teachers, sports coaches and governmental agencies can act in a bullying manner. Dictators and terrorists bully their target populations, unfortunately on a large scale.
One question is what to do immediately after a bullying incident has occurred. Both victim and bully need significant psychological attention. Interventions that parents and schools can take ideally will insure that initial bullying incidents do not continue. Effective treatment can prevent prevent the victim from ending up with lasting psychological scars. In addition, the bully needs to be guided from hostile to pro-social habits. Unfortunately, however, the long-term physical as well as emotional damage that results from having been bullied at any age may be far greater than most health professionals to this point have assumed.
I've been aware of the mental health impacts of bullying. In a recent couple therapy case for instance when the wife would freeze and then escape into her computer at any hint of concerns raised by her husband, her husband, believing his wife just didn't love him, filed for divorce. It turned out that in fact the freezing and escape were responses learned by his wife from having been severely bullied by girl classmates in junior high school.
In addition to the emotional sequelae however I learned from the following guest post by Jenny Hart, a British health writer, about the less well-known physical health consequences of bullying.
When Jenny wrote to me, requesting that I focus a blogpost on this topic, her poignant explanation touched me:
"My brother suffered awfully at school from bullying. At the time our parents couldn't understand why he had so many apparently unrelated health issues. As such I found researching this topic fascinating but at the same time saddening—some of the workplace statistics relating to adult on adult bullying were shocking to say the least. I'd love it if you could share my piece with your audience and help get the message out."
The Long-Term Health Consequences of Bullying
By Jenny Hart
If you have ever been bullied, you’re far from alone. According to the Centers for Disease Control and Prevention 20% of high school students reported being bullied in the last year and a survey by the Workplace Bullying Institute in 2010 found that nearly 1 in 10 workers were currently being bullied. You may well have suffered from anxiety, panic attacks and low mood during the time you were harassed. In addition, recent research has clarified longer term health consequences of having suffered as the victim of threatening behaviours.
Lasting psychological harm
Research published earlier this year in the journal JAMA Psychiatry showed that while anxiety and depression are a common problem in children who are bullied, these mental health issues can extend into adulthood. Young adults in the study were found to be at significantly increased risk of generalized anxiety, panic disorder and depression. Those who had been both victims and bullied others were also at greater risk of suicidal ideation as an adult.
These findings demonstrate that the psychological impact of bullying episodes can be long-lasting. A number of theories have been suggested for why this damage may occur. Victimization alters the way your body responds to stress, both physiologically and cognitively. The negative impact that being bullied can have on your self-esteem and confidence may also offer an explanation, as low self-esteem is itself a risk factor for mood disorders.
Experience of pain
It is not uncommon for victims to experience headaches and musculoskeletal or abdominal pain while they are being bullied. This has been demonstrated when it occurs in those of school age and when bullying occurs in the workplace. A study from 2006 that was published in the International Journal of Adolescent Medicine and Health showed that American high school students who experienced headaches, stomach aches and backache were up to 3.5 times more likely to have been bullied. In the workplace headaches, back, shoulder, neck and joint pain were shown to be significantly associated with whether someone had been bullied in a piece of work that appeared in the International Journal of Environmental Research and Public Health. So what may explain this association? When responding to the stress of victimization, the muscles tense and as the stress response is repeated regularly, the muscles remain contracted leading to discomfort and pain. However, it has also been suggested that as stress activates inflammation, this too may contribute to feelings of pain and worsen existing pain. Pain doesn’t simply last for the duration of being bullied though, as there is evidence that being a victim of this as a child increases feelings of pain as an adult.
Impact on digestion
It is no coincidence that while being bullied you may experience digestive upset, as stress is linked to the onset or worsening of irritable bowel syndrome, gastro-esophageal reflux disease, peptic ulcers and inflammatory bowel disease. This association appears to exist for two reasons. Firstly, the enteric nervous system that allows the gut to regulate digestion is closely linked to the central nervous system and the two interact by way of neurotransmitters and secondly, stress stimulates the gut’s immune system to generate cytokines that disrupt usual function. Therefore digestion is either slowed or temporarily stopped to allow energy to be diverted to the fight-flight response. Problems with digestion may be added to as being bullied increases the likelihood of reduced appetite, comfort eating and eating disorders, all of which can impact upon digestive activities.
Altered immune function
Being bullied also takes its toll on your immune system, which may increase your likelihood of infections, allergies, autoimmune conditions and even cancer. Periods of stress are linked to increased occurrence of upper respiratory tract infections. This association may relate to the interaction between the nervous and immune systems and the fact that white blood cells carry receptors for stress hormones.
Other factors may also be important in increasing your risk of infection during stressful situations: a poor diet, altered sleeping patterns or use of coping mechanisms such as alcohol or smoking could all explain reduced immunity, while seeking social support from others may increase your risk of exposure to microbes.
As many as 80% people with autoimmune disease such as lupus and the thyroid disorder Grave’s disease also report emotional upset prior to diagnosis. This may possibly be explained by the fact that cytokine production from stress potentially dysregulates the immune system, allowing the white blood cells to attack otherwise healthy tissue . Stress is equally known to make the symptoms worse in autoimmune diseases such as type 1 diabetes and rheumatoid arthritis.
A link has been found between negative life experience during adolescence such as being bullied and chronic health problem such as asthma, hay fever and eczema. Stress during pregnancy may also increase the risk of asthma and allergy in your children owing to the increased levels of stress hormones in the uterine environment. Stress such as bullying during early childhood may additionally increase the likelihood of allergy in children with a family history of these conditions.
Not only does stress often precede the development of asthma and allergies, but is known to increase complications and hospital admissions with asthma, worsen atopic dermatitis and make those with allergic rhinitis more likely to develop respiratory infections. Stress is believed to influence allergy through the production of cytokines which stimulate IgE allergy responses.
Researchers have recently identified that a gene activated by stress in cells of the immune system may explain the spread of cancer in individuals under stress. This activation alters the white cell function so that the cancerous cells are allowed to spread unchecked. The association between stress and cancer may also be explained through the fact that when coping with events such as being bullied, someone may take part in risky behaviours such as smoking or consumption of excess alcohol, which themselves are factors that influence cancer risk.
Increased risk of cardiovascular disease
A study published in the BMJ Occupational and Environmental Medicine Journal showed that the odds of heart disease are more than doubled in someone who has been bullied. This increased risk may be caused in part to the fact that they are more likely to be overweight, possibly due to comfort eating as a coping mechanism. However, the fight-flight response experienced when you are bullied can help to explain why your risk of heart disease and other vascular complications are increased. Production of the hormones cortisol and adrenaline are increased during the stress response. Excessive production of these hormones can trigger changes in the body that impact upon the cardiovascular system.
Blood pressure is raised in those who are bullied, which is one of the risk factors for heart disease. People with pre-existing raised blood pressure are likely to show an even greater deterioration in their health when bullied.
Although not specifically related to bullying, when under stress, levels of total and LDL cholesterol have been shown to be raised, which again can be accounted for by changes brought about by the stress response, which affects both the production and clearance of cholesterol. Increased levels of LDL cholesterol are associated with atherosclerosis, where fatty deposits cause narrowing of the arteries. However, psychological stress is also linked to two other risk factors for heart disease—inflammation and platelet aggregation. When cortisol is produced in increased amounts under stress such as when someone is bullied, this increase reduces the ability of the hormone to control inflammation. The inflammatory conditions build up, which negatively influences other factors related to circulatory disease. There is additionally increasing evidence that mental stress affects platelet activity, making them more likely to clump together to form a clot, which may further explain the link between cardiovascular disease and experiences of having been bullied .
The diverse range of health problems linked to the stress that accompanies being bullied, plus the unfortunate reality that many of these detrimental physical changes persist long after the bullying has ceased, demonstrate just how serious an impact bullying can have on long-term health. Taking steps to reduce the impact of this stress first by ending the bullying relationship and then by addressing the health consequences is therefore vital. At the same time, understanding the longterm physical consequences of bullying hopefully will increase everyone’s understanding of how vital it is to bring a halt to all types of bullying toward both children and adults in our world.
IMPORTANT RESOURCES ON BULLYING PREVENTION AND TREATMENT:
1. Please see The Bullying Project
2. Please see also the following comments and articles by my colleague Matt LeBauer:
Showing compassion for the bully is an essential step in extinguishing the behavior. When the bully's victim is involved in that process is an even richer experience for them both, teaching them both a model for resolving aggressive conflicts in the future. I have written four blog posts on bullying. This one is a primer, an intro to bullying of sorts: http://lebauercounseling.blogspot.com/2013/10/bullying-what-it-is-how-to-stop-it.htmlThis one is about bullying in the internet age and how to partner with our children in being responsible web citizens: http://lebauercounseling.blogspot.com/2013/10/bullying-in-internet-age.htmlThis one is about standing up to bullying, showing empathy to victims, and standing up in support: http://lebauercounseling.blogspot.com/2013/10/bullying-empathy-challenge-stand-up.html
3. Here's a PT post I've written with more on abusive and borderline-personality-disorder parenting.
4. Abusive parents bully their children. What can you do to help?
References from the article above by Jenny Hart
1 The Centers for Disease Control and Prevention (2011) Understanding Bullying Fact Sheet. Available at: http://www.cdc.gov/violenceprevention/pdf/bullying_factsheet-a.pdf.
2 Workplace Bullying Institute (2010) Results of the 2007 and 2010 WBI U.S. Workplace Bullying Survey. Available at: http://www.workplacebullying.org/wbiresearch/2010-wbi-national-survey/.
3 Copeland WE, Wolker D, Angold A & Costello EJ (2013) Adult Psychiatric outcomes of bullying and being bullied by peers in childhood and adolescence. JAMA Psychiatry. 70 (4): 419-26.
4 Martin B (2006) What are the risk factors for depression? Psych Central. Available at: http://psychcentral.com/lib/what-are-the-risk-factors-for-depression/000515.
5 Srabstein JC, McCarter RJ, Shao C & Huang ZJ (2006) Morbidities associated with bullying behaviors in adolescents. School based study of American adolescents. International Journal of Adolescent Medicine and Health. 18 (4): 587-96.
6 Takaki J, Taniquchi T & Hirokawa K (2013) Associations of workplace bullying and harassment with pain. International Journal of Environmental Research and Public Health. 10 (10): 4560-70.
7 Griffis CA, Crabb Breen E, Compton P, Goldberg A, Witarama T, Kotlerman J & Irwin MR (2013) Acute painful stress and inflammatory mediator production. NeuroImmunoModulation. 20 (3):127-33.
8 Sansone RA, Watts DA & Wiederman MW (2013) Being bullied in childhood, and pain and pain perception in adulthood. The International Journal of Social Psychiatry. Available at: http://isp.sagepub.com/content/early/2013/07/08/0020764013495526.abstract?rss=1.
9 Mayer EA (2000) The neurobiology of stress and gastrointestinal disease. Gut. 47: 861-69.
10 Harvard Medical School (2010) Stress and the sensitive gut. Available at: http://www.health.harvard.edu/newsletters/Harvard_Mental_Health_Letter/2010/August/stress-and-the-sensitive-gut.
11 Sansone RA & Sansone LA (2008) Bully victims: Psychological and somatic aftermaths. Psychiatry (Edgmont). 5 (6): 62-4.
12 Cohen s (1995) Psychological stress and susceptibility to upper respiratory infections. American Journal of Respiratory and Critical Care Medicine. 152: 553-8.
14 Haavet OR, Straand J, Saugstad OG & Grünfeld B (2004) Illness and exposure to negative life experiences in adolescence: two sides of the same coin? A study of 15-year-olds in Oslo, Norway. Acta Paediatrica. 93 (3):405-11.
15 Dave ND, Xiang L & Marshall GD (2011) Stress and allergic diseases. Immunology and Allergy Clinics of North America. 31 (1): 55-68.
16 Science Daily (2013) The stress and cancer link: “Master switch” stress gene enables cancer’s spread. Available at: http://www.sciencedaily.com/releases/2013/08/130822194143.htm.
17 National Cancer Institute (2012) Psychological stress and cancer. Available at: http://www.cancer.gov/cancertopics/factsheet/Risk/stress.
18Kivimäki M, Virtanen M, Vartia M, Elovainio M, Vahtera J & Keltikangas-Järvinen L (2003) Workplace bullying and the risk of cardiovascular disease and depression. BMJ Occupational and Environmental Medicine. 60: 779-83.
19 Hart J (2013) The mental and physical health impact of bullying. Luxury Medical. Available at: http://www.luxurymedical.co.uk/2013/the-mental-and-physical-health-impact-of-bullying/
20 Rosenthal L, Earnshaw VA, Carroll-Scott A, Henderson KE, Peters SM, McCaslin C & Ickovics JR (2013) Weight and race based bullying: health associations among urban adolescents. Journal of Health Psychology. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24155192.
22 Willenz P (2005) Mental stress raises cholesterol levels in healthy adults. Medical News Today. Available at: http://www.medicalnewstoday.com/releases/34047.php.
23 Science Daily (2012) How stress influences disease: Study reveals inflammation as the culprit. Available at: http://www.sciencedaily.com/releases/2012/04/120402162546.htm.
24 Koudouovoh-Tripp P (2012) Influence of mental stress on platelet bioactivity. World Journal of Psychiatry. 2 (6): 134-47.