Mary E. Muscari, PhD, CPNP, APRN-BC,CFNS


April 01, 2003


With all the talk of bullying in schools these days, how can I tell if my patients are being bullied? And what intervention strategies can I use to help both the child being bullied and the child doing the bullying?

Response from Mary E. Muscari, PhD, CPNP, APRN-BC,CFNS

Most bullying goes undetected since bullies rarely strike in front of authority figures, and victims seldom report the events. With nearly 30% of children reporting moderate or frequent involvement in bullying,[1] early identification and intervention for both bullies and victims is critical.

Bullying can create negative lifelong consequences for both bullies and victims. Bullies may develop delinquent behaviors, as well as later serious criminal behavior in adulthood. Victims fear school and can suffer from low self-esteem, depression, and anxiety. Some victims commit suicide out of sheer desperation, while others become bullies themselves or commit unspeakable acts of violence, as evidenced by past school shootings.[2]

NPs should routinely screen children and teens during health maintenance exams, especially vulnerable children (those with attention deficit- hyperactivity disorder, special needs, and extreme shyness).[3] NPs can also identify victims who present with school phobia, depressive and suicidal symptoms, somatic complaints, or malingering.

Other possible signs include:

  • Becoming aggressive, bullying siblings or other children;

  • Unexplained injuries or bruises or torn clothes;

  • Unusual hunger after school (bullies steal lunch and/or lunch money);

  • Nightmares or crying during sleep;

  • Waiting to use the bathroom at home (bullies attack in unsupervised restrooms);

  • Missing belongings;

  • Asking for extra money or stealing (to pay the bully);

  • Desire to carry protection, such as a knife or gun; and

  • Unwillingness to discuss school situation or improbable excuses for the above signs.

NPs can encourage victims and their parents to verbalize their feelings, and reassure them with effective ways to respond to bullying. Since children are less likely to be bullied in peer groups, NPs can empower victims to make and keep friends. Victims can join organizations such as scouting, boys and girls clubs, sports and martial arts, and after-school activities to better their social skills, boost self-confidence, and gain the respect of their peers. NPs can further foster self-esteem, teach problem-solving skills, and help children be assertive rather than submissive. Confident, resourceful children are less likely to be bullied or to bully others.

Parents should notify the school and remain persistent until action is taken. If the school refuses to do anything, parents could consider transferring their child to another school, writing a formal letter of complaint to the school board or superintendent, or taking legal action. Occasionally, situations call for reporting the incident to the police or filing a civil suit against the bully's parents and/or the school.

Bullies are adept at hiding their mistreatment, making them more difficult to detect. They may act arrogant and self-assured, and they may have difficulty accepting authority. When questioned about bullying, they become condescending in their responses.

Garrity and Baris[4] recommend asking bullies, "What do you do when others pick on you?" Bullies rarely admit to even occasional confrontation with other children. Since most lack empathy, they may appear pleased or amused when asked about other children getting hurt.

NPs must confront bullies and their parents about the bullying behaviors, an undertaking that proves difficult when both are reluctant to admit to bullying. NPs should avoid arguments and advise parents that this behavior will have negative consequences on their child's future. Bullies need to learn empathy and, like victims, benefit from learning appropriate social skills under adult supervision. If the child demonstrates significant bullying behavior or signs of a conduct disorder, referral to a mental health professional is appropriate.


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