Bullying Doubles Risk for Psychosomatic Ills in Kids

Janis Kelly

March 18, 2009

March 18, 2009 — School-age bullying is a public-health menace, with bullies and victims all winding up at increased risk for psychosomatic disorders, according to a new meta-analysis.

Bullying (intentionally harming another through verbal harassment, physical assault, or other methods of coercion) leads to significantly higher risk for psychosomatic problems for victims, bullies, and bully-victims (children who are both aggressive to peers and victimized by peers), compared with uninvolved peers. This conclusion was based on a meta-analysis of 11 studies and reported in the March issue of Pediatrics by Gianluca Gini, PhD, and Tiziana Pozzoli, MA, from the University of Padua, in Italy.

"In this meta-analysis, analyzing the results on more than 150,000 children and adolescents (aged 7 to 16 years) from several countries around the world, we found that students most frequently involved in bullying, especially as victims and bully-victims, are 2 times more likely to show a variety of psychosomatic problems than their uninvolved schoolmates," Dr. Gini told Medscape Psychiatry.

The authors performed 3 random-effects meta-analyses for children aged between 7 and 16 years who reported being victims, bullies, or bully-victims, the last of which Dr. Gini said are sometimes called provocative victims and are frequently characterized by conduct problems and hyperactivity.

They are a particularly problematic subgroup, since they tend to experience maladjustment in multiple domains of functioning and are at greatest risk for major aggressive behavior toward their peers, for injury, and for psychiatric disorders.

Psychosomatic complaints included headache, stomachache, backache, abdominal pain, dizziness, sleeping problems, poor appetite, bedwetting, skin problems, vomiting, feeling tired, or feeling tense.

International Public Health Issue

Dr. Gini noted that somatic problems affect 5% to 30% of children and adolescents and that organic reasons do not explain the frequent and persistent occurrence of these symptoms in the pediatric population.

"The current results suggest that 1 possible cause of such recurrent problems, especially during childhood and early adolescence, is bullying, which is a considerable source of stress in a child’s life," he said.

The researchers call bullying "a significant international public-health issue" and urge professionals to question children and their parents about emotional functioning and peer experiences.

Karen Weihs, MD, from the University of Arizona Medical Center, in Tucson, agreed that the study shows convincingly that children who report being bullied also report more symptoms.

However, Dr. Weihs is more cautious than the authors about what conclusions to draw from that association.

''The term psychosomatic makes the assumption that the bullying caused the somatic complaints of these children — even though the data do not support this conclusion. It would be more appropriate to describe these symptoms as somatic complaints or somatic symptoms, until the causal association is demonstrated in prospective studies," Dr. Weihs told Medscape Psychiatry.

"It is likely that bullying has adverse health effects that are physiologically compromising to children, such as elevated stress hormones and the associated increase in risk of hypertension and heart disease," Dr. Weihs added. "This should also be mentioned as a needed area for future research."

Meanwhile, she agrees with Dr. Gini that children with apparently psychosomatic symptoms should be questioned about bullying, "If bullying is present, an intervention to stop the child from being victimized should be undertaken," Dr. Weihs said.

The authors report no disclosures.

Pediatrics 2009;123:1059-1065. Abstract

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