October 27, 2010 — The shocking rash of 4 recent suicides involving young, allegedly gay, males where bullying was cited as a major factor in their deaths has refocused attention on what experts say is a national public health crisis that must be confronted.
The New York Times reports 15-year-old Billy Lucas hanged himself September 9 after being urged by students at his high school to commit suicide. Asher Brown and Seth Welsh, both 13 years old, also took their lives in September after being bullied for being gay.
|Vigil for Tyler Clementi. Reena Rose Sibayan/AP|
In the same month Rutgers University freshman Tyler Clementi jumped to his death from the George Washington Bridge after 2 of his fellow students videotaped a sexual encounter between Clementi and another man then posted it online.
A recent national survey, also released in September, and conducted by the Gay, Lesbian, and Straight Education Network (GLSEN), shows 90% of lesbian, gay, bisexual, and transgender (LGBT) youth experience harassment at school.
"It is so clear that anti-LGBT actions and behaviors and language are really the weapon of choice in a lot of American schools," Joseph Kosciw, PhD, GLSEN senior director of research and strategic initiatives, told Medscape Medical News.
Jack Drescher, MD, a distinguished fellow of the American Psychiatric Association (APA) and a past chair of the APA's committee on GLB issues, says based on his clinical experience working with LGBT patients, he is not surprised by the GLSEN findings.
One perennial idea that needs to be challenged is that being bullied toughens kids up...as we have seen in the reports of recent months, in some cases children do not toughen up but break down.
"I have treated many gay patients who, as adults, tell of stories of being publicly bullied and harassed, not only by other kids but by family members. The kids who are most at risk are those who are unable to hide gender atypical behavior — they are considered either too effeminate as boys or too masculine as girls," Dr. Drescher told Medscape Medical News.
"Not only do they experience verbal harassment, threats of violence, and actual violence, the way these kids are treated serves as a warning to other kids who may be LGBT but not so easily spotted," Dr. Drescher added.
Dr. Drescher went on to note that while much has been done in recent years to get schools and parents to take greater control of environments that permit bullying, more needs to be done.
"One perennial idea that needs to be challenged, for example, is that being bullied toughens kids up. However, this often serves as a pretext or rationalization for not exerting adult control over the antisocial behavior of some children. And as we have seen in the reports of recent months, in some cases children do not toughen up but break down," he said.
The Problem Persists
It is so clear that anti-LGBT actions and behaviors and language are really the weapon of choice in a lot of American schools.
Dr. Kosciw noted that although there is a growing awareness of the damaging effects of LGBT bullying, and bullying in general, the problem persists.
"We have been monitoring the experience of school students — LGBT as well as students in the general population — for the past 10 years, and sadly we haven't seen enormous changes in school climates for LGBT students.
"There has been some reduction in homophobic remarks and some changes since 2007 in victimization, but when you look at the whole picture there haven't been too many increases in school safety, particularly for this population, and there's much more work to be done," he said.
The survey also revealed that 61.1% of LGBT students felt unsafe in school because of their sexual orientation and 39.9% felt unsafe because of their gender expression.
National statistics show that in the United States approximately 30% of youth engage in bullying either as victims or perpetrators or both.
At the University of Houston, researcher Allison Dempsey, PhD, assistant professor, educational psychology, agreed and said that although subgroups such as LGBT youth have higher victimization rates, in the general population estimates of bullying among middle and high school students are also unacceptably high and run at about 30%.
"National statistics show in the United States approximately 30% of youth engage in bullying either as victims or perpetrators or both," she told Medscape Medical News. In fact, she added, the United States has a higher rate of youth bullying than many countries.
International rates of student victimization range from a low of 4.1% in Sweden to a staggering 41% in Lithuania, said Dr. Dempsey.
What constitutes bullying? "There is overt bullying which includes physical assaults, such as kicking and punching, as well as verbal assaults, such as name-calling.
"Then there is relational bullying, which can involve excluding people, spreading rumors about them, so essentially attacking their social status, and more recently we've seen the emergence of cyberbullying, where children are harassed via the Internet," said Dr. Dempsey.
Although cyberbullying accounts for about 10% of youth victimization, Dr. Dempsey added, it has the potential to be even more pernicious than "traditional" bullying settings.
"The most disturbing aspect of cyberbullying is that kids can't get away from it by leaving the school grounds or leaving the social situation. Nowadays kids have their phones with them almost all the time and have their computers in their bedrooms, so no matter where they are the bullies can get to them," she said.
"Cyberbullying is also a less noticeable form of bullying, so there is even less opportunity for bystanders to intervene. We know that only 1 in 10 kids that are bullied online actually tell somebody about it," she added.
Weighing in on this issue, APA President Carol Bernstein, MD, agreed there is an "ease" to cyberbullying that is unsettling. "The anonymity of it and the fact that you can taunt someone without having to face them is disturbing. It makes bullying easier," she said.
On the other hand, said Dr. Dempsey, it is worth noting that youth who use the Internet to victimize others are often unaware that they are leaving an "electronic trail" that can be used by the victim to prove bullying occurred and in potential legal proceedings.
"We are hearing a lot about cyberbullying, and while it is important, it only accounts for about 10% of [bullying] incidents. We definitely need to pay attention to it, but we should not neglect the issue of bullying in traditional settings because these account for the majority [of incidents]," she added.
There's no doubt, say the experts, that bullying can have serious negative consequences — in the short term and over time.
Bullying has been associated with increased school dropout rates, as well as higher rates of depression, social anxiety, suicidal ideation, aggression, and academic problems.
However, Dr. Dempsey noted, that longitudinal research also suggests that beyond an association, there is a causal effect, and victims can experience serious, long-term negative outcomes.
A study...showed young children who are severely or continually bullied have a 4-fold increased risk of developing psychotic symptoms in early adolescence.
A study published in May 2009 in Archives of General Psychiatry and reported by Medscape Medical News at that time showed young children who are severely or continually bullied have a 4-fold increased risk of developing psychotic symptoms in early adolescence.
Dr. Dempsey noted that recent work by her group, which is currently under review, shows a positive correlation between bullying and suicidal ideation and suicide attempts over time.
In addition to LGBT youth, there are other subgroups of young people who experience higher than average rates of victimization, including those with psychiatric and chronic medical conditions.
According to Dr. Dempsey, up to one-third of children with diabetes experience "disease-related" bullying, which can have a negative impact on their physical, as well as psychological, health.
"If kids are called 'junkies' for taking insulin shots, they may reduce the amount of insulin they inject. We also know that kids with asthma experience increased rates of victimization," she said.
In May, research published in the journal Pediatrics and also reported by Medscape Medical News showed obese and overweight children had up to a 2-fold increased risk of being bullied than their peers who were not obese.
"Kids who are overweight and obese are more often bullied, causing increased stress, which then leads to binge eating and ultimately increases their weight," said Dr. Dempsey.
So how can youth bullying be curbed if not eliminated? GLSEN's research shows schools with so-called Gay-Straight Alliances, clubs that offer an opportunity to address issues relevant to LGBT students, result in a more positive school experience.
Dr. Kosciw added that the presence of supportive staff and firm antibullying policies in schools contribute to more positive outcomes for all kids. This is a key priority for GLSEN, which, among other initiatives, recently relaunched its Safe Space Kit designed to help educators create a safe space for LGBT youth in schools.
If passed, federal antibullying legislation would require schools and districts that receive federal funding to adopt anti-bullying policies and codes of conduct.
GLSEN research also shows students who live in states with enumerated antibullying legislation —that is, laws that specifically list factors such as sexual orientation, gender identity, race, and religion — report more positive school climates and experiences compared with their counterparts who live in states without such laws.
At the national level, Dr. Kosciw notes that, GLSEN is a staunch supporter of the Safe Schools Improvement Act, which was introduced in the US Senate earlier this year.
If passed, this federal antibullying legislation would require schools and districts that receive federal funding to adopt antibullying policies and codes of conduct that prohibit bullying or harassment on the basis of race, color, religion, national origin, sex, disability, sexual orientation, and perceived or gender identity.
At the individual level, Dr. Dempsey said, it is important that educators, parents, and clinicians screen for bullying and directly ask children and youth about the issue.
It is also important that family physicians, pediatricians, and psychiatrists, who may have patients with chronic physical or mental illnesses, be aware that these patients are at increased risk for victimization and screen for it.
She noted that children who are bullied often experience changes in behavior, such as aggression, loss of appetite, insomnia, or a reluctance to go to school, among others, and that these should be treated as warning signs that bullying may be occurring.
"We need to educate people to look for this and understand all the different behaviors that are parts of bullying. It is not just hitting or punching, but it is also spreading rumors about somebody or trying to cause embarrassment to that person, and so people need to recognize and take it very seriously when they see it happening," said Dr. Dempsey.
"I personally wonder that if there's something about the culture [in the United States] that makes bullying more acceptable than in other countries. There are a lot of people out there that have the attitude that bullying is a part of growing up, and until we shift those attitudes we're not going to see change," she added.
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Cite this: Bullying in America: Time to Confront National Crisis Experts Say - Medscape - Oct 27, 2010.