Trying to stop the bullies: A physician's responsibility

The AMA is asking physicians to join with it in taking a stand against the serious youth violence issue of bullying.

Editorial. Dec. 16, 2002.

In a society in which children and adolescents face widely publicized problems including racism, pressure to use alcohol and drugs, and pressure to have sex, the problem of bullying has received little public attention. A 2001 survey by the Kaiser Family Foundation, however, showed that among 8- to 15-year-olds in this country, bullying was perceived as a greater problem than the more widely discussed issues mentioned above.

This surprising finding was part of a comprehensive evaluation of the problem prepared by the American Medical Association Council on Scientific Affairs and adopted by the House of Delegates at its June meeting. The report defines bullying as behavior involving a pattern of repeated aggression aimed at harming or disturbing a victim despite the apparent distress of the victim, with a more powerful child or group attacking a physically and/or psychologically vulnerable victim.

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The council found that bullies represent 7% to 15% of sampled adolescent populations, and victims represent about 10%. In elementary schools, more boys than girls are involved, but the gender difference decreases in middle and high schools. There is also an increase in so-called social bullying, most frequently manipulation done to hamper acceptance into a group. For the victims, the consequences vary, including potentially serious academic, social, emotional and legal problems.

In adopting the council's report, the House of Delegates committed the AMA to work with others in a broad-based campaign to address the problem of bullying. The AMA's partners will be federal agencies, other medical organizations, mental health professionals, schools and parent organizations, and youth organizations. A key goal is to change societal attitudes toward and tolerance of bullying. The report also recommends federal support for programs addressing the problem, including efforts to prevent bullying, develop clinical tools for identifying and treating traumatized patients, and uncover possible causes of aggressive and violent behavior in young people.

The AMA also is calling on individual doctors to be vigilant for signs and symptoms of bullying and other psychological trauma in children. Physicians should enhance their awareness of the consequences of such behavior, screen for psychiatric co-morbidities in at-risk patients and counsel affected patients and their families.

Obviously, the medical community cannot single-handedly eliminate the problem of bullying among the nation's young people. Successful efforts will require involved and motivated parents, school administrators, teachers and other adults with a positive interest in addressing the problem.

But the role of the individual remains important. Many physicians wear many hats in their communities. In addition to serving as caregivers, they also may fill the roles of community leader, school board member, friend, neighbor and parent. In any or all of these capacities, physicians may find themselves in a position to identify and take action against bullying behavior.

This is a situation in which members of the medical community are uniquely qualified to take a leadership role. The actions of the AMA are a significant step forward in confronting the problem of bullying.

But it is unlikely that an easily applied remedy will be developed and made available anytime soon. Instead, much of the activity will, by necessity, take place at the local level, on a case-by-case basis. Meeting this challenge is a responsibility physicians must not shirk.

ADDITIONAL INFORMATION:

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AMA violence prevention page with links to resources, including "Connecting the Dots to Prevent Youth Violence: A Training and Outreach Guide for Physicians and other Health Professionals" (http://www.ama-assn.org/go/violence)