Jimmy comes into his family physician’s office for his annual periodic health examination. His mother expresses concern that Jimmy has been caught drinking and smoking marijuana on several occasions. He has become increasingly aggressive with his younger brother, and over the past few months Jimmy’s grades have dropped.
Bullying is a form of abuse that can take various forms at various ages. In this article, we have limited our discussion to bullying among children and adolescents; however, bullying can occur within the family, in the workplace, or in any other setting and at any age.
is defined as the use of power and aggression to cause distress or control another.1–3
Although bullying was traditionally thought of as physical aggression, this is only one of many strategies that children use to control and distress others. Bullying can be broadly categorized into direct and indirect forms of aggression.2 Direct bullying
is an overt expression of power and can include physical aggression (eg, hitting, kicking) and verbal aggression (eg, insults, racial or sexual harassment, threats). Indirect bullying
(or relational aggression
) is the covert manipulation of social relationships to hurt (eg, gossiping, spreading rumours) or exclude the individual being victimized. In recent years, cyberbullying has emerged with technology, involving the use of the Internet and text messaging to cause distress to individuals.
Two elements of bullying are key to understanding its complexity. First, bullying is a form of aggressive behaviour imposed from a position of power: Children who bully (note that we avoid labeling children as bullies
because these labels constrain thinking of the problem as solely a characteristic of the individual, rather than as a problem that emerges from complex social dynamics) have more power than the children they victimize, and this power is often not evident to adults. Children’s power can derive from a physical advantage (such as size and strength) or from a social advantage (such as a higher social status in a peer group or strength in numbers). Recent research indicated that children with special health care needs were more likely to be victimized, whereas those with chronic behavioural, emotional, or developmental problems were more likely to be involved in bullying others or in both bullying and being victimized.4
The second key element is that bullying is repeated over time, and with each repeated incident, the power dynamics become consolidated. Although formal definitions include repetition, children believe that even a single occurrence of the use of power and aggression should be identified as bullying.5
Research reveals bullying as a destructive relationship problem: Children who bully are learning to use power and aggression to control and distress others; children who are victimized become increasingly powerless and unable to defend themselves from this form of abuse. Interventions are required to support children, neutralize the power dynamics, and promote healthy relationships.