There are known associations between childhood bullying victimization and mental health problems in childhood and adolescence, but recent evidence also shows that the impact of bullying can effect mental health into adulthood (Copeland, Wolke, Angold, & Costello, 2013; Evans-Lacko et al., 2017). One study found a higher prevalence of agoraphobia, generalized anxiety, young adult depression and panic disorder later in life for those who were victims of bullying as children (Copeland et al., 2013). Generally, studies have shown that those who have been bullied are more likely to use mental health services across the lifespan, which has implications for mental health professionals and increased costs to our healthcare systems.
One definition described bullying as being “exposed repeatedly and over time to negative actions from more powerful peers,” which includes teasing, exclusion and/or physical assaults (Sigurdson et al., 2015). Several studies have looked at internalizing versus externalizing symptoms in response to being bullied. Internalizing symptoms include depression, anxiety, fear and withdrawal from social interaction. The research has been inconsistent in identifying specific internal symptoms in victims of bullying (Sigurdson et al., 2015). Externalizing symptoms are directed outward and include anger, aggression and conduct issues. Bullying others in adolescence has been found to be associated with an increase in externalizing symptoms (Sigurdson et al., 2015).
Theories to Consider when Conceptualizing Effects of Bullying
Two theories that have been referenced in the literature to contextualizing effects of bullying include Social Ecology Theory and Diathesis-Stress Model (Sigurdson et al, 2015; Swearer & Shelley, 2015). Social Ecology Theory explores human development as a set of interrelations among personal and environmental factors including neighborhood, home, school and society. The Diathesis-Stress Model sees cognitive and biological vulnerabilities in interaction with environmental stressors as important to understanding the development of psychopathology. When considered over the course of human development, early adolescence (a common time for bullying) occurs along with changes to biological development and challenges in psychological and social development, which can increase vulnerability to external stressors. At this critical time, the development of psychological difficulties may occur when an adolescent experiences biological and cognitive vulnerabilities at the same time as a stressful life experience, such as bullying (Swearer & Hymel, 2015).
Most importantly, Swearer and Hymel (2015) emphasize that if negative events are attributed to negative beliefs about the self, individuals are especially at risk for internalizing and externalizing problems.
Implications for Mental Health Professionals
For those treating adults who were victims of bullying in childhood or adolescence, it is helpful to address identity issues and negative self-concept. For individuals who experienced bullying at that critical developmental stage of adolescence during identity exploration, internalized feelings about their self-worth may be impacting current mental health concerns. Swearer and Hymel (2015) also recommend helping clients to feel safe and in control in their lives.
Another consideration for mental health professionals concerns initial assessment processes and early appointment information gathering. It may be helpful to assess for bullying as part of the intake process. While some individuals may not be aware of the effects of bullying on their mental health issues as adults, others may be ashamed of the memory of being bullied or even that it still bothers them. It may be helpful for counselors to include standard questions about bullying in their initial assessment process.
References and Resources
Swearer, S., & Hymel, S. (2015) Understanding the psychology of bullying: Moving toward a social-ecological diathesis-stress model. American Psychologist. Vol. 70, No. 4, 344–353 Retrieved from https://www.apa.org/pubs/journ...
Evans-Lacko, S., Takizawa, R., Brimblecombe, N., King, D., Knapp, M., Maughan, B., & Arseneault, L. (2017). Childhood bullying victimization is associated with use of mental health services over five decades: a longitudinal nationally representative cohort study. Psychological Medicine, 47(1), 127-135. doi:10.1017/S0033291716001719
Copeland, W. E., Wolke, D., Angold, A., & Costello, E. J. (2013). Adult psychiatric outcomes of bullying and being bullied by peers in childhood and adolescence. JAMA Psychiatry, 70(4), 419-426. doi:10.1001/jamapsychiatry.2013.504
Sigurdson, J. F., Undheim, A. M., Wallander, J. L., Lydersen, S., & Sund, A. M. (2015). The long-term effects of being bullied or a bully in adolescence on externalizing and internalizing mental health problems in adulthood. Child & Adolescent Psychiatry & Mental Health, 9(1), 1-13. doi:10.1186/s13034-015-0075-