| Column |
DECEMBER , 2022 | THE HEALTH
27
Addressing bullying from a clinical perspective
The presence of underlying psychological disorders needs to be addressed and treated accordingly
MINDTALK
BY DR ROZANIZAM ZAKARIA
AIMAN is a school-going teenager , who was referred to a psychiatry clinic after the family noticed a change in his behaviour recently . He became withdrawn socially and appeared to be in despair most of the time .
He lost his usual interest in sports and has difficulty staying focused in class . More recently , he refused to go to school and became irritable when asked to go .
This was certainly uncharacteristic of him . After a few sessions with the psychiatrist only then did he admit to his horrifying experience of being bullied at school . What initially had been considered as jokes had become a fearful experience for him , enough to stir his emotion into dreadful depressive episodes .
Bullying is when someone repeatedly and on purpose says or does mean and hurtful things to another person who has a hard time defending himself or herself ( Olweus 1993 , Smith & Sharp 1994 ). The key feature is its intention to cause harm to others involving threats , rumours , physical , verbal , online , and / or purposely excluding some from the group .
Another important element is the presence of power imbalance between the two parties . In this context , power can be either physical strength , access to embarrassing information , popularity , sociodemographic , skills , or access to resources or numbers .
What was experienced by Aiman was certainly not an isolated case . Globally , it is estimated that 20 – 25 per cent of youths are directly involved in bullying as perpetrators , victims , or both ( Nansel , 2001 ).
Four main risk factors
Large-scale studies in Western nations suggest that 4-9 per cent of youths frequently engage in bullying behaviors and 9 – 25 per cent of schoolage children are bullied ( Stassen Berger 2007 ). The National Health and Morbidity Survey ( 2017 ) revealed that one in six Malaysian adolescents was a recent victim of bullying with boys being bullied more than girls . A local study by Sabramani et . al . ( 2021 ) also reported that verbal bullying was the main type of bullying ( 51.2 per cent ) and cyberbullying is the least common form ( 13.1 per cent ).
The risk factors associated with the act of bullying can be divided into four main factors – individuals , family , peers and community . These factors usually are inter-connected and need to be addressed holistically .
All bullying cases should be viewed thoroughly to address the main underlying issues . Most of the time ,
the actual incidence is only the tip of the iceberg .
There are many more issues that need to be addressed , more than simply punishing the perpetrator . In most cases , normally the individual involved will be referred to a doctor for an assessment .
Clinicians need to address a few important issues when assessing the affected individuals with bullying . The assessment should be done in multiple settings , involving disciplines such as clinical psychologist and social worker where possible .
Apart from the depth understanding of bully circumstances , we also need to address issues of possible underlying psychiatric issues pertaining to the bully . For example , the bully may occur in individuals with attention deficit and hyperactivity disorder , conduct disorder , mood disorder and substance use disorder . On the other hand , victims of bullying may have certain vulnerability factors such as developmental disorders , intellectual problems , mood disorders and psychosocial issues such as adjustment disorder .
In addition , there could be parental practices , parent-child interactions , parental psychopathology and child ’ s peer relationships . The assessment should also adopt a culturally-sensitive and developmental-specific approach . Educational assessment should also be performed if a learning problem is suspected .
Parents play a vital role
In the case of Aiman , the issue of depression needs to be addressed first . This is important as the condition may worsen and affect his functioning . The co-morbidity of anxiety , post-traumatic stress disorder and self-harming behaviour should also be monitored to ensure that all possible psychological issues are being addressed .
The affected individual may also require psychological input to address difficulties in adjusting back to his normal routine after the incident . Self-esteem can be severely affected and lead to a poor social adjustment in the longer term .
The person may need to be equipped with some skills to be more assertive in communicating with others to avoid the possible recurrence of the incident . In addition , the issue of safety at school should also be addressed , especially with the school administrator . This is so that the likelihood of future incidence is minimised and proper safety plans can be put in place .
Parents also play a vital role in the management of bullying cases . Parents should provide safety attachments for their children for them to feel trusted and supported . They should not minimise the child ’ s concern and address the issue delicately .
The same principle is applied to the perpetrator ’ s case in the bullying incidence . The child needs to be assessed thoroughly for any the presence of any modifiable risk factors .
The presence of underlying psychological disorders need to be addressed and treated accordingly . The psychosocial factors should also be looked at and tackled accordingly . This may involve multi-disciplinary involvement and long-term input . – The Health
Dr Rozanizam Zakaria is an Assistant Professor in Psychiatry , Kulliyyah of Medicine , International Islamic University Malaysia ( UIAM ) and Fellow in Child and Adolescent Psychiatry , Ministry of Health .