Bullying Is No Joke

How would you define bullying?

There are many definitions of bullying, most of which include common themes of power imbalance and aggressive behavior:

CDC: “Any unwanted aggressive behavior(s) by another youth or group of youths, who are not siblings or current dating partners that involves an observed or perceived power imbalance and is repeated multiple times or is highly likely to be repeated. Bullying may inflict harm or distress on the targeted youth including physical, psychological, social, or educational harm.”

American Psychological Association: “Bullying is a form of aggressive behavior in which someone intentionally and repeatedly causes another person injury or discomfort. Bullying can take the form of physical contact, words, or more subtle actions. Cyberbullying is verbally threatening or harassing behavior conducted through such electronic technology as cell phones, email, social media, or text messaging.”

Merriam Webster: “Abuse and mistreatment of someone vulnerable by someone stronger, more powerful, etc.”

Rhode Island’s Anti-Bullying Law: “Bullying” means the use by one or more students of a written, verbal or electronic expression or a physical act or gesture or any combination thereof directed at a student that:

  1. Causes physical or emotional harm to the student or damage to the student’s property;
  2. Places the student in reasonable fear of harm to himself/herself or of damage to his/her property;
  3. Creates an intimidating, threatening, hostile, or abusive educational environment for the student;
  4. Infringes on the rights of the student to participate in school activities; or
  5. Materially and substantially disrupts the education process or the orderly operation of a school. The expression, physical act or gesture may include, but is not limited to, an incident or incidents that may be reasonably perceived as being motivated by characteristics such as race, color, religion, ancestry, national origin, gender, sexual orientation, gender identity and expression or mental, physical, or sensory disability, intellectual ability or by any other distinguishing characteristic.


Bullying is common:

  • Bullying is the most common discipline problem in public schools—12% report that it occurs at least once weekly
  • 1 in 5 high school students report being bullied on school property
  • 1 in 6 students report being cyberbullied within the past year
  • Reports of bullying are highest in middle school (22%) followed by high school (15%)
  • LGBTQI+ youth are at high risk for being bullied
    • The Trevor Project’s 2021 national survey of over 34,000 youth found that 33% of respondents reported being bullied in-person (e.g., at school) while 42% were bullied electronically; LGBTQ students who reported being bullied in the past year had 3x greater odds of attempting suicide in the past year (see graph below)
Source: The Trevor Project, Bullying and Suicide Risk among LGBTQ Youth. 2021

Furthermore, bullying is associated with an increased risk for weapon carrying, physical fighting, and other forms of violence, such as suicide, teen dating violence, and subsequent sexual harassment perpetration.


Bullying is PREVENTABLE. But how?

First, we need to recognize the number of factors that may increase or decrease the risk for perpetrating or experiencing youth violence, which includes bullying.

Risk Factors for Violence Perpetration:

IndividualHistory of violent victimization
Attention deficits, hyperactivity, or learning disorders
History of early aggressive behavior
Involvement with drugs, alcohol, or tobacco
Low IQ
Poor behavioral control
Deficits in social cognitive or information-processing abilities
High emotional distress
History of treatment for emotional problems
Antisocial beliefs and attitudes
Exposure to violence and conflict in the family
FamilyAuthoritarian childrearing attitudes
Harsh, lax, or inconsistent disciplinary practices
Low parental involvement
Low emotional attachment to parents or caregivers
Low parental education and income
Parental substance abuse or criminality
Poor family functioning
Poor monitoring and supervision of children
Peer / SocialAssociation with delinquent peers
Involvement in gangs
Social rejection by peers
Lack of involvement in conventional activities
Poor academic performance
Low commitment to school and school failure
CommunityDiminished economic opportunities
High concentrations of poor residents
High level of transiency
High level of family disruption
Low levels of community participation
Socially disorganized neighborhoods
Source: CDC Violence Prevention, Risk and Protective Factors, Risk Factors for Perpetration. 2020

Protective Factors for Violence Perpetration:

IndividualIntolerant attitude toward deviance
High IQ
High grade point average (as an indicator of high academic achievement)
High educational aspirations
Positive social orientation
Popularity acknowledged by peers
Highly developed social skills/competencies
Highly developed skills for realistic planning
Religious beliefs
FamilyConnectedness to family or adults outside the family
Ability to discuss problems with parents
Perceived parental expectations about school performance are high
Frequent shared activities with parents
Consistent presence of parent during at least one of the following: when awakening, when arriving home from school, at evening mealtime, or when going to bed
Involvement in social activities
Parental/family use of constructive strategies for coping with problems (provision of models of constructive coping)
Peer / SocialPossession of affective relationships with those at school that are strong, close, and prosocially oriented
Commitment to school (an investment in school and in doing well at school)
Close relationships with non-deviant peers
Membership in peer groups that do not condone antisocial behavior
Involvement in prosocial activities
Exposure to supportive school climates (e.g., intensive supervision, clear behavior rules, firm disciplinary methods, and engagement of parents and teachers)
Source: CDC Violence Prevention, Risk and Protective Factors, Risk Factors for Perpetration. 2020

Per CDC, different types of violence are connected and often share root causes. Addressing and preventing one form of violence may have an impact on preventing other forms of violence:

Source: CDC Violence Prevention, Fast Fact: Preventing Bullying. 2021

What can we do in clinic?

Potential screening questions to incorporate:

  • I’d like to hear about how school is going – how many good friends do you have?
  • Do you ever feel afraid to go to school? Why?
  • Do other kids ever bully you at school, online, or in your neighborhood?
    • Who bullies you? Where/when does it happen? What do they say/do?
  • What do you do if you see other kids getting bullied?
  • Who can you go to for help if you or someone you know is bullied?
  • Also incorporate screening questions for mood issues as well as suicidal ideation and homicidal ideation

Encourage kids being bullied to speak to a trusted adult and to stand up safely for themselves.

Encourage parents/caregivers to talk to their kids about what bullying is, how to stand up to it safely, check in with kids frequently, and model how to treat others with kindness and respect.

Utilize resources—there are TONS of great resources at StopBullying.gov!

Take Action: Rhode Island Law

All 50 states have anti-bullying laws!

Rhode Island’s anti-bullying laws have several features, including requirements that school districts prevent and respond appropriately to incidents of bullying, provide referrals to appropriate counseling and/or social services for affected students, and procedures for promptly notifying the parents or guardians of a victim and a perpetrator and about any action taken to prevent further acts of bullying or retaliation.

Specifically, RI’s Statewide Bullying Policy mandates that

  • Parents/guardians of the victim of bullying and of the alleged perpetrator shall be notified within 24hr of the incident report
  • The school principal, director or head of school shall promptly investigate all allegations of bullying, harassment, or intimidation
  • The investigation will include an assessment by the school psychologist and/or social worker of what effect the bullying, harassment or intimidation has had on the victim. A student who engages in continuous and/or serious acts of bullying will also be referred to the school psychologist and/or social worker

If we as providers feel that a school is not taking appropriate action for our patient, we can file a complaint through the Office for Civil Rights or the Civil Rights Division of the Department of Justice.


You are seeing a 12-year-old patient for a well visit, during which you perform a HEADS assessment and ask about education. You screen for bullying and start by asking if she has any good friends to which she replies “a few.” You also ask if she is afraid to go to school, for which she states “yes.”

  • What are some follow-up questions you could ask?
  • What would you make sure is in place for this patient?
  • What resources could you provide the patient?
  • What resources would you provide the patient’s family?

Further reading!

Blog post based on Med-Peds Forum talk by Anita Gandhi, PGY1

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