Teens with Chronic Pain and Bullying

What is bullying? At any age it is the systematic abuse of power. It is aggressive behavior against a peer via cyberbullying, direct verbal or physical bullying, or deliberate exclusion. The abuse is intentional harming of a peer that is repeated and involves a perceived imbalance of power.

During adolescence, the bullying may be done by a single individual against a peer or by a group, often during middle school through exaggerated exclusion from the group. It can be carried out in different ways, such as via social media through fabricated stories about the person who is being bullied.

Who is at Risk?

Teens and preteens being bullied are typically seen as “different” in some way. Often the first “difference” noted is physical appearance. Thus, obese teens and those with any bodily malformations may be singled out for bullying.

Teens with chronic pain may be at significant risk of bullying if they miss a significant amount of school and then return “looking perfectly fine.” Since pain is an inward experience, there are often no casts or other “medical equipment” that signals a plausible reason for missing school. Teens with chronic pain may need wheelchairs or crutches at different times because of pain, especially in lower extremities, and then not need such aids at other times. They may be accused by peers or teachers of ‘faking it” to get attention or special privileges, like use of an elevator or teacher’s lounge.

Teens with irritable bowel syndrome who may need to rush to a restroom can become the target of bullying because they have diarrhea or vomiting. They may then avoid going to school for fear of being embarrassed by past experiences, or they may fear that such an experience may happen in front of peers and make them the target of bullying.

Teen who are neuroatypical (a term previously called Asperger’s or high-functioning autism) are often at risk of being bullied. It may begin during elementary school and become worse during middle and high school. If such a student has chronic pain, the problems and risk for bullying are magnified. Such individuals may not know peer-associated social skills and are thus seen as “odd” or “different.” They may not make eye contact in communicating with peers, and may be overwhelmed by all the commotion and noise at school, especially during class-changing times.

Physical and Emotional Consequences of Bullying

Data show that bullying can have both short-term and long-term physical and emotional consequences. Studies have shown that teens who are bullied have high levels of stress hormones, and we know that high stress hormones increase pain signaling. For a teen with chronic pain, bullying may be a cause of school absenteeism in addition to the pain itself, although the teen may blame the pain as the sole reason for the inability to attend school. Studies have shown that peer bullying can have short-term and long-term consequences, both for health and for psychological well-being. Bullying can be a trigger for suicide in a depressed adolescent and can certainly be a cause of ongoing stress.

What Parents Can Do

Often teens fear telling their parents about bullying because they worry that parent involvement will “make things worse.” Parents need to explore bullying experiences with their children, however, many do not know how to handle bullying without making their children feel that they’re more likely to become a victim upon returning to school. If discussions within the family about how to handle bullying are not helpful, the family needs to get professional help before avoidance of school due to bullying becomes a chronic problem.

References for Further Reading

Below are references for those who want to read more on bullying of youth with chronic pain and bullying of youth in general:

1: Marin TJ, Hayden JA, Lewinson R, Mahood Q, Pepler D, Katz J. A Systematic Review of the Prospective Relationship Between Bullying Victimization and Pain. J Pain Res. 2021 Jun 23;14:1875-1885.

2: Garmy P, Hansson E, Vilhjálmsson R, Kristjánsdóttir G. Bullying, pain and analgesic use in school-age children. Acta Paediatr. 2019 Oct;108(10):1896-1900.

3: Garmy P, Hansson E, Vilhjálmsson R, Kristjánsdóttir G. Bullying and Pain in School-Aged Children and Adolescents: A Cross-Sectional Study. SAGE Open Nurs. 2019 Nov 10;5:2377960819887556.

4: Fales JL, Rice S, Aaron RV, Palermo TM. Traditional and cyber-victimization among adolescents with and without chronic pain. Health Psychol. 2018 Mar;37(3):291-300.

5: Skarstein S, Helseth S, Kvarme LG. It hurts inside: a qualitative study investigating social exclusion and bullying among adolescents reporting frequent pain and high use of non-prescription analgesics. BMC Psychol. 2020 Oct 28;8(1):112.

6: Malhi P, Bharti B. School Bullying and Association with Somatic Complaints in Victimized Children. Indian J Pediatr. 2021 Oct;88(10):962-967.

7: Östberg V, Låftman SB, Modin B, Lindfors P. Bullying as a Stressor in Mid-Adolescent Girls and Boys-Associations with Perceived Stress, Recurrent Pain, and Salivary Cortisol. Int J Environ Res Public Health. 2018 Feb 20;15(2):364.

8: Lamb J, Pepler DJ, Craig W. Approach to bullying and victimization. Can Fam Physician. 2009 Apr;55(4):356-60.

9: Rosati P, Jenkner A, De Vito R, Boldrini R, Chiodi P, Celesti L, Giampaolo R. 'Tell me about your pain': abdominal pain and a history of bullying. BMJ Case Rep. 2011 Mar 24;2011:bcr1220103611.

10: Ayonrinde OT, Ayonrinde OA, Adams LA, Sanfilippo FM, O' Sullivan TA, Robinson M, Oddy WH, Olynyk JK. The relationship between abdominal pain and emotional wellbeing in children and adolescents in the Raine Study. Sci Rep. 2020 Feb 3;10(1):1646.

11: Armitage R. Bullying in children: impact on child health. BMJ Paediatr Open. 2021 Mar 11;5(1):e000939.

12: Wolke D, Lereya ST. Long-term effects of bullying. Arch Dis Child. 2015 Sep;100(9):879-85.

13: Menesini E, Salmivalli C. Bullying in schools: the state of knowledge and effective interventions. Psychol Health Med. 2017 Mar;22(sup1):240-253.

14: Zaborskis A, Ilionsky G, Tesler R, Heinz A. The Association Between Cyberbullying, School Bullying, and Suicidality Among Adolescents. Crisis. 2019 Mar;40(2):100-114.

15: Ybarra ML, Espelage DL, Valido A, Hong JS, Prescott TL. Perceptions of middle school youth about school bullying. J Adolesc. 2019 Aug;75:175-187.

16: Khan L. The Changing Face of Bullying and What We Can Do to Stop It. PediatrAnn. 2021 Oct;50(10):e398-e401.

17: Wolke D, Tippett N, Dantchev S. Bullying in the family: sibling bullying. Lancet Psychiatry. 2015 Oct;2(10):917-29.

18: Bitsika V, Heyne DA, Sharpley CF. Is Bullying Associated with Emerging School Refusal in Autistic Boys? J Autism Dev Disord. 2021 Apr;51(4):1081-1092.