ESCAP 2017 KEYNOTE LECTURE ON LONG-TERM EFFECTS OF BULLYING

Dieter Wolke: "Important developmental influences have been ignored"

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Half of these children suffer in silence. If they have parents who are very harsh they don't dare to talk about it. And if they have overprotective parents, they do not tell because all hell breaks loose if they do. It is most important for them to disclose and talk to someone about it – a parent, a teacher or perhaps a child psychiatrist.

Dieter Wolke (Warwick University, UK)Bullying is an underestimated threat to mental health. And it will stay that way as long as therapists do not understand how bullies tick and why the victims keep silent. Professor Dieter Wolke (University of Warwick, UK) is doing research on the subject. As a keynote speaker at the ESCAP 2017 Congress, he will explain how serious an issue bullying is, outline the differences in emotional reception between pure victims and bully-victims, and discuss the different cognitive biases and how the problem can be addressed in interventions.
Dieter Wolke: "I started this research not expecting much. But the more I researched, the more astonished I became about how strong the effect of bullying can be."

It seems as if bullying has not been taken seriously for a long time. Do you have an explanation for this?
"Some 25 per cent of all children are confronted with bullying in some way. Still people say: 'Oh, but if it happens so often, that's normal. That is the way kids are, you don't need to treat that.' You try and suggest not treating the 20 to 50 per cent of the population that break a bone at some point in their lives... How could the prevalence ever be a reason not to treat people?"
"We are only at the cast of awareness that this is an important problem. When we apply for grants, they still send us from pillar to post and we have been rejected more than once. Is this about health, school or parenting? Whether this belongs to child psychiatry or to education, to general practice or to psychology is not a very interesting discussion. It affects the lives of children across many areas of functioning and many professionals are involved. I would prefer to look at the facts and help those kids. The first thing we have to do is show that bullying matters."

Peer relations
The title of your keynote lecture underlines the importance of peers and siblings. Why would it be relevant for a child psychiatrist or psychologist to know about their patients' peer relations?
"Some thirty years ago, the research was all about parenting and how parenting would influence the development of children. In my early research we looked at children who were very difficult – who were crying a lot, not sleeping et cetera. In those days we found out that very often parents live with the illusion that they can educate their children, and change them in a big way. There was a lot of genetic and other research that raised the question: How can it be that the children within one family can be so different, even though they have the same parents? Then, in the nineties, we started the bullying research – first in Germany and then in Britain – and what I found interesting as a developmental psychologist interested in developmental psychopathology, was the fact that once these children reach eighteen, they will have spent much more time with their peers than with their parents. From kindergarten through school and in college, the young people around them must have had at least as much influence as the parents. Michael Rutter and Barbara Maughan wrote their Fifteen thousand hours about this aspect in relation to educational influences. I found it quite amazing when I looked at psychopathology, that peer relations were more or less ignored in research. Furthermore, we found that doctors – general practitioners and even child and adolescent psychiatrists – when a child comes in with a head ache or tummy ache or a psychological problem, they possibly looked at their relationship with the parents, but they never asked what their sibling relationships were or what their relationships with their peers at school were like."

Three different groups
Mental health professionals have underestimated the importance of good peer relationships?
"Yes, it has been very much overlooked. There has been some research on antisocial peers in connection with conduct disorder. They looked at delinquency, they looked at family factors related to it, groups and gangs. But bullies are not necessarily conduct-disordered. We distinguish between three different groups in bullying. First the pure bully who is dominant and has a high social status. Everyone at school knows them, they fear them and others think they are cool. Then we have the victim who never bullies but just becomes victimised. And a third group that actually has the worst psychiatric outcome are the bully-victims – these are kids who are getting victimised and then try unsuccessfully to bully others themselves. They get socially defeated all the time. Kids in this category are usually orchestrated by the dominant bully who is like a leader. Other children will recognise the bully-victim's lower social position and may start victimising them as well."

Researching long-term consequenses
"In other fields, such as education, research has been done into for example peer learning and relationships within groups. But if you look at psychopathology, for example the development of depression or psychosis, until twenty years ago there was no mention of peer influences. When we started researching psychotic symptoms, the main criteria for getting the grant were: social factors, migration status, prenatal and perinatal effects, and genetic factors. But in fact of the whole research, the strongest effect sizes in developing psychotic symptoms were found for having been bullied. To look at the long-term consequences of bullying, particularly in psychiatry, is a relatively recent theme."

ESCAP 2017 Congress GenevaGenes and parenting
Bullying is done by peers and siblings. You are saying: don't blame the parents?
"I am not saying that parents are irrelevant. The question is not as simple as: do genes matter, or is it all about parenting? Of course both matter. What I am saying is that – in addition to parenting – an important area of developmental influences which can lead to psychopathology has been ignored and we should look into it. In two studies from the United States and Great Britain we published that the effects of being bullied on anxiety and depression or mood disorder were greater than the effects of being sexually or physically abused. They are at least on a similar footing and just as severe."
"Another part of the answer to this question is about whether becoming a bully, a bully-victim or a pure victim is all due to the parents. We analysed what the influence of parenting might be. We found that when children had harsh experiences with abusive parents, they were more likely to become a bully-victim or a victim. But interestingly enough, you are also more likely to become a pure victim if your parents are very protective – the so-called helicopter parenting – because you have never learned how to deal with conflicts. In these cases, the parents manage everything. In fact, when it comes to disclosure about bullying, these are often the parents where all hell breaks loose. They repeatedly call the school, the other parents and everybody else, arranging meetings and making a lot of noise. Although they do not intend to make things worse, to the child it might feel like they are having to go through the whole thing all over again. Because now everybody knows..."

Bullying often starts at home
"Also, at home is the place where bullying often begins: it starts between siblings. If a child bullies their brother or sister, they are three times more likely to also bully other children at school. This is learned behaviour. And if you are a victim, it is as if you are caged: you may be bullied at school and at home, 24 hours a day – for some there is no safe place. So actually, parents can do something in the home."

The other side is about the genes, the child’s characteristics?
"Yes. Bullies who enter a new classroom will not know beforehand who will become their victim. They will try every child. And they will hone in on those who do not just walk away but are shaken, who may begin to cry. They scan whether these children have friends to help them; if not they are easy targets where no fights are to be expected. So the individual characteristics of children are important factors in who becomes a victim. The psychological characteristics are especially important, such as being vulnerable or emotional or having poor social skills. Physical characteristics matter much less than is often thought. For boys it may matter if they are smaller and physically not as strong, and with adolescent girls the more physically attractive ones are at increased risk of being excluded. However, while individual characteristics matter, we should not take this to blame the victims. Every child has the right to grow up in a safe environment.”

Peer rejection
Would you consider 'peer rejection' a kind of bullying?
"Bullying is abuse of power which is done repeatedly and with the intention to harm. That is the definition. All children engage in conflict, and that is not a bad thing because it teaches them how to negotiate. But bullying happens to children every week, often several times a week. It can be verbal, it can be physical, it can be blackmail and it also can be relational, which is slightly more common between girls, for example through social exclusion such a rumour spreading, not including a child in activities or playing nasty tricks. So behaviours intended to reject a peer are part of the definition of bullying. In the child development literature peer rejection is usually measured by peer nominations in the classroom, and the measures are standardised within the classroom to define who is rejected or not. In contrast, bullying is defined by behaviour and how often it occurs. Thus rates of bullying can be compared between classes, schools and even countries while peer rejection measures cannot as they are normed within each classroom.”

How serious is the impact of bullying?
"It is serious. A recent survey found that some 16,000 children in Britain do not go to school at all because they are bullied by their peers. Fitting in with other kids is such an important area of our children's social lives and development, and a crucial life task. In transition to adulthood, they have to learn how to get on with their peers – their lives depend on it, because their parents will ultimately die and without proper peer relationships they will become outcasts and be lonely."

Serious mental disorders
"The relationship between bullying and serious mental disorders is quite strong and there is relatively little that we do about it. One of our studies shows, for example, that 27 per cent of all occurrences of depression are attributed to bullying. Similar results are found for anxiety disorder, increased self-harm, increased suicide, and psychotic symptoms. Of course this research is rather new, but these studies have already been replicated by different researchers in various countries."
"The long-term effects into adulthood also include an impact on wealth. Adults who have been bullied as a child find it difficult to work in groups. They end up leaving their jobs because they prefer to work in niches, on their own. And they have social problems with for example partnering, trusting others, team work and maintaining confident friendships."

Could you say more on the specific effects of bullying on the transition to adulthood?
"Bullying can be present from early childhood but increases in adolescence because bullying is all about dominance and social control. If you move higher up in the social hierarchy, you will get access to resources. One of these resources is finding a partner and having access to sexual relationships. So if you are a cool and powerful kid, boy or girl, you associate with more peers and increase your opportunities. In this competition, bullying is one strategy to get rid of competitors. For example, with girls it is often not just a matter of enhancing yourself in attractiveness by putting make-up on and attractive clothing, but some use bullying as an instrument to defame and exclude others. Correspondingly, we found a higher rate of relational bullying in girl schools where the resource boys is scarce and others studies have shown that defamation is higher the more attractive the potential competitor."

More inequality, more bullying
"For the pure bully, we have found hardly any negative effects into adulthood. That really is disturbing when you think about it – as if nature is telling us that it is good to become a pure bully who never gets victimised. In some societies it has been found that bullying increases when the resources get scarce and even more interesting is the comparison between different levels of socio-economic status: the greater the discrepancy between richest and poorest, the more bullies you will find. I think the reason for this is that in areas with a great disparity in income, anything that will get you ahead is valued. And in countries that have resources for everyone, there is less need to bully. My presentation at ESCAP in Geneva will include a map that shows the contrast between the Nordic countries versus countries like Russia, United States and Great Britain. The same mechanism works in schools, where for example classrooms that have a clearer developed social hierarchy, bullying rates are higher or more stable.” (Read more about social inequality and children's mental health)

How does someone learn to be a bully?
"Most research has been done on victims. We know relatively little about pure bullies. What we know is that they are actually good at social recognition: they spot other children's emotions easily and they seem to have an understanding of how groups work. But they show very little empathy, they have less of a moral dilemma and there is a callousness in their social behaviour. Of course we have asked ourselves if they could have learned this at home. In most cases I do not think that parents are endorsing their children to become a bully – I tend to think that it is more likely to evolve from their individual characteristics in interaction with caretaking behaviour that unintentionally condones bullying behaviour, getting ahead. There may be a fine line in the difference between good leadership and being a bully. When you look at the vice chancellors of universities, the CEO's of multinational companies or the bankers of this world: who are the good leaders and who are the bullies? The difference may be in how they consult others, empathise and integrate other people’s views in their decision-making. A crucial difference may be that a bully can sleep at night whatever happens to other people – that is where the callousness comes in. In future, research should be done to try to figure out what makes a pure bully tick in order to develop more effective interventions."

Neuroimaging
"We have not been able to find a specific activation pattern in neuroimaging. However, this research is in its infancy where bullying is concerned. The question is, where should we find differences: is it in the reward system? In emotion recognition? Where is the moral part in our brain where this would show up? But it does not really make a difference in the short term. I can report about these problems and analyse them without knowing where it happens in the brain. I know it is not in the big toe, but it is not a prerequisite for effective intervention to understand the brain activation patterns. It would be highly publishable and of great basic scientific interest, but for a school teacher, an analysis of the characteristics and class room dynamics, along with tools to deal with bullying, would be sufficient to effect a change."

Is moving to another school a possible solution for the victims?
"Some parents actually do transfer their children to another school. But they still will have double the likelihood that their child will be become a victim again, because its characteristics may not have changed since the previous experiences. And if you change schools more often, you have a bigger chance of getting bullied because you have fewer friends. So moving to another school can help but it needs to be well -managed."

Cyberbullying
You have said before that cyberbullying – using social media on the internet –  is less serious than has been suggested by some experts?
"We have just submitted a paper entitled 'Cyberbullying: a storm in a tea cup'. Cyberbullying has as adverse and serious effects as face to face bullying. However, the question is whether it creates many new victims, or if it is mainly another tool in the bullies’ armoury. Cyberbullying is all over the media and it does make people anxious. However, we found – along with a number of other recent studies – that it only creates a few new victims. Rather, we found that over eighty-five percent of all bullying still happens face-to-face. It is done physically, verbally or relationally and cyberbullying is mostly another tool to hurt those that are already being victimised face to face. Since bullying is about power and dominance, a bully gains little from hurting a stranger from another region or another country; it is mainly focused locally on those already being victimised. However, being displayed additionally on social media as the target of bullies is very hurtful and can tip the victim over the edge: coming to school and finding that everyone has seen the nasty messages or embarrassing pictures and having to deal with their sniggers. It allows bullies to reach a victim 24/7. Therefore we have to take it very seriously."

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