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Bethany Thompson’s “crooked” smile was a symbol of survival, a reminder of the life-saving operation that removed a brain tumor when she was just a toddler but also damaged facial nerves.

To Bethany and her family, it was a small price to pay for beating cancer, but the imperfection sometimes made the girl a target for taunts. In October 2016, after what was later described by a friend as relentless bullying by classmates, Bethany returned home from school, took a gun into the backyard, and fatally shot herself. She was 11.

“I think that she was just done,” her mother told The Columbus Dispatch after the tragedy. “People need to know that even the littlest things can break someone.”

Bethany’s story, sadly, is one among too many that highlights the troubling link between bullying and youth suicide.

Research shows, for example, that any involvement with bullying, whether as a victim, a perpetrator, or even just as a witness, means a higher risk of suicide-related behavior, including thinking about or planning suicide and suicide attempts. At the greatest suicide risk are the bully-victims, meaning those who both bully and are bullied.

Those same researchers, however, caution that it is misleading to say that bullying directly causes suicide. Suicide is complex, and there are almost always other factors at play—depression, family dysfunction, substance abuse, or past trauma, to name a few. And it’s important to note that most youth who are bullied do not have thoughts of suicide or make suicide attempts.

Still, suicide is the third leading cause of death among those ages 10-14, and it’s the second leading cause among those 15-34. How many of these deaths have links to bullying is hard to quantify. But one thing is certain: Bullying has enormous power to prompt feelings of helplessness and humiliation, and ignoring bullying or treating it as a normal part of childhood can have disastrous consequences.


The power dynamic

For parents, caregivers, schools, communities, and young people, themselves, preventing bullying and helping those affected by it means getting educated about what it is, who is most vulnerable, and what helps and what hurts when addressing it.

Some key things to understand:

  • Bullying is at its heart an imbalance of power, in which the person uses physical strength, information, or social standing to harm or control someone. It can include things such as spreading rumors, harassing them online (called cyberbullying), hitting and kicking, making inappropriate sexual comments, mocking them, and leaving them out. The more it happens, the more harmful it is.
  • In addition to the increased risk for suicide-related behavior, bullying can cause a whole range of negative effects, such as depression, anxiety, alcohol or drug abuse, academic issues, and trouble with social functioning. These extend not just to the person bullied, but to the bully as well. Even bystanders can be affected, reporting feelings of helplessness and less sense of connection with responsible adults.


Bullying risk factors

So what puts some kids at risk of being bullied, being a bully, or both? In most cases, bullied youth tend to fit into one or more of the following categories:

  • They’re seen as different. Perhaps they wear out-of-the-ordinary clothing, or are outside the norm in weight or height, or have a physical or mental disability.

Or they may be in a group with a history of being discriminated against, such as the LGBTQI community.

  • They’re seen as easy to dominate physically or mentally.
  • They have low self-esteem or anxiety or depression issues.
  • They struggle to connect socially and make friends.
  • They’re seen as annoying or aggressive in their bids for attention or find it tough to get along.

Kids who bully others may do so because they enjoy flexing their social or physical power, or they may be reacting to a lack of such power. Either way, they tend to fit these descriptions:

  • Are easily frustrated or aggressive
  • Have problems at home and limited parental oversight
  • Hang out with other bullies
  • Have trouble following rules
  • See violence as a positive
  • Mask low self-esteem by looking down on others

Bully-victims have characteristics from both groups, and often use bullying as a way of dealing with their negative emotions and regaining the power they lost from their own experience being bullied.

It’s worth noting that bullying isn’t something that just occurs outside the home. A 2013 study by the University of New Hampshire found, for example, that bullying by a sibling can be just as harmful to mental health as bullying done by a peer.


Beyond tragedy

Although each tragic story of bullying reminds us of how much still needs to be done, there is some encouraging news. According to the 2015 Indicators of School Crime and Safety report from the U.S. Department of Education, the percentage of students who reported being bullied moved from 32% in 2007 to 22% in 2013. And the number of schools that reported at least weekly incidents of bullying dropped from 29% in 1999-2000 to 16% in 2013-2014.

But there’s still far to go in the effort to conquer bullying and break its link to suicidal thoughts and behavior. Here’s what can help:

  • Empower youth by teaching resilience and coping and life skills so that they’ll be better able to handle what comes.
  • Teach problem-solving and conflict resolution so that power imbalances can be addressed and issues solved peacefully.
  • Encourage empathy and acceptance of the difference of others, and foster a sense of connection with people and with institutions such as school and church.
  • Take sibling rivalries seriously. And don’t allow violence at home that you wouldn’t accept outside of it.
  • Don’t forget the bystanders. Those who witness bullying are also affected. Empower them to be part of the solution. This will not only diminish their sense of helplessness, it will help influence social norms so that bullying is no longer seen as something that is acceptable or inevitable.

When youth bullying does happen, take it seriously. Listen to and focus on the bullied child, ensure their safety, and help them understand what they’ve experienced and develop strategies to deal with it. Therapy can help them deal with their mental distress and also resist the temptation to turn to unhealthy means of coping, such as alcohol or drugs.

And don’t forget the bully. While it can be tempting to focus on punishment, it’s important to remember that a youth who bullies often does so because they, too, are suffering emotionally. Providing help as well as consequences can make it much less likely the bully will return to form, and that means less chance of one more tragedy.

David Sack, MD
David Sack, MD, CEO of Elements Behavioral Health, is board certified in psychiatry, addiction psychiatry, and addiction medicine. After earning his medical degree from Rush Medical College and completing his residency in psychiatry at the UCLA-Neuropsychiatric Institute, he worked as a senior clinical scientist at the National Institute of Mental Health and as senior vice president for clinical research for Comprehensive Neurosciences. Dr. Sack is actively involved in programming at every one of Elements’ programs. He brings a level of clinical sophistication to each treatment program that is unparalleled in the treatment field. His background in both research and treatment enables Dr. Sack to enrich each program and ensure that every decision made takes into consideration the impact on clinical effectiveness. Dr. Sack’s expertise in addiction and mental health has made him a sought-after expert by the media. He is often quoted in major newspapers (NY Times, LA Times, Washington Post); appears on television shows such as The Doctors, Dateline NBC, and Good Morning America; and writes regularly for The Huffington Post, Psychology Today, and Psych Central.


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