Did the ugly duckling have PTSD? Bullying, its effects, and the role of pediatricians.

Draco Malfoy of Harry Potter, Nellie Oleson of Little House on the Prairie, Lumpy Rutherford of Leave it to Beaver, Amber Von Tussle of Hairspray, Nelson Muntz of The Simpsons, Regina George of Mean Girls, all 3 Heathers of the eponymous movie, and last but not least, pretty much all the ducks in the Ugly Duckling: regardless of one’s generation, such bullies are a staple of child and adolescent life in literature, movies, and television. Throughout the media, bullied kids’ “crimes” are varied: they may have a different race, religion, or sexual orientation; they may be too poor, too rich, too heavy, too short; they may suffer for their lineage, as do the magical children of Muggles in Harry Potter. Sometimes they are just the new kid in town. Sometimes they are the socially clumsy kid without friends, an easy target for a bully who wants to assert power and impress others. What happens to bullies in fiction, beyond driving the plot? Sometimes they get sent to the principal, sometimes they get a talkingto by an embarrassed parent, and sometimes they get a knowing wink and an at-a-boy from a parent when the principal is not looking. They often get their comeuppance in the end of the movie or book, having the tables turned on them or developing a newfound respect for their target. Although the bully has been a stock character for years, something has recently changed in the United States. The bully has jumped off the page and out of the screen, and into everyday life and legislation and pediatric practice. The bully is no longer simply a representation of a moral lesson or a source of humor. We have come to recognize the bully as a real person with complex needs and motives who can inflict great harm on others, not to mention on his or herself. The rise of cyberbullying,1–5 with its potential for broad public humiliation, has highlighted the damage that bullying can cause. Since 1999, almost all US states have enacted antibullying legislation and have established requirements that school districts implement antibullying policies.6 In research studies, bullying is typically defined as intentional and repeated perpetration of aggression over time by a more powerful person or group against a less powerful person or group.7,8 In study after study, a substantial proportion of youth report having been bullied,3–5,8–13 with the prevalence peaking in middle school.4,8,10 Most studies find that at least 1 in 10 middle school students report being bullied in the previous year,4,8,10 and the proportions are much higher in some studies.3,4,8–12 The variation across studies may reflect differences in setting, timeframe, and specific questions asked. Research also shows that bullies, who are often perceived as popular by their peers, are motivated to denigrate others to attain a dominant social position.14–16 Moreover, bullies have a tendency to target others AUTHORS: Mark A. Schuster, MD, PhDab and Laura M. Bogart, PhDab Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts; and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts