Child and Adolescent Psychiatry

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School and Peer Factors 293

are supposed to be supervised at school, most bullying goes unrecognised
by teachers, and the victims commonly feel unable to report the bullying
either to teachers or parents. Roughly 2–8% of pupils are bullied at least
once a week, and 2–4% engage in bullying at least once a week. Less
severe levels of victimisation and bullying are substantially commoner.
English studies have found similar rates of bullying in childhood and
adolescence, though studies elsewhere have reported that bullying de-
clines with age. Most bullies are boys, and there may be a small excess
of boys among victims too. Physical aggression is most characteristic of
boys’ bullying; girls’ bullying is more likely to involve social exclusion or
whispering campaigns.
Bullies are more likely to have witnessed domestic violence. They, in
turn, are typically aggressive not only to their peers but also to their sib-
lings, parents and teachers. They have a positive attitude towards violence
and little empathy for victims. At least among boys, bullies are likely to
be physically stronger than their peers. The development of aggressive
personality patterns may reflect both temperament and parenting (with
the parents of bullies being more prone to use power-assertive child-
rearing methods, and failing to provide adequate warmth, control and
supervision). Most bullies are not especially prone to anxiety, insecurity, or
poor self-esteem (though there may be a minority of anxious bullies who
dominate their victims in order to bolster a fragile sense of self-worth).
Bullies are not generally unhappy or unpopular at the time. In the longer
term, bullies are at an increased risk of criminality and alcohol abuse in
adulthood.
Some pupils are both bullies and victims, often referred to asbully-
victims. These individuals may be described as provocative (or high-
aggressive) victims. Provocative victims show a high level of aggression
and disruptive behaviour: picking fights, taunting others, getting people
into trouble and being easily angered. Clinical experience suggests that
individuals with ADHD are particularly likely to become provocative bully-
victims.
By contrast,passive(or low-aggressive) victims are anxious, insecure,
quiet individuals who withdraw when attacked and may cry. They typ-
ically lack friends and have very poor self-esteem. Among boys at least,
passive victims are likely to be physically weaker than their peers. A
cautious and sensitive personality probably predates the victimisation, but
many of the other characteristics of victims are as likely to be consequences
as causes of victim status. Victimisation may be more likely in larger
schools. It is uncertain how far victimisation is influenced by physical
appearance, physical disabilities, or minority group status. While there
is no doubt that victims often experience considerable distress at the
time, the long-term consequences are less clear. Possible consequences
include lasting problems with self-esteem, peer relationships, and intimate
friendships. One study showed that frequent victimisation at age 8 in-
creased the rate of attempted and completed suicide by age 25, but the
nature of the link varied with gender. In males, the link disappeared after

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