Victim of Long-Term Bullying or Harassment and PTSD

What is Bullying?

Bullying is unwanted, aggressive behavior that involves real or perceived power imbalance. The behavior happens repeatedly, or has the potential to happen repeatedly.³

Bullying isn’t just traumatic in childhood, though, and it’s not a passing phase. Research shows bullying and harassment can cause adult symptoms of post-traumatic stress disorder (PTSD).⁴ In fact, one study examining mental health in college students found experiencing bullying to be the strongest predictor of developing PTSD symptoms. This surpassed physical abuse, neglect, and exposure to community violence.⁵ Another literature review examining 29 relevant studies on bullying and harassment found that 57% of victims scored above the threshold for meeting PTSD criteria.⁴

Why Is Bullying or Harassment So Harmful?

When you are a victim of bullying or harassment, you can experience a wide range of emotions, ranging from mild embarrassment to extreme fear because your safety is compromised. No matter the situation, however, it never feels pleasant to be attacked or criticized by your peers. Bullying is a distinct social stressor because it represents a systematic form of interpersonal aggression, coupled with intense feelings of powerlessness and defenselessness.⁶

In people of all ages, there are several mental and physical health effects associated with bullying, which may include:^6,7

• Anxiety and depression.
• Sleeping problems.
• Fatigue or general restlessness.
• Somatic complaints like muscle aches or bone pain.
• Gastrointestinal issues (e.g., irritable bowel syndrome, ulcers).
• Lack of concentration at school and work.
• Cardiovascular issues (e.g., high blood pressure).

Victims of bullying may grow to feel like they could be attacked or criticized at any time and may come to question who they can trust within various interpersonal dynamics. Even if the abuse stops, they may live in anticipation and fear, waiting for the next incident to occur. This combination of uneasy and restless feelings can make it difficult for victims to focus on their school or work, which may lead to performance decline, isolation behaviors, and low self-esteem.^6,7

Moreover, targets of bullying are at a high risk of developing mental illnesses, such as depression and anxiety disorders.⁷ While research continues to emerge and unfold about the long-term impact of bullying on a person’s psychosocial behavior, studies show that as many as 75% of bullied victims report higher likelihood to develop mental illness.⁴ Someone who was bullied is also more likely to develop problems with substance use as well—from alcohol to marijuana and illicit substances, too.²

How Can Bullying Cause PTSD?

When a person is repeatedly bullied or harassed, they experience continued negative reinforcement, systematic abuse of power, and ongoing intimidation and emotional pain. And those who are bullied as children tend to have a greater risk of being bullied in their adult lives.⁶ The characteristic symptoms that develop as a result of being bullied—feelings of powerlessness, helplessness, anger, fear—are also strongly correlated with that of PTSD, making it more likely that a person who was bullied may develop the disorder.

PTSD is classified as an anxiety disorder that consists of 3 categories of symptoms, including:⁶

• Persistently re-experiencing the event.
• An intensified desire to avoid stimuli associated with the traumatic event.
• Persistent feelings of arousal and hypervigilance.

Persistently experiencing the event means having nightmares or flashbacks associated with the bullying. Memories flood the person’s mind at inconvenient times and are distressing and unwanted. Or, when a person sees someone who reminds them of an old perpetrator, they may feel their chest tightening or their stomach clenching.⁶

Those who avoid stimuli associated with bullying trauma may distance themselves from peers or coworkers. And they may try and avoid social situations where they will be targeted or victimized in some fashion or stay away from certain places or events where the bullying or harassment happened in the past. It does not matter whether they are experiencing real or perceived danger, what matters is that they experience a general sense of feeling unsafe and threatened.⁶

Finally, persistent feelings of arousal, reactivity, and hypervigilance refer to the psychological effects associated with trauma reenactment.

These symptoms may include:⁶

• Difficulty sleeping.
• Heightened startled reactions.
• Irritability or aggression.
• Risky or destructive behavior.
• Intensified panic and panic attacks.

The presence of these symptoms can interfere with other areas of functioning, including a person’s interpersonal dynamics and academic and occupational success.

How to Spot PTSD in Children

While some PTSD symptoms look similar in children and adults, children may engage in repetitive, trauma-specific play movements (e.g., using dolls to show the bullying or drawing out a scene with crayons). They are also likely to exhibit and complain of somatic symptoms, such as stomach and head pains. Due to cognitive capacities, however, most children also do not always describe their avoidance tendencies as such, since they don’t necessarily recognize that’s what it is.⁶

All PTSD diagnoses require the experiencing or witnessing of a traumatic event.⁸ However, with most forms of bullying and harassment, the trauma occurs in a cyclical or chronic manner. But regardless of the type of trauma, a person’s cognitive perception of themselves, others, and the world around them is often disrupted and even destroyed.⁶

In children, both males and females have equal chances of experiencing physical bullying (e.g., being pushed, slapped, or hit). However, in terms of relational aggression (emotional bullying or teasing), females are at a greater risk.⁹ In terms of race, as many as 24% of white students ages 12–18 report bullying, which is significantly higher than Asian students (9%) and somewhat higher than black (20%) and Hispanic (19%) students.⁹

Cyberbullying is a big problem too, especially among children and adolescents. Cyberbullying is bullying that takes place over digital devices like smartphones, computers, and tablets. It takes places via text, through apps, or on social media platforms. It includes sending or sharing any negative, harmful, false, or mean content about someone else.¹⁰

Bullying in the Workplace

Workplace bullying is a persistent series of mistreatments of others in the workplace. This may include verbal criticism or direct personal attacks done with the intent to intentionally belittle or humiliate others. Many employees are subjected to bullying of some kind at some point during their career.¹¹ Research indicates that bullying affects approximately 11% of workers.¹²

While anyone can be susceptible to bullying, research shows that different socioeconomic backgrounds may impact workplace harassment. For example, victims are more likely to have less powerful occupational positions, lower to no higher education, and lower household incomes. However, other research shows that people with opposite traits (higher levels of authority, education, and income) are also susceptible to workplace harassment.⁸

Bullying, harassment, and subsequent PTSD can exist in all ages and demographics.¹

How to Treat It

There is not one single cure for PTSD, but there are several evidence-based treatment methods that can help reduce or eliminate the distressing symptoms associated with trauma. The efficacy of these methods largely depends on the severity of the symptoms, the person’s capacity to use positive coping skills, and their existing support system.

It is always recommended that people seek out trauma-informed care when getting professional support. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that a trauma-informed approach includes:¹³

• Safety.
• Trustworthiness and transparency.
• Peer support.
• Collaboration and mutuality.
• Empowerment, voice, and choice.
• Cultural, historical, and gender issues.

Trauma-informed approaches can be implemented in any type of service setting and don’t necessarily refer to a set of specific interventions, but an overarching perception of treatment. In general, this approach recognizes the survivor’s need for mutual respect, information, and a sense of hope for their recovery. Treatment professionals should also understand the interconnection between trauma and other related issues, such as interpersonal problems, work or school issues, and mental or physical illness.

It is particularly important that treatment professionals assess for substance use issues in anyone who has been chronically bullied. Victims of chronic bullying may be at increased risk of problematic alcohol or drug use and may benefit from simultaneous management of such issues. If there are co-occurring substance use issues, it is important to find a clinician who is trained and experienced in treating both trauma and addiction.

Therapeutic Techniques

Common therapeutic techniques used to achieve these goals may include:

• Cognitive-Behavioral Therapy (CBT). CBT is a structured psychotherapeutic approach that assists clients in identifying the events, situations, or objects that often trigger the unwanted symptoms. In this mode of therapy, clients learn how to change their negative thinking, address painful feelings of guilt, shame, and blame, and practice healthier relaxation and coping skills.¹⁴

• Eye Movement Desensitization and Reprocessing Therapy (EMDR). EMDR integrates rapid and rhythmic eye movements to stimulate the brain in conjunction with a guided, safe recollection of trauma. This process harnesses the negative emotions caused by the trauma and helps the person decrease their reactivity and distress to such memories.¹⁴
• Medications. In some people, antidepressants can help control and manage PTSD symptoms, such as sadness, anger, or numbness. They can also be used to help with other co-occurring mental illnesses, such as depression.¹⁴

Many people benefit from complementary therapy methods that help improve their sense of self-esteem and well-being. Because bullying and harassment can severely impact a person’s confidence, it is essential that they learn the appropriate tools for rebuilding a positive perception of themselves.

Some of these strategies may include:¹⁴

• Mindfulness training and meditation.
• Yoga therapy.
• Aerobic exercise and fitness.
• Psychoeducation (resources and education about the effects of bullying).
• Acupuncture.
• Finding meaningful relationships.
• Living in a safe and supportive environment.
• Finding meaning in a career.

If you or a loved one struggle with PTSD or the residual struggles associated with harassment or bullying, help is available, and there are several settings that provide trauma-informed treatment.

Help options may include:

• Your family doctor or OB/GYN.
• A local community mental health clinic.
• Private clinics.
• Psychiatric services at local universities, schools, or hospitals.
• Your current therapist or psychiatrist.

While there isn’t a one-size-fits-all approach to care, feeling supported and understood by a trusted professional can make a world of difference in helping you heal and move toward a happier and more fulfilled life.

American Addiction Centers’ Tampa-based rehab facility, River Oaks Treatment Center, will soon begin offering primary mental health services. This program is not designed to manage substance use disorders, but instead focuses on treating other debilitating mental health issues that can benefit from inpatient/residential care, including anxiety, depression and other mood disorders, trauma-related conditions, as well as other non-substance related psychiatric concerns. Patients will require a comprehensive assessment by treatment staff to ensure the program is an appropriate for them. Admission is dependent upon patients being able to fully participate in treatment. Call an admissions navigator to learn more or verify your insurance online.