Elsevier

Clinics in Dermatology

Volume 31, Issue 1, January–February 2013, Pages 66-71
Clinics in Dermatology

Appearance-related bullying and skin disorders

https://doi.org/10.1016/j.clindermatol.2011.11.009Get rights and content

Abstract

Bullying encompasses verbal aggression, physical aggression, and social exclusion. It involves “harm-doing” that is carried out repeatedly, over time, and within a relationship, involving a power imbalance between the bully and the bullied. Being bullied may have considerable adverse sequelae, including psychologic or psychiatric harm. Much bullying is appearance-related, and it would be surprising if some individuals with skin disease were not bullied given the high visibility of skin diseases. The limited evidence available does suggest that individuals with skin disease, particularly those with acne, psoriasis, and atopic dermatitis, are often bullied, which can adversely affect them psychologically.

Introduction

Bullying is a complex construct encompassing elements of verbal aggression, physical aggression, and social exclusion.1 It is proposed as being aggressive behavior or intentional “harm-doing” that is carried out repeatedly and over time.1 A defining feature is that it occurs in an interpersonal relationship characterized by an imbalance of power in which the victim finds it difficult to defend himself or herself.1, 2 Distinction can be made between bullying that is “direct,” “indirect,” and “relational.”1, 3, 4 Direct bullying involves physical or verbal attacks or aggression. Indirect bullying involves rumor-spreading and gossiping and will often rely on a third party, whereas relational bullying (sometimes considered a subcategory of indirect bullying) involves behaviors such as hurtful manipulation of peer relationships through social exclusion and ignoring.1, 3, 4 Bullying is particularly common and problematic among children and adolescents.2, 4, 5, 6, 7, 8, 9, 10, 11

Teasing is often characterized as a specific form of bullying12 but “can have a milder connotation of verbal and possibly playful aggression.” 1 Thus, the construct of teasing may not necessarily meet common definitions of bullying in that it can be “playful” or “pro-social.”13 “Peer victimization” is a further term that is used in connection to, or interchangeably with, bullying and encompasses bullying and teasing,8 as well as other elements such as harassment. Harassment is similar to bullying, but this term is often used to describe adult or adolescent rather than child behaviors, as in sexual harassment.14

A particular variant of bullying, cyberbullying, has been identified. Definitions of cyberbullying are similar to traditional bullying definitions but include “using electronic forms of contact.”15 Cyberbullying can be via text message, e-mail, phone call, and picture or video clip.16 Research about cyberbullying is still in its early stages,17 but similar patterns of bullying (and similar patterns of harm arising from this form of bullying) are emerging.15, 16, 17

Section snippets

Bullying research

Studies of teasing and bullying have often been of bullying in general. Studies of particular circumstances have often been of weight-related bullying and teasing, usually in children and adolescents.8, 11, 14, 18, 19

Teasing and bullying have also been documented in a wide range of medical conditions. Bullying has been shown to be associated with suffering from a chronic medical condition11, 20, 21 and with somatic illness.17 Specific medical conditions in which teasing or bullying of sufferers

Bullying in skin diseases

A feature of bullying, both in nonmedical (including weight-related bullying)8, 14, 18, 38 and in these particular health-related settings23, 24, 29, 36 is that it is frequently appearance-related. Thus, it would be surprising if bullying were not associated with skin diseases, given the high visibility of skin diseases. Other aspects of skin diseases that render sufferers particularly vulnerable to teasing and bullying are their age distribution and common misconceptions regarding contagion.

Prevalence of bullying in skin diseases

There is limited literature on bullying in skin diseases; therefore, it is difficult to compare the prevalence of bullying in skin disease sufferers with prevalence in other situations. In a schools-based cross-sectional study of Norwegian 15-year-olds,39 dermatitis was significantly associated with being bullied in boys, with an odds ratio of 1.3 (95% confidence interval, 1.1–1.7), but not in girls. The absolute prevalence of bullying was not reported. Several other studies have, however,

The nature of bullying in skin diseases

Alternative approaches have attempted to explore the topic of bullying in more depth. One approach has been to present children with video clips of individual children with and without a (false) facial port wine stain and then assess their attitudes to the children depicted in the videos.46 Participants were significantly more likely to think that the children portrayed with port wine stains would attract teasing from their peers.

Three qualitative studies have explored bullying and teasing in

What can clinicians do about bullying in their patients?

The position paper of the Society for Adolescent Medicine on bullying and peer victimization states:

Health care providers should be familiar with the characteristics of youth that may be involved in bullying, either as aggressors or victims. They need to be sensitive to signs and symptoms of bullying, victimization, their influences and their sequelae.4

This advice may be especially pertinent in the case of skin disease where doctors (both family physicians and dermatologists) have been reported

Conclusions

Bullying and teasing are recognized as major problems in children and adolescents. Despite limited evidence, it is reasonable to conclude that children and adolescents with skin diseases are especially prone to bullying and teasing on the basis of their condition. Dermatologists and other clinicians should be aware of this and of the potential for bullying and teasing to effect their patients' psychological well-being.

References (79)

  • StorchEA et al.

    Bullying, regimen self-management, and metabolic control in youth with type I diabetes

    J Pediatr

    (2006)
  • HornerT et al.

    Psychosocial profile of adults with complex congenital heart disease

    Mayo Clin Proc

    (2000)
  • RickertVI et al.

    The effects of peer ridicule on depression and self-image among adolescent females with Turner syndrome

    J Adolesc Health

    (1996)
  • RajakSN et al.

    Tinted contact lenses as an alternative management for photophobia in stationary cone dystrophies in children

    J AAPOS

    (2006)
  • MontesG et al.

    Bullying among children with autism and the influence of comorbidity with ADHD: a population-based study

    Ambul Pediatr

    (2007)
  • StorchEA et al.

    The measurement and impact of childhood teasing in a sample of young adults

    J Anxiety Disord

    (2004)
  • KlomekAB et al.

    Childhood bullying behaviors as a risk for suicide attempts and completed suicides: a population-based birth cohort study

    J Am Acad Child Adolesc Psychiatry

    (2009)
  • BarkerED et al.

    Joint development of bullying and victimization in adolescence: relations to delinquency and self-harm

    J Am Acad Child Adolesc Psychiatry

    (2008)
  • KlomekAB et al.

    Childhood bullying as a risk for later depression and suicidal ideation among Finnish males

    J Affect Disord

    (2008)
  • SmithPK et al.

    Definitions of bullying: a comparison of terms used, and age and gender differences, in a fourteen-country international comparison

    Child Dev

    (2002)
  • RigbyK

    Consequences of bullying in schools

    Can J Psychiatry

    (2003)
  • WolkeD et al.

    The association between direct and relational bullying and behaviour problems among primary school children

    J Child Psychol Psychiatry

    (2000)
  • FrisénA et al.

    Health-related quality of life and bullying in adolescence

    Acta Paediatr

    (2010)
  • BondL et al.

    Does bullying cause emotional problems? A prospective study of young teenagers

    BMJ

    (2001)
  • RigbyK

    Peer victimisation at school and the health of secondary school students

    Br J Educ Psychol

    (1999)
  • AnalitisF et al.

    Being bullied: associated factors in children and adolescents 8 to 18 years old in 11 European countries

    Pediatrics

    (2009)
  • BarnettMA et al.

    Antisocial and prosocial teasing among children: perceptions and individual differences

    Soc Dev

    (2004)
  • FrisénA et al.

    Peer victimisation and its relationships with perceptions of body composition

    Educ Stud

    (2009)
  • SmithPK et al.

    Cyberbullying: its nature and impact in secondary school pupils

    J Child Psychol Psychiatry

    (2008)
  • SlonjeR et al.

    Cyberbullying: another main type of bullying?

    Scand J Psychol

    (2008)
  • SouranderA et al.

    Psychosocial risk factors associated with cyberbullying among adolescents: a population-based study

    Arch Gen Psychiatry

    (2010)
  • PittetI et al.

    Are adolescents with chronic conditions particularly at risk for bullying?

    Arch Dis Child

    (2010)
  • WilliamsonH et al.

    Adolescents' and parents' experiences of managing the psychosocial impact of appearance change during cancer treatment

    J Pediatr Oncol Nurs

    (2010)
  • StorchEA et al.

    Peer victimization and psychosocial adjustment in children with type 1 diabetes

    Clin Pediatr (Phila)

    (2004)
  • PetersCD et al.

    Victimization of youth with type-1 diabetes by teachers: relations with adherence and metabolic control

    J Child Health Care

    (2008)
  • RossDM et al.

    Teaching the child with leukemia to cope with teasing

    Issues Compr Pediatr Nurs

    (1984)
  • StorchEA et al.

    Peer victimization in children with obsessive-compulsive disorder: relations with symptoms of psychopathology

    J Clin Child Adolesc Psychol

    (2006)
  • NashKB.A

    psychosocial perspective. Growing up with thalassemia, a chronic disorder

    Ann N Y Acad Sci

    (1990)
  • TwymanKA et al.

    Bullying and ostracism experiences in children with special health care needs

    J Dev Behav Pediatr

    (2010)
  • Cited by (0)

    View full text