PSYCHOTIC SYMPTOMS AND TRAUMATIC EXPERIENCES

There is research evidence [Kelleher et.al; American Journal of Psychiatry Vol 70: Issue 7: Pages. 734-741]that adolescents who are assaulted or bullied are significantly more likely to experience psychotic symptoms. They also noted that adolescents with psychotic symptoms were significantly more likely to be assaulted and more likely to be bullied.  So, they found a bidirectional relationship between psychotic symptoms and trauma for adolescents.  If you have psychotic symptoms you are significantly more likely to be traumatized and if you are traumatized you are significantly more likely to have psychotic symptoms. Also of significance is the finding that the more an adolescent is traumatized the more likely to have psychotic symptoms.  Importantly, they also found that if trauma was reduced the psychotic symptoms were also reduced. 

The above highlights the severe stress that adolescents experience when they are traumatized including leading to psychotic symptoms that are directly related to the traumas and will be reduced [go away completely?] when traumas are reduced.  Also, it is important to realize that adolescents with psychotic symptoms are more likely to be traumatized and hopefully can be protected from this happening. 

I have seen psychotic symptoms in traumatized adolescents and adults that can be successfully treated by stopping the trauma and reducing or eliminating flashback experiences related to the traumas.

GUNS DON'T KILL PEOPLE, MENTALLY ILL PEOPLE DO!

Well of course that is only a very small part of killings with guns in the world. It just gets a whole lot more attention from the media.  A recent killing rampage in California by Elliot Rodger has led to more calls for the involuntary comittment of the mentally ill as Elloit's recent and past behavior suggests that he was mentally ill. This is commented upon in an opinion piece in the June 3, 2014 NY Times by Joe Nocera.  Mr. Nocera does not believe that locking up the mentally ill who are agitated and yet not making specific threats to individuals, and who can function independently, is the answer. Mr. Nocera ends his opinion piece wondering if the focus should be on making it harder for anyone to get guns, not just the mentally ill. 

Well, that idea suffers from being too logical and effective in signifantly reducing gun related deaths. It requires that we as a country take responsibility for the suffering and loss that are insistence on the right to arm ourselves has caused. We are now moving toward defining our right to bear arms to include carrying concealed weapons on college campuses (according to the National Conference of State Legislatures website seven states have laws permitting this). I have blogged before about the problem of access to weapons and all the deaths, including children, related to this. As I've mentioned, "guns don't kill people, but people with guns do!"

Getting back to potentially violent people suffering from mental illnesses, I have two points to make. The first one is that Elliot Rodger's parents reported that Elliot was severely bullied as a child. I have blogged a couple of times about the damage that bullying can do and the deadly reactions that can occur, including suicide and homicide. My second point is that it might be time to take seriously general threats made online and in other settings. It seems prudent and reasonable to consider these threats a crime. This could have led to Elloit getting help.  Finally, people who are bullied will sometimes cope by bullying others. Another reason to work to reduce bullying and provide more help for those who are bullied and even for the bullies!

CYBERBULLYING AND SUICIDAL THOUGHTS AND ATTEMPTS

I have previously blogged about the impact of bullying including an increased suicide risk.  There is evidence now that bullying online or via social media is at least as traumatizing as other forms of bullying. A recent study by Van Geel, et al. reported on their meta-analysis of 34 studies involving over 284,000 children.  They found that being bullied [peer victimization] increased the odds ratio for suicidal ideation to 2.23 and for suicide attempts to 2.55.  In their study, cyberbullying was at least as toxic as other forms of bullying.  The odds ratio number represents the odds of having suicidal ideas or actions and having been bullied.  Thus, of the children with suicidal ideas or actions, they were two and a forth to two and a half times as likely to have been bullied.  This is one way of determining the link between being bullied and developing suicidal ideas or suicidal actions.  

It seems clear that cyberbullying is both traumatic for children and adolescents and significantly increases the risk of suicidal behavior.  It is important for mental health professionals to always ask about bullying, including cyberbullying.  It is also important for parents to be aware of what types of experiences their children and adolescents are having on the internet and social media as well as what they are experiencing at school.  Parents must risk being considered intrusive and controlling since their children or adolescents lives might depend on them being this way.

BULLYING AND PHYSICAL COMPLAINTS

Children who are being bullied are more than twice as likely to have psychosomatic [physical complaints caused by stress] complaints compared to children who are not being bullied.  This was reported in a study in Pediatrics by G. Gini, Ph.D. and T. Pozzoli, Ph.D.  They did a meta-analysis of 30 studies involving more than 219,000 children who had psychosomatic symptoms.  Some of the children had been bullied.  The study determined that any repeated and/or unexplained somatic [physical] symptoms are a warning sign of the possibility that the child is being bullied. The somatic complaints can include: recurrent headaches. breathing problems, poor appetite, sleeping problems, etc.  

So, if your child has somatic complaints with no reason for them besides stress [psychosomatic] then it is very important to check for bullying as one of the causes of the stress. 

BEING BULLIED IN CHILDHOOD AND SELF-HARM BEHAVIOR AS AN ADOLESCENT

Earlier, I wrote about the impact of being bullied and being a bully, ten years later.  One study showed that children who were bullied were at significantly inreased risk for anxiety and depressive disorders while males were also more likely to be suicidal and girls to have agoraphobia [fear of public spaces and crowds]. The bullies had an increased risk of antisocial personality disorder.  I felt that the bullied children were also at increased risk for post traumatic stress disorder.

Another study by S.T. Lereya, Ph.D., et al, in the June, 2013 issue of the Journal of the Academy of Child and Adolescent Psychiatry reported on the impact of being bullied in childhood on adolescent self-harm [cutting and suicidal] behavior. They controlled for a number of other variables that also can lead to self-harm behavior and found that about 20% of the total self-harm behavior was caused by the bullying.  This is a very large effect from the bullying. 

It is a critical problem, especially as children [and adolescents] very often suffer in silence and do not tell their parents or teachers.  They also tend to  hold their feelings in so it is not easy to detect depressive symptoms.  Frequently they will complain of a number of different nonspecific symptoms that include headaches, stomach aches, backaches, dizziness, sleep problems and they may resist going to school and be withdrawn. When they do tell an adult they often feel that it doesn't help as they expect the adult to get the bullies to stop.  It would seem that a focus on helping the victims of bullies to cope with this stress so that they are no longer feeling overwelmed and can ignore the bullies more successfully.  Another focus, of course, would be to stop bullying from occuring in the first place.  Zero tolerance for violence or the threat of violence, so why not zeo tolerance for bullying?  I wonder if educating children and adolescents on the impact of bullying and the different forms it takes and then how to resist being part of bullying, wouldn't help reduce bullying significantly.  I am interested in your thoughts about how to prevent or at least reduce significantly, the bullying of our children and adolescents. 

Of course, it happens with adults, too.