Abstract
Objective
This study was designed to explore correlations between a history of being bullied in childhood and borderline personality disorder (BPD) in adulthood, several externalizing behaviors, and mental health care utilization.
Method
Using a cross-sectional consecutive sample of internal medicine outpatients (N = 414), we examined the relationship between history of being bullied in childhood and 2 measures of BPD: the borderline personality scale of the Personality Diagnostic Questionnaire–4 and the Self-Harm Inventory. We also explored whether having ever been bullied was related to a number of externalizing behaviors (eg, rage reactions, road rage, excessive spending, alcohol and substance misuse, binge eating) as well as greater mental health care utilization.
1. Introduction
Being bullied appears to encompass approximately 9% to 14% of children and adolescents. For example, in a nationally representative sample of more than 11,000 adolescents in grades 6 through 10, 9% of survey respondents reported being bullied, with an additional 3% describing themselves as both victims and bullies [1]. In another study of more than 2000 New York state high school students, 9% reported being the victims of bullies [2]. Finally, in a California study of more than 1300 boys in grades 7 through 12, 13.7% were classified by researchers as being bullied [3]. From these data, it appears that approximately 9% to 14% of children and adolescents in the United States are the victims of being bullied.
The phenomenon of being bullied clearly exists outside of the United States as well. Studies from other countries proffer various prevalence rates among children and adolescents, including Italy (7.1%) [4], Canada (6.1%) [5], Sweden (10%) [6], the United Kingdom (39.8%) [7], Norway (15%) [8], and Germany (10%) [9]. Despite the wide intercountry variation in prevalence rates, which is likely attributable to differing methodologies, the phenomenon of being bullied appears to be a universal phenomenon that affects a substantial minority of children and adolescents.
Existing data indicate that victims who are bullied may suffer a variety of psychologic consequences (eg, social difficulties, internalizing symptoms, anxiety, depression, suicidal ideation/attempts, eating disorders, multiple psychiatric disorders) and somatic consequences (eg, sore throats, cough, colds, poor appetite, headaches, sleep disturbances, abdominal pain, musculoskeletal pain, dizziness, fatigue, greater medication use) [10]. Those who are bullied may also demonstrate behavioral problems [11], difficulty with anger control [12], and other externalizing behaviors [13], [14] and [15]. According to Liu [16], externalizing behaviors refer to outward behaviors in which the child or adolescent negatively acts upon his or her environment. Examples of externalizing behaviors include aggression, delinquent behaviors, hyperactivity, and alcohol and substance misuse; and these behaviors may coalesce into conduct disorder, antisocial behavior, or simply undercontrolled behaviors. Note that some of these behaviors are similar to those encountered in borderline personality disorder (BPD; eg, aggression, undercontrolled behaviors, alcohol and substance misuse).
With regard to possible relationships between being bullied in childhood and adult BPD, this Axis II disorder is frequently associated with noxious experiences during childhood, including various forms of childhood trauma (eg, sexual, emotional, and physical abuses), failures in parenting, and dysfunctional family environments [17] and [18]. However, BPD is not entirely environmental in origin, as there may be genetic contributions to BPD in terms of temperamental vulnerability. Yet the similar features in both being bullied and BPD led us to hypothesize correlations between the two. Specifically, both being bullied and BPD are associated with noxious social experiences during childhood; and both may result in some of the same psychologic sequelae, namely, aggression, difficulty with anger control, and poorly controlled behaviors (ie, self-regulation difficulties manifesting as alcohol and drug misuse).
In reviewing the PubMed and PsycINFO databases, we found no empirical literature on a potential association or correlation between childhood victimization by bullies and adult indications of BPD. Therefore, the focus of the present study was to investigate such potential correlations between having ever been bullied in childhood and self-reported symptoms of BPD in adulthood.
Of the 419 respondents, 5 did not complete the item asking about a history of being bullied. Of the 414 remaining respondents, 183 (44.2%) indicated they had been bullied; and 231 (55.8%) reported they had not. There was not a statistically significant difference in the proportions of men (49.2%) and women (42.0%) who reported having been bullied (χ2 = 1.89, P < .17). With regard to the number of bullies, the most common response was “2” (38.1%) followed by “3” (25.4%), “1” (23.0%), and “4” (13.5%). The number of years of victimization by bullies ranged from 1 to 12 (M = 5.25 years, SD = 3.86).
With regard to being bullied, we first considered the 2 measures of BPD. Scores on the PDQ-4 were statistically significantly higher among those respondents who reported having been bullied (M = 2.55, SD = 2.44) than those respondents who had not (M = 1.41, SD = 1.71, F1,413 = P < .001). Similarly, scores on the SHI were statistically significantly higher among those respondents who reported having been bullied (M = 2.93, SD = 3.84) than those respondents who had not (M = 1.03, SD = 2.01, F1,413 = P < .001).
Comparisons between those who had ever been bullied and those who had not with regard to the remaining categorical mental health variables are presented in Table 1. Note that, compared with those without a history of victimization by bullies, those who had been bullied reported a statistically significantly greater likelihood of all measured forms of mental health problems.
