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Breaking the silence: The complex landscape of teen bullying
Social media is a huge part of young people’s lives and Dr Andrew Leech says GPs play a pivotal role in asking about their online encounters.
Recent e-safety research found that 50% of teenagers aged 14–17 experience negative behaviours online.
I saw a 14-year-old boy recently whose life was turned upside down when they sent their friend an inappropriate ‘selfie’.
Within minutes, the selfie was shared among other friends and reached the school community. For this teenager it was a moment in time that he would never get back. That one image led to suspension, embarrassment, and mental health distress – before long he was self-harming and in a state of depression.
I also recently saw an 11-year-old who was sent Facebook messages online telling her she was ‘fat’ and ‘ugly’.
As would be the case with any 11-year-old, she took it to heart and starved herself of food for three days, unawares to her family or school. She became unwell and ended up collapsing and in the emergency department.
These are two of hundreds of comparable stories of adolescents having negative experiences online.
We can’t judge these kids. Social media is designed to draw them in and trap them in a cycle of feeds, often with themes of physical appearances or how cool someone is.
It’s also developmentally normal for teenagers to make decisions without realising the consequences. So, it’s easy to understand why we’re seeing increasingly poor mental health outcomes because of social media use and in particular, online bullying.
According to the Australian Institute of Health and Welfare, 70% of children aged 12–13 in 2016 experienced at least one bullying-like behaviour. That was before COVID lockdowns and the rise of apps like TikTok, which now has 8.5 million users in Australia.
According to the most recent Australian e-safety research, 50% of teenagers aged 14–17 reported experiencing negative behaviours online, while a concerning 30% reported being contacted by a stranger they did not know.
The digital space is increasingly encroaching on young people’s lives, which is why GPs play such a pivotal role in asking teenagers about their online encounters.
Around half of the teenagers I see tell me information about their online behaviours that they would not have told their own parents or family – behaviours that put them at risk of harm but also play a role in their mental health.
Online bullying is no different to bullying at school and quite often is committed by the same perpetrators. It just means that instead of going home and forgetting about it, the bullying continues into the night, affecting their sleep.
When we see young people with poor mental health including self-harm and suicidal thoughts, it is crucial that we enquire about their social worlds both at school and online.
I would rate bullying as one of the most significant contributing factors for children and teenagers harming themselves or becoming severely anxious or depressed. It also is a key risk factor for eating disorders and school refusal.
We never learnt about TikTok at medical school. The quickest way to learn about it is to ask the patients themselves.
‘What apps are you using? What do you do on those apps? Who are you talking to and what are you talking about?’ Once I have rapport, I have no issues with asking these questions, especially if we can maintain confidentiality and speak to them on their own.
Quite often, they will have multiple apps and multiple social encounters occurring from the moment they get home from school, all the way until they fall asleep. There is an exceedingly high chance not all these encounters will be positive.
I’m also amazed at the number of children chatting to people within the online gaming world, people they don’t even know. I can’t help but speak to parents about the risks of online gaming and social media when there are interactions like these and try to produce a balance.
On the flipside I’ve recently had some teenagers presenting following self-harm attempts because their phones were confiscated by their parents. One teen didn’t know what to do, panicked because they couldn’t talk to their friends about a critical issue occurring at school, and ended up cutting themselves.
I really feel for parents, because it seems like they can’t win. There’s also no clear guide for them to follow and the online world evolves faster than anyone can keep up with.
The good news is, those teenagers who have experienced bullying either online or at school, go on to realise the impact it’s had on them and strive to create positive experiences in the same environments.
In a strange way, being a victim of bullying creates some form of resilience and a more positive outlook over the longer term.
It’s also good to note that many young people use online media to talk to each other when they’re struggling or in a crisis. This is one way they seek help and for me, that provides some level of reassurance.
So, how do GPs play a role in all this?
I feel we need more education to understand the evolution of bullying. GPs also need updates in social media and gaming, because whatever we knew in our training has changed completely now and will keep changing!
Even without understanding it fully, there are practical things we can do to support our young people with bullying:
- Assure them of confidentiality when speaking to them, even if a parent is present. Let them know they are in a safe space to explain what is happening to them and how it is affecting them. Avoid using judgement, even when they have been the perpetrator of the bullying or made a mistake online
- Manage the mental health impact, just as you would any other mental health condition. Assess the risk, especially self-harm, and suicidal thoughts. Manage any mood disorder just as you would for other patients. For teens, bullying can be the biggest thing that has ever happened to them, and they feel like there is no escape. Remind them that while it hurts right now and feels impossible to change, it will change, and it does get better
- Figure out a plan for school and for home. I sometimes write letters to the school to let them know what’s happening and to support the young person with what they’re going through. Likewise, I’ll bring the parent or key support person in and suggest we work on a solution together. This also helps reassure me that they have a safety net, someone they can turn to
- Review them as much as you can. I’ll arrange a telehealth check-in for some of my teenage patients every couple of weeks
- Encourage teenagers to walk away from those who are upsetting them, and to build resilience by not letting words and actions get in the way of who they are and how they feel about themselves. They need to speak up, inform their parents, speak to a psychologist, and inform the school. It is not ok for others to treat them in this way
Bullying has been around forever, and sadly this is not going to change.
Young people need us to be open to discussing their social connections and keeping up to date on the impacts social media can have on them.
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