Though cyberbullying has become especially prominent over the past few years due to our growing dependence on social media, most bullies will use more than one form of intimidation on their victims.
While most commonly associated with school-age victims, bullying can occur just about anywhere, including in work settings, prisons, military bases, and so on. Since many victims of bullying often have difficulty proving what is happening, filing a report with school authorities or police often fails to stop the harassment. This can lead to significant emotional problems for most bullying victims due to the sense of helplessness and paranoia that can develop with time. Cases of victims committing suicide or developing serious mental health issues or substance abuse issues are hardly uncommon.
The role that bullying can play in the mental health of adolescents is especially serious, as it often occurs at a time when young people are still developing their own sense of self-esteem and social competence. Undermining this self-esteem and isolating victims from the support of friends or family often leads to a sense of helplessness; social anxiety; and, in many cases, a “no way out” mentality.
Research studies examining the effects of chronic bullying on adolescents have consistently shown that all forms of bullying can lead to increased risk of depression as well as suicidal thoughts and attempts. Young people bullied in school are also prone to academic problems as well as have a greater likelihood of dropping out of school to escape harassment. Though most research to date has focused on verbal and physical bullying, high-profile news stories of adolescents committing suicide due to cyberbullying have demonstrated the kind of impact it can have.
But bullying doesn’t just lead to psychological problems for victims. Recent studies looking at the role of bullying on physical health have shown that victimized young people are at risk for problems such as insomnia, headaches, gastrointestinal problems (including ulcers), and respiratory problems. This is largely due to the impact of stress, which can lead to a compromised immune system, hypertension, greater production of stomach acid, and other health issues.
A 2017 study looking at over eleven thousand European adolescents reported an overall prevalence rate of 9.2 percent for physical bullying, 36.1 percent for verbal bullying, and 33.0 percent for relational bullying. While victims of physical bullying are at the highest risk for suicide, any bullying victim should be considered at risk for suicide. This is especially true if they are dealing with other problems such as depression or a perceived lack of support from parents. There were also gender differences in the kind of bullying experienced (boys were more likely to be physically bullied while girls were more prone to relational bullying).
As for the long-term effects of chronic bullying, many adults who reported being bullied when younger reported symptoms that persisted well into adulthood. Not only are victims of chronic bullying more prone to mental health problems such as depression and social anxiety, but they can require treatment to deal with posttraumatic stress as well.
Not only is bullying a pervasive problem among young people in particular, but the rise of the Internet and popularity of digital communication tools has provided bullies with even more tools to use in targeting victims. Since cyberbullying is usually anonymous, seeking legal protections against this kind of harassment is often difficult.
While bullying prevention programs are becoming more widely used in schools and other venues where bullying problems have been reported, many victims still prefer not to come forward due to fear of not being believed or possible retaliation. This often leaves the victim with no recourse except to suffer in silence or find some way of escape. Escape usually manifests through dropping out of school completely or else through negative coping strategies such as substance abuse, violent response, or suicidal behavior.
There are resources available for victims of bullying and their families, both in terms of working to stop the abuse as well as in dealing with the psychological consequences. The appendix provides information on national organizations that can refer bullying victims to local treatment services.
21. How is grief related to depression?
Anyone who has ever experienced the loss of a close family member or friend is going to find themselves dealing with grief. While the usual symptoms of grief are going to resemble depression in many ways (including feelings of restlessness, appetite changes, sleep difficulties, concentration problems, etc.), there are important differences as well.
Though not everyone is going to grieve in the same way, working through the emotional turmoil of grief is a healthy way to come to terms with this kind of loss. Still, sooner or later, the grieving process usually comes to an end. While there is no fixed time period associated with grief, symptoms usually subside after a year or so as we learn to move on with our lives. Though we can still feel the loss on anniversary dates, for example, this grief is usually manageable and temporary.
For some people, however, the symptoms of grief can persist much longer than usual. They may also find themselves experiencing symptoms that are much more intense than what is typically seen in normal grief. These symptoms often include an inability to focus on anything other than the death of the loved one, emotional numbness, a sense that life has lost its purpose, and a sense of personal blame (such as believing that they could have prevented the death somehow). People showing these symptoms are often diagnosed as suffering from complicated grief.
While not formally recognized as a mental disorder in the latest version of the DSM-V, complicated grief appears most likely to occur in females, particularly older females, following a traumatic loss, such as the unexpected or violent death of a loved one. A previous history of mental health problems, including depression or PTSD, can also make people more vulnerable, especially if they are socially isolated and lack a strong support network of friends and family. In extreme cases, people dealing with complicated grief may also develop psychotic symptoms, including hallucinations of a loved one’s voice or image, as well as distorted thinking and delusional beliefs.
Since the symptoms of complicated grief are so similar to major depression, diagnosis and treatment should only be carried out by qualified medical professionals. Also, considering that people with complicated grief are often at risk for suicide, substance abuse, or other negative coping strategies, cases of suspected complicated grief need to be carefully monitored for their own safety. While bereavement counseling can often be useful in dealing with grief, more severe mental health problems will often require treatment with medication as well as supportive counseling to help control grief symptoms.
If left untreated, the symptoms of complicated grief will often lead to serious mental health problems as well as medical issues resulting from chronic stress and increased risk of suicide or substance abuse. The stress of prolonged grief can also lead to a wide range of physical ailments, including heart disease, a reduced immune system, increased risk of stroke, and dementia.
For people dealing with grief symptoms that don’t seem to be going away, it is essential that they see their family doctors to determine what kind of treatment they might need. Along with medications that might help, there are also specialized cognitive behavioral therapy programs that have been developed for people dealing with this kind of grief.
22. Is depression linked to early childhood problems?
As we have already seen, people who have experienced childhood abuse, whether physical, sexual, or emotional, are going to have an increased risk of developing depression later in life. But this isn’t simply due to the effect of trauma but also because of the very nature of the emotional bond that forms between parents and their children during the first few years of life.
Psychologists have long known that children raised in impersonal institutions such as orphanages are at a much higher risk of developing mental health problems. According to psychiatrist John Bowlby and other researchers, children are born with a biological need to form strong attachments as a way of surviving.
The first attachment children develop is toward their mother (or some other primary caregiver) who supplies all their biological needs during infancy and early childhood.
According to attachment theory, there is a critical period between infancy and the age of five when a strong attachment needs to form to allow for healthy emotional development. If that attachment fails to form or is disrupted for any reason, children will develop behavioral and emotional problems that will get even worse with time.
As part of her own research with children, psychologist Mary Ainsworth identified four attachment styles that can result from how children interact with parents during those first few years:
Secure attachment. This is the attachment style most likely to lead to healthy emotional development as children become adults. They also represent the majority of the children Ainsworth studied. These are the children who are confident in their relationship with an attachment figure (usually the mother) who is sensitive to their needs. Because of this secure attachment, children are less afraid and more curious about the world around them.
Insecure avoidant. In some children, lacking a normal attachment can result in a more independent attachment style including reduced stranger anxiety and lack of distress when the mother/caregiver leaves. This attachment style often results from a caregiver who is emotionally distant and who does not attend to the child’s needs.
Insecure resistant/ambivalent. Due to inconsistent care during the first few years of life, children may become more clingy but also reject the caregiver when they attempt to interact with them. Also, these children have no sense of security from their caregiver and can be difficult to soothe as a result.
Fearful avoidant. Children who have experienced significant trauma early in life may develop an inability to trust others and avoid any kind of emotional closeness. Not only do they avoid emotional attachments, but they may also feel they are unworthy.
As children grow older, these early attachment styles can play an important role in their later emotional and social development, not to mention the kind of mental health problems that they can develop as they become adults. For example, research studies have shown that adults with a history of insecure attachments are much more prone to developing depression than secure individuals. They are also much more prone to relationship problems, have lower self-esteem, sleep problems, are more prone to serious health problems, and have greater difficulty managing emotions.
Most of the treatment programs for helping with attachment issues as well as mental health problems have been developed for adolescents in particular. Such programs focus on helping adolescents overcome problems of early childhood and develop into successful adults. For adults dealing with long-term attachment problems along with depression or other mental health problems, treatment is usually much more intensive than for adolescents and can take much longer as a result.
There are few research studies looking into how successful adult treatment can be. All that can really be said is that the impact of early childhood attachment problems can last a lifetime in many cases. This is why it is essential for adolescents dealing with relationship problems to get proper counseling as soon as possible.
23. Is chronic pain linked to depression?
Chronic pain remains one of the most vexing medical problems facing us today—usually defined as persistent pain that lasts six months or longer, chronic pain can strike people of all ages. While estimates vary widely around the world, most surveys suggest that anywhere from 10 to 55 percent of all adults are going to report chronic pain problems at some point in their lives. In the United States alone, nearly half of all Americans suffer from one or more chronic conditions that can produce the kind of aches and pains that seriously undermine quality of life.
And the costs of dealing with chronic pain are often astronomical. In the United States alone, the annual cost for society runs to about $125 billion annually in terms of health care services, disability payments, time lost from work, and lost taxes. But this doesn’t even take into consideration how chronic pain can affect people, both mentally and physically.
Along with familiar culprits such as arthritis, bursitis, fibromyalgia, gout, and stomach ulcers, people can also experience persistent pain from gallbladder disease, cancer, and multiple sclerosis to name just a few potential causes. But pain can also result from lifestyle issues such as poor posture, obesity, injuries from accidents, poor working conditions, and even simple repetitive movements that can lead to carpal tunnel syndrome, rotator cuff problems, joint aches, and so on.
For that matter, many people going to their doctors complaining of persistent pain may not have any apparent physical cause. Doctors can often be as mystified as their patients over what can be causing the pain. Even with improvements in diagnosis and treatment, chronic pain can have multiple causes that are often difficult to untangle. This can mean years of treatment as doctors experiment with different medications, therapies, and surgeries to try to alleviate the suffering.
So, is it any surprise that people with chronic pain are especially prone to depression? As we have already seen, depression often arises from a sense of helplessness that certain problems have no solution. People coping with long-term chronic pain often have to deal with additional problems such as loss of sleep, fatigue, worry about their financial future, and their long-term prospect for recovery. All of these factors are going to reduce their ability to cope with what they are experiencing. Add to that the sense that there is no apparent relief in sight, and feelings of depression are almost impossible to avoid.
Research looking at chronic pain patients suggests that guilt and uncertainty are two of the main factors that can contribute to depression. The guilt is often due to patients being unable to function as they once did due to the pain. This means being less able to care for themselves and having to depend on other people. Since chronic pain patients also have no idea how long their pain will continue, this sense of uncertainty can also lead them to feel helpless and despondent about the future.
But along with chronic pain causing depression, it is also possible for depressive symptoms to make the pain much worse. Depressed people are often going to ruminate about the problems in their life, and this frequent rumination will also make them less able to take their minds off the pain they are feeling. They are also prone to catastrophizing their pain (exaggerating symptoms to make them seem much worse than they actually are). As a result, their ability to cope with the pain is reduced as well.
Since chronic pain and depression often go together, therapists have developed specialized treatment programs to help patients learn to manage their pain and control depression as well. One program that has been particularly successful is cognitive behavioral therapy for chronic pain (CBT-CP). Developed by therapists at the Veterans Administration for treating injured veterans, CBT-CP teaches patients to manage their chronic pain as part of a comprehensive pain treatment program. They are taught valuable coping techniques including relaxation training, cognitive restructuring, and ways to prevent the kind of catastrophizing and rumination that make chronic pain worse. Numerous research studies have shown the benefits of joint chronic pain-depression treatment. It can also help prevent more severe problems from developing, including substance abuse and suicidal thinking.
While chronic pain can often be emotionally draining for many people, supportive counseling can be an effective way to learn better ways of coping. Check with your doctor if you are experiencing depression because of chronic pain.
24. Why is depression so common in the military?
As you are probably already aware, returning veterans, particularly veterans who have served highly dangerous tours of duty overseas are prone to a wide variety of mental health problems due to their experiences. In addition to posttraumatic stress disorder, returning veterans often face significant medical issues due to the injuries they’ve received.
This means treatment for chronic pain, traumatic brain injury, and other leng
thy medical procedures. Not surprisingly, returning veterans, especially veterans who have been exposed to combat, are also prone to many of the behavioral problems linked to depression, including an increased risk of suicide, substance abuse, and self-injury.
Not that this is limited to veterans alone. Virtually anyone with posttraumatic symptoms resulting from exposure to combat stress is going to be more at risk for depression. Along with people serving in the military, these symptoms can appear in civilians as well. This includes refugees from war-torn countries, aid workers, journalists, and emergency responders. Studies looking at posttraumatic trauma following war typically find veterans reporting problems with depression, insomnia, irritability, concentration problems, and increased social isolation. These symptoms typically last much longer in veterans than in nonveterans as a rule, though there are prominent exceptions.
There also appear to be significant sex differences between male and female veterans in terms of reported problems with depression. This is often because men are less likely than women to admit to emotional problems unless the symptoms are severe enough to force them to seek help. Women veterans are also vulnerable to trauma that men may not typically experience, including sexual assault and sexual harassment. While men may also have such experiences, it is far less common than with women (men are also less likely to report such abuse). Though sexual abuse is becoming more widely recognized in the military, victims often feel isolated because of their experiences and the lack of support they receive.
When left untreated, the consequences of depression in current and former military personnel can be fatal. According to the most recent report released by the U.S. Department of Veterans Affairs, roughly twenty-two veterans die from suicide each day with an overall suicide rate twice that found in civilians. Though the overwhelming majority of these suicides are men, women veterans also have a suicide rate far higher than that found in civilians. Research has shown that posttraumatic stress, depression, hopelessness, and access to firearms significantly increase suicide risk in veterans. Traumatic brain injuries, even relatively mild injuries, can also increase suicide risk by making veterans less able to cope with the stress of returning to normal life and with managing their emotions.
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