Can schoolyard bullying lead to PTSD?

Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert answer

Dear Michelle,

I feel for you, because I was also bullied growing up, not just at school but in the neighborhood, too. One bully in particular left a lasting impression on me. And not just on me. Recently I saw a childhood friend I hadn't seen for 30 years, and the first thing he wanted to comment on was how much he still hated, and was haunted by, this particular bully. The bully himself has spent much of his adult life in jail.

So, yes, one can develop PTSD (or post-traumatic stress disorder) symptoms around all sorts of traumatic events, not just the classic ones like warfare or rape. For example, many people develop PTSD after motor vehicle accidents or after a stay in a hospital intensive care unit. There are even a couple of studies showing that bullying does indeed increase the risk of PTSD -- and that women are twice as likely to develop symptoms as are men subjected to the same traumas. Thus, anything that really shakes a person up, scares her half to death or makes her feel completely vulnerable and out of control can produce PTSD symptoms.

Although I've written about PTSD before, let me just remind folks that PTSD symptoms cluster into three large groups.

The first group revolves around re-experiencing the traumatic event, sometimes in the form of flashbacks, sometimes in the form of dreams. The second group is like a mirror image of the first and involves all sorts of attempts to avoid things that remind one of the trauma. This behavior is often linked to growing feelings of social withdrawal and a loss of a sense of being fully alive. The third group of symptoms relates to what has been called hyperarousal, which means an emotional, mental and physical tendency to drive one's flight-or-flight nervous system too hard, a classic sign of which is a tendency to startle too easily.

If you have some combination of these symptoms, you most likely are struggling with PTSD to at least some degree and would benefit from treatment.

As with psychiatric conditions in general, treatment options tend to be either psychotherapeutic or pharmacological. Researchers still debate the best type of psychotherapy for PTSD; it's a complicated and fascinating story that is too long to tell here. Even given this, I think you would be helped a great deal by finding a warm and empathic therapist to whom you could share your situation. In addition to PTSD proper, such a therapist would help you recognize and deal with the feelings of anger and shame that almost always come with having been bullied.

I still carry anger and fear toward the bully of my childhood: When I go home, I won't walk by his parent's house (where he still lives) out of fear that he'll come out and hurt me. And I tend to be more stern than I need to be with patients who try to bully others, almost certainly another legacy of my own early experience.

Antidepressants are the best studied and probably most useful agents for treating PTSD. There is no evidence that one brand is better than another, but evidence would suggest that you want to choose one that has serotonin activity, as most new antidepressants do. If your life is really being affected by the trauma of your schoolyard, I strongly recommend you see a specialist who will be better able to decide what mix of therapy and medications are most appropriate, given the details of your situation.