Coll. Antropol. 38 (2014) Suppl.

2: 211214
Case report

Bullying among School Children: A Case Report

Miro Ben~i}
Health Centre Zagreb-County, Family Practice Brdovec, Zapre{i}, Croatia

AB S T R AC T
The case study shows an example of peer violence, a physical attack on a high school student. The attacker was a child his own
age attending the same school. Immediately after the attack the victim visited his chosen family doctor accompa-nying by mother.
After interviewing in calm and safe environment and physical examination he was referred to the hospi-tal emergency, because of
evident trauma. During the follow up, it was obvious that the patient is interested in talking about the event but is uncomfortable to
do so in front of his mother. Having obtained the mothers permission the conver-sation was carried out alone and the patient
revealed all the details regarding the assault as well as his own feelings. The case study contains a description of the incident, the
basic information regarding types of abuse amongst children, information on how to approach a victim as well as the obligation to
report every type of abuse.
Key word: bullying, physical abuse amongst children, reporting, family doctor
and management of school
bullying.

Introduction

logical disorders, anxiety,

Bullying is defined as repeated, negative acts commit-ted by phobias and symptoms of deone or more children against another child. It may come in the pression than children who
forms of physical, verbal or different kinds of emotional bullying, had never been exposed to
such as friendship manipulation or intentional exclusion from violence4. Involvement in
common activities. It should be differentiated from child abuse or school a bulling victim was a
1
child neglect which mostly happens within the family context . strong indicator of trauma
According to the literature, bullying is a highly preva-lent symptoms, particularly anxiety, anger, posttraumatic
2,3
phenomenon, ranging from 1559% . In Bosnia andstress, dissociations and had
Herzegovina around 16% of students experienced at least one high probability to develop
from of bullying almost every day, while 7% of students depressive symptoms. But, at
4
constantly bullied other children . In a study done by Buljan-the same time school bullying
Flander, prevalence of bullying in Croatia is at a worrying level usually has a certain im-pact
on the school atmosphere in
th
th
and it happens in all age-groups, mostly in the 7 and 8 grade of
6,7
primary school. The boys more frequently bully other children butgeneral .
Until
1998,
school
5
are also more frequently bullied than the girls . The types of bulmedicine
service
was
lying are also related to gender differences. The boys are mostly
responsible
for
providing
6
bullied physically and girls emotionally .
primary health care for school
Children involved in such violence, either as victims or children
in
Croatia.
perpetrators, shows poor psychological and emotional adjustment Afterwards, it mostly became
and have more health problems. If exposed to bullying at school the responsibility of family
children will develop negative attitude towards school and other doctors (FDs) and rarely
students and will have prob-lems focusing on their school work. pediatricians. The main aim of
Also, these children are more prone to developing different types this case report is to discuss
of psychothe role of FD in the diagnosis

Case Report
One day, at the end of my
working shift, a 15-year old
boy entered my practice,
accompanied by his mother.
The school had called the
mother because her son was
pun-ched in the head by
another boy. The victim was
very quiet, avoiding direct
eye-contact, giving only short
an-swers. He was not ready to
talk about the incident and
circumstances, saying that he
was there only because the
school requested so.

Received for publication

November 8, 2014

211

M. Ben~i}: Bullying at Schools, Coll. Antropol. 38 (2014) Suppl. 2: 211214

much
more
concerned
with
The patient was fully
getting punished by
conscious, oriented both in
the school than he
space and time and was not
was about being
experiencing any kind of
attacked or being in
pain, vomiting or vertigo.
physical
pain.
There was a hematoma on
Although he was
his nose and right eye
only
defending
covering both his upper and
himself he still felt
lower lid, normal papillary
guilty
and
light
reflex
and
no
embarrassed to go to
hematoma of the eye
school.
bulbuls. There were no
signs of other physical
injuries. The boy was
referred to the hospital At the end of our
he
emergency
(ER)
forconversation,
allowed
his
mother
additional
examinations.
The mother was present atto enter the room.
all time in the examinationShe was completely
of
the
room. At the end, I askedunaware
and
her if this incident had been physical
reported to the police. Shepsychological
told me that it had been, byviolence against her
son. The boy had
the school itself.
never talked about it
The next day, the boyat home. Now, he
accompanied by his mother was talk-ing about
re-turned with the medicalhow helpless he felt,
documentation from thethe anger towards his
ER. The fracture of nasalbully but also about
the
school
septum was diagnosed andhow
would
punish
him
rethe pa-tients nose was
externally immobilized. Nogardless of the fact
pathology or any other typethat he was only
of trauma was found duringdefending himself.
the
eye fundo-scopy. Again, the During
boy was very quiet andfollowing week we
abrupt in an-swering mytalked several more
questions,
constantlytimes, every time
looking at his mothermore openly. He was
during the conversation.getting ready to
After the mother left thereturn to school. Six
room the patient was readymonth later he told
to talk more openly. Heme that he had got a
warning
said he had an argumentschool
expulsion
with a boy from schoolpending
during recess. The bullyand that the bully
threatened him, telling himhad already been
that he would wait for himexpelled. He had also
after school. My patientbeen in-cluded in the
became afraid because theworkshop on abusive
bully was well known forbehavior
managehis abusive behavior. Thisment organized by
is ex-actly what happened.the local institution
The bully, together withfor Social Affairs.
some other boys, attacked
him immediately after
school. In the beginning,Discussion and
my patient tried avoidingConclusion
the punches, but later
According to the
started to defend himself.
Croatian normative,
The other students stoodabusive
behav-ior
around them, just watching. recognition
and
At the time my patient wasvictim
protection

mechanisms need to
be implemented into
all the segments of
8
society . As far as
protecting children, it
is an imperative to
imple-ment
intervention
procedures into the
school system and
work on developing
both pro-social skills
and
interper-sonal
9
relations . It is very
important to point
out the fact that the
teachers are not
obliged to react in
cases of vio-lent
behavior if they
estimate that the
children involved

are old enough to solve There

is
no
about
their own problems or, indilemma
other words, that they havewhether to report a
enough experience andvio-lent act against a
knowledge
to
protectchild since according
themselves against theto the Family Act
9
everyone is obliged
bullies .
to inform the social
Similarly, FDs are notservices
about
and should not be excludedchildrens
rights
from this problem matter.violation, including
As shown in the paper onmedical professionVirovitica S.O.S. phoneals
who
notice
line
regarding
familyevidence of possible
violence, a medical worker
12
child abuse . The
i.e. a family doctor should
mere
suspicion
of
provide
care
without
any
kind
of
violent
judging
the
victims
behavior or child
behavior, ask questions
abuse is a valid
about possible presence of
enough reason for
violent behavior within the
reporting. Even in
family,
thoroughly
cases where there
document the act of
isnt
enough
violence and its conse8
information
.
quences, educate the victim
about family violence, pro-Violence can be
vide information aboutreported to either
Services,
where the victim can get Social
Delinhelp
and
support,Juvenile
encourage the victim toquency Centre within
local Police
assess the dangers she andthe
her family members areStation or directly to
exposed to and plan herMunicipal or County
safety. Furthermore, theStates11,12 Attorney
.
Unconversation about violenceOffice
should not be limited onlyfortunately,
to physical violence sinceaccording to the
there are other types ofsurvey carried out
medical
problematic
behaviorsamongst
10 workers by [ari},
linked to control issues .
only 27% of the
The same procedure must
examinees stated that
be applied to other types of they
are
well
abusive behavior, includinginformed about the
a school bull-ing and itproblem of violence
must be clear that reportingagainst
children
violent behavior is anwhereas 67% stated
obligation
and
notthat
they
were
someones
good
will
13
merely informed .
gesture. It is estimated by
the regulations that only byWhat is worrying is
reporting and sanctioningthe fact that even
medical
bullies can stop to violent
professionals do not
8,10,11
behavior
.
consider
reporting
vio-lent behavior as
an obligation. In a lot
212

of cases medical
professionals are not
directly involved in
reporting child abuse
since they do not
want to meddle in
peoples
pri-vate
lives and do not think
it
is
their
professional
res13
ponsibility .
The
similar results were
obtained from the
study of knowledge
and attitudes of
pediatricians,
general
practitioners,
family doctors and
school
children
doctors. They only
rarely or occasionally
detected the problem
of abuse. Although
they clearly take
their
duties
professionally, they
are aware that they
have not had enough
education
and
consequently they do
not have enough
knowledge in this
field. Up to 86% of
pediatri-cians
and
83%
of
general
practitioners, family
doctors and school
children doctors want
further education in
the field of child
14
abuse and neglect .
Family doctor in
his work is likely to
come across vic-tims
of some form of
abuse
including
school bullying. In
such cases it is
important to sustain a
calm and safe environment. Give the
victim enough time
to open up and

M. Ben~i}: Bullying at Schools, Coll. Antropol. 38 (2014) Suppl. 2: 211214

10.1348/000712601162419
. 4. ^ERNI OBRDALJ
start describing the courseE, RUMBOLDT M, Croat
J, 49 (2008) 528.
of events and details. TryMed
DOI: 10.3325/cmj.2008.4.
de-scribing the course of528. 5. BULJAN
events in as many details asFLANDER G, DURMAN
possi-ble using victimsMARIJANOVI] Z, ^ORI]
[POLJAR R, Dru{tvena
terminology.
Showistra`ivanja, 16 (2007) 157.
compassion and tell the 6. MARU[I] I, PAVIN
victim they are not toIVANEC T, Ljetopis
rada, 15 (2008)
blame. Direct the victim tosocijalnog
5. 7. ^ERNI OBRDALJ
un-dergo an examination atE, SESAR K, ANTI] @,
a specialized institution ifKLARI] M, SESAR I,
there is a need to tend to RUMBOLDT M, Coll
Antropol, 37 (2013) 11.
physical injuries. Also, the 8.
MINISTARSTVO
victim needs psychologicalOBITELJI,
BRAI
help as the psychologicalNITELJA
ME\UGENERACIJSKE
trauma fol-lowing abuseSOLIDARNOSTI,
can
cause
seriousProtokol o po-stupanju u
slu~aju
nasilja
me|u
psychological disordjecom
i
mladima,
ders8,10,11.
accessed
15.09.2014.
When reporting abusiveAvaible from: URL:
behavior it is necessary tohttp://www.iusinfo.hr/Usef
ulDocs/Content.aspx?
list all the informationSOPI=DDHR20140128N8
about the incident as well 8&Doc=DDOKU_HR.
ZLOKOVI]
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as the de-tailed description9.
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(2004) 207. 10.
Furthermore, it is necessaryKOLESARI] D, Mitovi i
to describe all visible signs~injenice o nasilju u
accessed
of physical abuse, noteobitelji,
Available
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URL:
verbal assaults if spokenhttp://public.carnet.hr/prev
during physical abuse.entivni/wpAlso, in cases of emotional content/uploads/2012/04/S
OS-Mi-

abuse everything spoken by

the bully should be
8,10,11

noted
.
As it is pointed out in
the research carried out by
Buljan-Flander, it is also
important to pay attention
to the bullies, in other
words children, who are the
perpe-trators.
These
children, in comparison to
children who are not
involved in violent acts,
more often suffer from
depression, are prone to
having suicidal thoughts
and are diagnosed with
15
psychiatric disorders . As
it is the case with the boy
described earlier, there are
more and more

REFERENCES
1. BULJAN FLANDER G,
^OSI] I, Medix, 9 (2003) 122. 2.
KRIS-TENSEN SM, SMITH PK,
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Psychology, 44 (2003) 479. DOI:
10.1046/j.14679450.2003.00369.x. 3. WOLKE
D, WOODS S, STANFORD K,
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counseling centers
opening up and
workshop
being
orga-nized
within
schools,
social
centers
or
nongovernment
institutions focusing
on anger control
1618
management
.
Most
of
the
programmes
are
based on UNICEF
rec-ommendations
For a safe and
encouraging
environment
in
schools. UNICEF
Office for Croatia
has been implementing a bullying
prevention
project
for five years. In
accordance with the
adopted Criteria of
quality
assur-ance
and
sustainability,
schools which have
successfully
implemented
all
seven
steps
of
UNICEF programme
are every three years
awarded
a
renewal/confirmation
of their ViolenceFree
status.
By
adopting
the
mentioned criteria,
the schools made a
commitment
to
continuously
keep
the
established
values and activities
aimed at pre-vention
and
reaction
to
19
bullying .

Acknowledgemen
ts
This study was
supported by the
Foundation for the
Development
of
Family Medicine in
Croatia and WHO
Collaborating Centre
for Primary Health
Care, School of
Public
Health
Andrija [tampar,
School of Medicine,

u obitelji, Narodne novine,

137 (2008). 13. [ARI]
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djece, Hrvat-ski ~asopis za
javno zdravstvo, l7 (2011),
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University of Zagreb.

M. Ben~i}
H
e
a
l
t
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C
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n
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r
e
Z
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b
C
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F
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l
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a
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a
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e
l
u
h
a
n
a

ia e-mail:
miro.ben
cic@zg.tcom.hr

3
,

VR[NJA^KO NASILJE:
PRIMJER BOLESNIKA

1
0
2
9
0
Z
a
p
r
e
{
i
}
,
C
r
o
a
t

S A@ E TAK
U radu je prikaz slu~aj
vr{nja~kog nasilja, radilo se
o fizi~kom napadu na
srednjo{kolca. Napada~ je
bio dje~ak njego-ve dobi i
napad se dogodio u {koli
koju su obojica poha|ala.
@rtva se u ambulantu
obiteljske medicine javila
neposredno nakon napada,
obavljen je pregled, `rtva je
upu}ena na daljnju obradu u
bolnicu. Prilikom prvog
pregleda pacijent je

M. Ben~i}: Bullying at Schools, Coll. Antropol. 38 (2014) Suppl. 2: 211214

vrlo {turo iznio slijed doga|aja, kako se radilo o malodobnoj osobi prvi pregled obavljen je uz prisutnost roditelja. Tije-kom
kontrolnog pregleda vidjev{i da pacijent `eli razgovor o doga|aju, ali je roditelj bio prepreka za izno{enje detalja i osje}aja, razgovor
je uz dopu{tenje roditelja obavljen bez njegove prisutnosti. Tijekom tog razgovora s pacijentom doz-naju se detalji napada, ali i
pacijent pokazuje sve osje}aje koje ima. U radu je prikazan opis slu~aja, ali i osnovne infor-macije o vrstama zlostavljanja u djece,
pristup zlostavljanoj osobi i obveza prijavljivanja svih oblika zlostavljanja.

214

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