By Jacque Buck

Adam Kizer and Taylor Alesana, both high school students, committed suicide at the age of sixteen. Adam ended his life because he was bullied by peers for being bisexual. Taylor ended her life because she was victimized as a transgender woman.

Adam and Taylor’s experiences of bullying by peers are not isolated incidents. In the United States, bullying is extremely prevalent among LGBT youth and can hinder multiple dimensions of health. Pediatricians can act as a supportive third party as they have extensive medical and scientific knowledge, can monitor youth for signs of bullying at regular intervals, and can refer youth to greater support when needed. The article “Bullying Among Lesbian, Gay, Bisexual, and Transgender Youth” which was published in the Pediatric Clinics of North America aims to provide recommendations for pediatricians to address bullying and its psychological, physical, and behavioral health consequences among LGBT youth.

Key Concepts

Before diving into the world of LGBT youth and bullying, it is important to understand a few key concepts.

Sexual orientation is a combination of behavior, identity, and desire. Basically, who individuals date, how individuals think of themselves, and to whom individuals are romantically and/or sexually attracted to. Gender identity is the gender an individual feels represents them best – man, woman, or otherwise. Gender expression is a culmination of “masculine” or “feminine” traits that are expressed to the world every day through personality, appearance, and behavior. Those who are transgender may identify and/or express a gender that is not aligned with the sex assigned to them at birth.

Youth who have a minority sexual orientation, gender identity, and/or gender expression are more likely to be bullied. Bullying can be verbal, physical, or social and ultimately, this unwanted behavior can inflict psychological, physical, or educational harm.

Why Should Pediatricians Care?

It is important to note that the majority of LGBT youth face some type or a combination of bullying, with verbal and social aggression being the most common. The table below is based on data reported by the 2011 National School Climate conducted by GLSEN and gives some insight into the extent of the problem:

Type	Definition	Examples	Prevalence Among LGBT Youth in past Year (%)
Verbal	Harmful oral or written communication	Taunting, name calling, threatening	92.3
Physical	Use of physical force	Hitting, kicking, tripping, spitting	44.7
Social or relational	Behavior intended to harm reputations or relationships	Spreading rumors, posting embarrassing media content, isolating socially	89.5
Damage to property	Stealing, damaging, or altering property	Stealing or deleting electronic information	47.7

Pediatricians have both the ability and duty to care for the psychological, behavioral, and physical health needs of youth, which includes the negative consequences of bullying among LGBT youth. Overall, LGBT youth experience more bullying than non-LGBT youth, making this topic a pressing matter in the pediatric community regarding the short-term and long-term health of their patients.

It is important for pediatricians to know that LGBT youth who are bullied are more likely to experience worse mental health, such as depression and anxiety, and engage in risky behaviors, such as substance use, school absenteeism, and sexual behavior. Some of the mental and behavioral effects of bullying can encroach on LGBT youths’ physical health as well, including by leading to sleeping problems, lack of appetite, and headaches. In general, research suggests that the consequences of bullying among LGBT youth are greater than among non-LGBT youth. That is, bullying may actually be more harmful to LGBT youth than to non-LGBT youth.

Recommendations for Clinicians

The question remains – how can pediatricians assist LGBT youth in maintaining their psychological, physical, and behavioral health in the face of bullying?

Prevention: 

Pediatricians can help prevent bullying by educating parents and youth about bullying and its consequences, and urge parents and youth to stop bullying behavior. In addition, they can discuss ways to safely respond to bullying. There are general guides to bullying created by the American Academy of Pediatrics, American Medical Association, and the U.S. Department of Health and Human Services. Pediatricians can also reach out to school districts for information on school policies and government laws.

Identify:

To identify LGBT youth who are being bullied, pediatricians should create a safe environment in which youth feel comfortable discussing sexual orientation and gender identity. Pediatricians can also regularly screen youth for bullying and identify the type of bullying and youth involved. Identifying victims of bullying is vital because youth often do not disclose these experiences to adults at school out of fear that the adult will make the situation worse or not help.

Counsel:

Pediatricians can counsel youth by helping them identify accepting adults in their lives who can provide them with support. In addition, they can advise parents on how to advocate for their children in the school system. Pediatricians can advise youth on how to react to being bullied and encourage them to join safe, supportive networks to reduce social isolation.

Advocate: 

Pediatricians can advocate for LGBT youth by speaking out against bullying and stigma, and by supporting policies to address this bullying within their community.

Conclusion

Many LGBT youth face bullying and the negative physical, mental, and behavioral health consequences of bullying. LGBT stigma can result in a lack of support from parents, teachers, and peers. Therefore, pediatricians are in a position to promote the wellbeing of LGBT youth by preventing bullying, identifying bullying, providing counsel, and advocating for protective programs and policies. Pediatricians’ influence gives them the ability to contribute to reducing LGBT stigma and supporting youth who are bullied, which could potentially save lives.

Reference: Earnshaw, V. A., Bogart, L. M., Poteat, V. P., Reisner, S. L., & Schuster, M. A. (2016). Bullying among lesbian, gay, bisexual, and transgender youth. Pediatric Clinics of North America, 63, 999-1010.