A psychiatrist who grew up on the rough side of his town in New Zealand and whom some of his colleagues call "a defender of the underdog" has become a school bullying expert over the years.

Stuart Twemlow, M.D., now a professor of psychiatry at Baylor College of Medicine, is waging a battle against bullies not just in American schools, but in schools in Australia, Hungary, Finland, and Jamaica.

Twemlow shared some of his findings regarding school bullies and bullying at the American Psychoanalytic Association meeting in New York City in January. Some of his latest results on the subject are also in press with Pediatrics.

"Most bullies are psychopathic, which makes it hard for them to empathize," he reported. "Yet punishing bullies is not the answer to bullying. There is a video game called ‘Bullying’ where you can beat the bully up. That's not good."

Part of an effective solution, he emphasized, is obtaining the help of those "many students who do not bully, but who get a buzz out of watching someone else do it," and especially obtaining the help of youngsters who don't like it and who could serve as natural leaders. Indeed, in his efforts to reduce bullying in schools, he attempts to recruit such bystanders to help in dispute mediation between the bully and bullying victim, and more often than not they are happy to assist, he said.

Twemlow's approach to dealing with bullying "sounds like an interesting and innovative approach," David Fassler, M.D., a clinical professor of psychiatry at the University of Vermont and a child psychiatrist, told Psychiatric News. "Many programs aimed at reducing the incidence of bullying have now been developed. However, there are few well-designed studies demonstrating efficacy over time. Hopefully, increased awareness will lead to additional funding for much-needed research in this area." Fassler is also treasurer of APA.

Twemlow and his colleagues have also found that once bullying becomes less common in schools, academic performance improves most in the bystanders—not in the bullies themselves or the bully victims. "This surprised me," he said.

"Bullying is much worse in affluent schools than in poor schools," he continued. "Most teachers are not aware of what is going on with bullies, especially in affluent schools, where students suck up to their teachers. There is also a considerable number of teachers who bully students. So we also need to address that problem as well if we want to solve bullying in schools."

In the study that is in press with Pediatrics, Twemlow and his colleagues studied 590 children in grades 3 through 5 from six public elementary schools in the Midwest. During the fall semester, cases of bully victimization and cases of bully aggression were identified—the former via self-report and the latter via peer report. Although there was no gender difference as far as bully victimization was concerned, more boys than girls played the role of bully, they found.

School nursing logs were also examined to learn how often each child visited the school nurse during the fall semester because of a somatic complaint, illness, or injury. The average number was five. The researchers then looked to see whether instances of being victimized by a bully or instances of doing the bullying were significantly related to school-nurse visits, controlling for demographic variables.

They found that such a relationship did exist. Involvement in bully-victim interactions, as a bully, a victim, or both, was associated with increased somatic illnesses and injury complaints to the school nurse. One reason why the bully victims were at heightened risk for somatic illnesses, the researchers proposed, may be because chronic victimization compromises the immune system.

In any event, if a child often visits the school nurse for either somatic illnesses or injuries, it may be a red flag for parents and pediatricians that the child is being victimized by a bully, Twemlow and his team concluded.