Children and adolescents who have diabetes are more likely to experience diabetes-related bullying. This can lead to some serious mental health issues, as well as negatively affecting their diabetes management and overall well-being.

Meet Siya

Siya (not his real name) was diagnosed with T1DM when he was 11-years-old. His parents brought him to see me when he was 14. They were worried that he seemed sad and withdrawn and that he wasn’t willing to help them understand why.

Once Siya felt that he could trust me and the confidentiality of the space, Siya began to open-up. It turned out that once he had moved to a new high school, his peers started to mock and tease him about his diabetes.

The bullying really was relentless. Every time he scanned his CGM or adjusted his insulin dose, this would attract the attention of his peers. Their nasty comments would make him feel ashamed and angry.

He would frequently sit through class with symptoms of high blood glucose, rather than take his insulin. Apart from wreaking havoc with his HbA1c and emotional well-being, Siya’s grades started to drop rapidly, as the high blood-glucose stopped him from being able to focus properly.

More than just bullying 

Discrimination is the unjust or prejudicial treatment of different categories of people based on what makes them different. When somebody is denied a job opportunity because of their gender, for example, this is a clear example of discrimination.

If Siya is being bullied and ostracised because of his diabetes, isn’t this a case of discrimination? The answer is yes; and to support kids like Siya we, as adults, need to start calling a spade a spade.

Calling a spade a spade

When Siya came to see me, he had been ashamed to raise the issue of bullying with his parents or teachers. He didn’t want to be labelled as a tattle-tale. He also didn’t want to “make a big deal out of something that happens to other people every day.”

A part of his treatment involved helping Siya to name and identify what was happening as being both bullying and discrimination. This helped him to understand the seriousness of what was going on. Most importantly, this made Siya feel confident enough to act by raising the issue with his teachers.

Many kids like Siya think that this is “just bullying” and that they need to simply get over it. It’s important for us to recognise, however, that this sort of discrimination, when it happens to people with diabetes, can worsen their blood-glucose control and emotional well-being.

What is the impact of diabetes-related bullying?

Research tells us what we all know intuitively: bullying can lead to some serious mental health consequences. These include:

• Depression
• Panic attacks
• Low self-esteem
• Impaired concentration
• Social anxiety
• Poor peer relationships
• Missing out on opportunities for social development
• Greater chances of developing depression in adulthood.

The fact that kids who get bullied are at risk of experiencing these sorts of outcomes means that for those with diabetes, in particular, bullying needs to be addressed. This is because having these sorts of psychological difficulties, over and above having diabetes, can make it that much harder to effectively manage one’s physical health.

Other ways in which diabetes-related bullying negatively affects T1DMs

As was the case with Siya: people with diabetes might end up skipping tests or injections, to avoid attracting attention to themselves. Alternatively, they might be more likely to eat things which are not conducive to their health (and without making appropriate corrections) when they are out in public, to feel more “normal”.

Furthermore, the stress that bullying causes triggers a cascade of hormones in the bloodstream which can raise blood glucose. Kids who are chronically stressed are also more likely to eat sugary snacks which can bring them a moment of comfort and calm amidst the chaos.

How can therapy help?

It seems strange to even suggest that your child who is being bullied should see a therapist, given that the problem clearly lies with the person doing the bullying.

Nonetheless, therapy can provide a valuable space for a child or adolescent who has been bullied to build resilience and learn how to assert themselves constructively.

In my own work with Type 1s who are bullied, a space is provided in which they become self-empowered to take decisive action against bullies. Different forms of practical action are appropriate for different types of bullying. What’s vital here, however, is that we focus on helping to empower a child to take control. Why?

Quite simply, bullying makes a person feel powerless. Having uncontrolled diabetes also makes a person feel powerless. People with diabetes need the right support so that they can take responsibility for themselves. The same applies for children with diabetes who are being bullied.

As parents (or therapists, for that matter), the impulse is often to “swoop-in” and help. Often, depending on the impact of the bullying and the age of the child, this is necessary. To do so without fostering a sense of empowerment and autonomy in your child at the same time, however, is to do them a disservice.

Therapy can also help to:

• Foster personal growth. This involves developing an understanding that bullies are not bad people: they are simply emotionally and psychologically wounded. As a result, they need to inflict pain to process their own sense of inadequacy. The implication here is that fighting back is not the answer. The best way to deal with bullies is through firm boundaries and an attitude of empathy.
• Helping kids to understand and regulate the emotions which they experience because of bullying. For children with T1DM it is valuable to confront and take ownership of the sense of “otherness” (i.e. of being different) that gets elicited when others bully them about their diabetes. This is an important aspect of personality development for us; and when we make peace with our fears of being different, we are better able to thrive with diabetes.
• Finally, therapy helps to bolster children’s self-esteem by showing them that they are neither alone nor powerless.

Summing up

Research has shown that children and adolescents with Type 1 diabetes are victimised by their classmates more often than people who don’t have diabetes. As if people with diabetes didn’t already have enough to worry about!

Unfortunately, bullying can cause an emotional response in children with diabetes that makes it harder for them to thrive with their self-management. Therefore diabetes-related bullying needs to be addressed as a priority.

Not sure how best to manage? Reach out to your doctor and request a referral to a counsellor or psychologist who can provide the right support.

References

Ando, M., Asakura, T., & Simons-Morton, B. (2005). Psychosocial influences on physical, verbal, and indirect bullying among Japanese early adolescents. The Journal of Early Adolescence, 25(3), 268-297.

Nascimento Andrade, C. J., & Alves, C. D. A. D. (2019). Relationship between bullying and type 1 diabetes mellitus in children and adolescents: a systematic review. Jornal de Pediatria, 95(5), 509-518.