Bullying: Concealed by behavioral and somatic symptoms

Martin T. Stein, Nerissa B. San Luis, Robert Sege

Research output: Contribution to journalArticle

2 Scopus citations


Jason is a 10-year-old boy accompanied by his mother for a health supervision visit. His family moved from another state four months ago when his father started a new job. When the pediatrician entered the examination room, Jason's mother was nursing his one-month-old sister. Jason sat next to her, facing the wall, and looking at his hands. In response to a greeting by the pediatrician, he looked up briefly with a fleeting gaze. Jason's mother was concerned that he was "quick to anger" when she asked him to help with chores, attend to schoolwork, or stop playing videogames. The tantrums were described as yelling for at least ten minutes; he settled only after he was sent to his room. Jason never hit a person or threw objects. His mother described feeling distressed when she realized that the outbursts were directed toward her. Jason's father has a new management position and works erratic hours. His mother stated that she feels overwhelmed with the care of a newborn, household chores, and Jason's behavior. The pediatrician turned her attention to Jason. He was cooperative but did not look at her; his voice was soft and his affect was flat. When the pediatrician talked about video games, Jason initiated sustained eye contact but his affect was unchanged. When he was asked about school, he responded, "What about it?" A question about his teacher and his favorite subject stimulated a response from his mother. "He used to get A's and B's, but now he is getting C's. I'm going to meet with his teacher next week." Jason was then asked about friends at school. "Yah, I have friends. Everyone has friends." His facial expression did not change. When asked if he has a best friend, Jason responds, "Yes, Rick. But I hardly see him...he doesn't live close by." Jason reported episodic abdominal pain during the past month occurring once or twice a week. He denied other gastrointestinal symptoms, headache, fatigue, appetite change, fever, or change in sleep pattern. He was sent home twice in the past three weeks due to abdominal pain. A physical examination revealed that Jason's height and weight were in the fifth percentile. His mother commented that Jason was always " on the shorter side." The examination was otherwise normal, including visual acuity (with glasses) and a screening audiogram. The pediatrician commented, "You know, other kids sometimes can be mean and say things or do things that hurt others' feelings. Sometimes kids don't tell adults about this because they feel embarrassed. Sometimes they feel sad. Do you ever feel sad?" Jason nodded. The pediatrician put her hand on his shoulder and said, "When things like this happen, we sometimes start to worry and get all tight inside. Sometimes we can have bellyaches."

Original languageEnglish (US)
Pages (from-to)347-351
Number of pages5
JournalJournal of Developmental and Behavioral Pediatrics
Issue number5
StatePublished - Oct 1 2004


  • Aggression
  • Bully

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental and Educational Psychology
  • Psychiatry and Mental health

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