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The role of bullying in childhood voiding dysfunction
Philip Zhao

INTRODUCTION AND OBJECTIVES: A quarter of US school-age children experience bullying on a regular basis. Bullying has been linked to emotional maladjustment and poor academic performance. While its etiology is debatable, several attributes have been associated with victims of bullying including enuresis. The psychological burden of daytime dysfunctional voiding symptoms (DVS) as it relates to bullying has largely been ignored by the public and media. The purpose of our case-control study is to examine the relationship between bullying and anxiety in the pediatric population with DVS, defined as frequency, urgency, and incontinence.

METHODS: In a pediatric urology practice, 66 patients (ages 7-10) were consecutively accrued in a prospective fashion after IRB approval. One pediatric urologist graded their symptoms using a Voiding Severity Score (VSS, 1-5). They were given a 20- question survey with 7 that indirectly characterized aspects of being bullied, constructing a Bullied Index Score (BIS, 7-28). They were also asked to color a thermometer scale (TS) that correlated with their level of anxiety at school with their peers (0-10, 10 "very nervous"). We excluded patients with physical deformities, neurogenic bladder, cord injury, developmental delay, VUR, and recurrent UTI. We correlated the severity of urinary symptoms to BIS and the level of social anxiety experienced at school (implied by TS). Data were analyzed using the two-tailed Fisher's test. We hypothesized that children with DVS experienced higher rates of bullying.

RESULTS: After accounting for exclusion criteria and missing data, we compiled 56 subjects 27 control (without DVS) and 29 experimental (with DVS). Subjects with BIS 7-11 were considered "not bullied" and BIS 12-28 were "bullied." 22.2% of the control versus 55.2% of the experimental group were bullied (p=0.015); see Graph. In addition, subjects with DVS experienced more anxiety (TS > 2) around their peers (62.1% compared to 3.7%, p=0.0001). All six of VSS 5 (most severe) patients were bullied concomitant with high anxiety (TS >= 5).

CONCLUSIONS: Our study showed that bullying is significantly associated with DVS and that the anxiety of dysfunctional voiding patients is substantially higher than that of their non-DVS peers. Although we did not demonstrate cause and effect, our study is the first to establish the role of bullying in childhood voiding dysfunction.

Source of Funding: none


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