thesis effects of bullying

• Research article
• Open access
• Published: 14 December 2021

Bullying at school and mental health problems among adolescents: a repeated cross-sectional study

• Håkan Källmén 1 &
• Mats Hallgren   ORCID: orcid.org/0000-0002-0599-2403 2  

Child and Adolescent Psychiatry and Mental Health volume  15 , Article number:  74 ( 2021 ) Cite this article

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To examine recent trends in bullying and mental health problems among adolescents and the association between them.

A questionnaire measuring mental health problems, bullying at school, socio-economic status, and the school environment was distributed to all secondary school students aged 15 (school-year 9) and 18 (school-year 11) in Stockholm during 2014, 2018, and 2020 (n = 32,722). Associations between bullying and mental health problems were assessed using logistic regression analyses adjusting for relevant demographic, socio-economic, and school-related factors.

The prevalence of bullying remained stable and was highest among girls in year 9; range = 4.9% to 16.9%. Mental health problems increased; range = + 1.2% (year 9 boys) to + 4.6% (year 11 girls) and were consistently higher among girls (17.2% in year 11, 2020). In adjusted models, having been bullied was detrimentally associated with mental health (OR = 2.57 [2.24–2.96]). Reports of mental health problems were four times higher among boys who had been bullied compared to those not bullied. The corresponding figure for girls was 2.4 times higher.

Conclusions

Exposure to bullying at school was associated with higher odds of mental health problems. Boys appear to be more vulnerable to the deleterious effects of bullying than girls.

Introduction

Bullying involves repeated hurtful actions between peers where an imbalance of power exists [ 1 ]. Arseneault et al. [ 2 ] conducted a review of the mental health consequences of bullying for children and adolescents and found that bullying is associated with severe symptoms of mental health problems, including self-harm and suicidality. Bullying was shown to have detrimental effects that persist into late adolescence and contribute independently to mental health problems. Updated reviews have presented evidence indicating that bullying is causative of mental illness in many adolescents [ 3 , 4 ].

There are indications that mental health problems are increasing among adolescents in some Nordic countries. Hagquist et al. [ 5 ] examined trends in mental health among Scandinavian adolescents (n = 116, 531) aged 11–15 years between 1993 and 2014. Mental health problems were operationalized as difficulty concentrating, sleep disorders, headache, stomach pain, feeling tense, sad and/or dizzy. The study revealed increasing rates of adolescent mental health problems in all four counties (Finland, Sweden, Norway, and Denmark), with Sweden experiencing the sharpest increase among older adolescents, particularly girls. Worsening adolescent mental health has also been reported in the United Kingdom. A study of 28,100 school-aged adolescents in England found that two out of five young people scored above thresholds for emotional problems, conduct problems or hyperactivity [ 6 ]. Female gender, deprivation, high needs status (educational/social), ethnic background, and older age were all associated with higher odds of experiencing mental health difficulties.

Bullying is shown to increase the risk of poor mental health and may partly explain these detrimental changes. Le et al. [ 7 ] reported an inverse association between bullying and mental health among 11–16-year-olds in Vietnam. They also found that poor mental health can make some children and adolescents more vulnerable to bullying at school. Bayer et al. [ 8 ] examined links between bullying at school and mental health among 8–9-year-old children in Australia. Those who experienced bullying more than once a week had poorer mental health than children who experienced bullying less frequently. Friendships moderated this association, such that children with more friends experienced fewer mental health problems (protective effect). Hysing et al. [ 9 ] investigated the association between experiences of bullying (as a victim or perpetrator) and mental health, sleep disorders, and school performance among 16–19 year olds from Norway (n = 10,200). Participants were categorized as victims, bullies, or bully-victims (that is, victims who also bullied others). All three categories were associated with worse mental health, school performance, and sleeping difficulties. Those who had been bullied also reported more emotional problems, while those who bullied others reported more conduct disorders [ 9 ].

As most adolescents spend a considerable amount of time at school, the school environment has been a major focus of mental health research [ 10 , 11 ]. In a recent review, Saminathen et al. [ 12 ] concluded that school is a potential protective factor against mental health problems, as it provides a socially supportive context and prepares students for higher education and employment. However, it may also be the primary setting for protracted bullying and stress [ 13 ]. Another factor associated with adolescent mental health is parental socio-economic status (SES) [ 14 ]. A systematic review indicated that lower parental SES is associated with poorer adolescent mental health [ 15 ]. However, no previous studies have examined whether SES modifies or attenuates the association between bullying and mental health. Similarly, it remains unclear whether school related factors, such as school grades and the school environment, influence the relationship between bullying and mental health. This information could help to identify those adolescents most at risk of harm from bullying.

To address these issues, we investigated the prevalence of bullying at school and mental health problems among Swedish adolescents aged 15–18 years between 2014 and 2020 using a population-based school survey. We also examined associations between bullying at school and mental health problems adjusting for relevant demographic, socioeconomic, and school-related factors. We hypothesized that: (1) bullying and adolescent mental health problems have increased over time; (2) There is an association between bullying victimization and mental health, so that mental health problems are more prevalent among those who have been victims of bullying; and (3) that school-related factors would attenuate the association between bullying and mental health.

Participants

The Stockholm school survey is completed every other year by students in lower secondary school (year 9—compulsory) and upper secondary school (year 11). The survey is mandatory for public schools, but voluntary for private schools. The purpose of the survey is to help inform decision making by local authorities that will ultimately improve students’ wellbeing. The questions relate to life circumstances, including SES, schoolwork, bullying, drug use, health, and crime. Non-completers are those who were absent from school when the survey was completed (< 5%). Response rates vary from year to year but are typically around 75%. For the current study data were available for 2014, 2018 and 2020. In 2014; 5235 boys and 5761 girls responded, in 2018; 5017 boys and 5211 girls responded, and in 2020; 5633 boys and 5865 girls responded (total n = 32,722). Data for the exposure variable, bullied at school, were missing for 4159 students, leaving 28,563 participants in the crude model. The fully adjusted model (described below) included 15,985 participants. The mean age in grade 9 was 15.3 years (SD = 0.51) and in grade 11, 17.3 years (SD = 0.61). As the data are completely anonymous, the study was exempt from ethical approval according to an earlier decision from the Ethical Review Board in Stockholm (2010-241 31-5). Details of the survey are available via a website [ 16 ], and are described in a previous paper [ 17 ].

Students completed the questionnaire during a school lesson, placed it in a sealed envelope and handed it to their teacher. Student were permitted the entire lesson (about 40 min) to complete the questionnaire and were informed that participation was voluntary (and that they were free to cancel their participation at any time without consequences). Students were also informed that the Origo Group was responsible for collection of the data on behalf of the City of Stockholm.

Study outcome

Mental health problems were assessed by using a modified version of the Psychosomatic Problem Scale [ 18 ] shown to be appropriate for children and adolescents and invariant across gender and years. The scale was later modified [ 19 ]. In the modified version, items about difficulty concentrating and feeling giddy were deleted and an item about ‘life being great to live’ was added. Seven different symptoms or problems, such as headaches, depression, feeling fear, stomach problems, difficulty sleeping, believing it’s great to live (coded negatively as seldom or rarely) and poor appetite were used. Students who responded (on a 5-point scale) that any of these problems typically occurs ‘at least once a week’ were considered as having indicators of a mental health problem. Cronbach alpha was 0.69 across the whole sample. Adding these problem areas, a total index was created from 0 to 7 mental health symptoms. Those who scored between 0 and 4 points on the total symptoms index were considered to have a low indication of mental health problems (coded as 0); those who scored between 5 and 7 symptoms were considered as likely having mental health problems (coded as 1).

Primary exposure

Experiences of bullying were measured by the following two questions: Have you felt bullied or harassed during the past school year? Have you been involved in bullying or harassing other students during this school year? Alternatives for the first question were: yes or no with several options describing how the bullying had taken place (if yes). Alternatives indicating emotional bullying were feelings of being mocked, ridiculed, socially excluded, or teased. Alternatives indicating physical bullying were being beaten, kicked, forced to do something against their will, robbed, or locked away somewhere. The response alternatives for the second question gave an estimation of how often the respondent had participated in bullying others (from once to several times a week). Combining the answers to these two questions, five different categories of bullying were identified: (1) never been bullied and never bully others; (2) victims of emotional (verbal) bullying who have never bullied others; (3) victims of physical bullying who have never bullied others; (4) victims of bullying who have also bullied others; and (5) perpetrators of bullying, but not victims. As the number of positive cases in the last three categories was low (range = 3–15 cases) bully categories 2–4 were combined into one primary exposure variable: ‘bullied at school’.

Assessment year was operationalized as the year when data was collected: 2014, 2018, and 2020. Age was operationalized as school grade 9 (15–16 years) or 11 (17–18 years). Gender was self-reported (boy or girl). The school situation To assess experiences of the school situation, students responded to 18 statements about well-being in school, participation in important school matters, perceptions of their teachers, and teaching quality. Responses were given on a four-point Likert scale ranging from ‘do not agree at all’ to ‘fully agree’. To reduce the 18-items down to their essential factors, we performed a principal axis factor analysis. Results showed that the 18 statements formed five factors which, according to the Kaiser criterion (eigen values > 1) explained 56% of the covariance in the student’s experience of the school situation. The five factors identified were: (1) Participation in school; (2) Interesting and meaningful work; (3) Feeling well at school; (4) Structured school lessons; and (5) Praise for achievements. For each factor, an index was created that was dichotomised (poor versus good circumstance) using the median-split and dummy coded with ‘good circumstance’ as reference. A description of the items included in each factor is available as Additional file 1 . Socio-economic status (SES) was assessed with three questions about the education level of the student’s mother and father (dichotomized as university degree versus not), and the amount of spending money the student typically received for entertainment each month (> SEK 1000 [approximately $120] versus less). Higher parental education and more spending money were used as reference categories. School grades in Swedish, English, and mathematics were measured separately on a 7-point scale and dichotomized as high (grades A, B, and C) versus low (grades D, E, and F). High school grades were used as the reference category.

Statistical analyses

The prevalence of mental health problems and bullying at school are presented using descriptive statistics, stratified by survey year (2014, 2018, 2020), gender, and school year (9 versus 11). As noted, we reduced the 18-item questionnaire assessing school function down to five essential factors by conducting a principal axis factor analysis (see Additional file 1 ). We then calculated the association between bullying at school (defined above) and mental health problems using multivariable logistic regression. Results are presented as odds ratios (OR) with 95% confidence intervals (Cis). To assess the contribution of SES and school-related factors to this association, three models are presented: Crude, Model 1 adjusted for demographic factors: age, gender, and assessment year; Model 2 adjusted for Model 1 plus SES (parental education and student spending money), and Model 3 adjusted for Model 2 plus school-related factors (school grades and the five factors identified in the principal factor analysis). These covariates were entered into the regression models in three blocks, where the final model represents the fully adjusted analyses. In all models, the category ‘not bullied at school’ was used as the reference. Pseudo R-square was calculated to estimate what proportion of the variance in mental health problems was explained by each model. Unlike the R-square statistic derived from linear regression, the Pseudo R-square statistic derived from logistic regression gives an indicator of the explained variance, as opposed to an exact estimate, and is considered informative in identifying the relative contribution of each model to the outcome [ 20 ]. All analyses were performed using SPSS v. 26.0.

Prevalence of bullying at school and mental health problems

Estimates of the prevalence of bullying at school and mental health problems across the 12 strata of data (3 years × 2 school grades × 2 genders) are shown in Table 1 . The prevalence of bullying at school increased minimally (< 1%) between 2014 and 2020, except among girls in grade 11 (2.5% increase). Mental health problems increased between 2014 and 2020 (range = 1.2% [boys in year 11] to 4.6% [girls in year 11]); were three to four times more prevalent among girls (range = 11.6% to 17.2%) compared to boys (range = 2.6% to 4.9%); and were more prevalent among older adolescents compared to younger adolescents (range = 1% to 3.1% higher). Pooling all data, reports of mental health problems were four times more prevalent among boys who had been victims of bullying compared to those who reported no experiences with bullying. The corresponding figure for girls was two and a half times as prevalent.

Associations between bullying at school and mental health problems

Table 2 shows the association between bullying at school and mental health problems after adjustment for relevant covariates. Demographic factors, including female gender (OR = 3.87; CI 3.48–4.29), older age (OR = 1.38, CI 1.26–1.50), and more recent assessment year (OR = 1.18, CI 1.13–1.25) were associated with higher odds of mental health problems. In Model 2, none of the included SES variables (parental education and student spending money) were associated with mental health problems. In Model 3 (fully adjusted), the following school-related factors were associated with higher odds of mental health problems: lower grades in Swedish (OR = 1.42, CI 1.22–1.67); uninteresting or meaningless schoolwork (OR = 2.44, CI 2.13–2.78); feeling unwell at school (OR = 1.64, CI 1.34–1.85); unstructured school lessons (OR = 1.31, CI = 1.16–1.47); and no praise for achievements (OR = 1.19, CI 1.06–1.34). After adjustment for all covariates, being bullied at school remained associated with higher odds of mental health problems (OR = 2.57; CI 2.24–2.96). Demographic and school-related factors explained 12% and 6% of the variance in mental health problems, respectively (Pseudo R-Square). The inclusion of socioeconomic factors did not alter the variance explained.

Our findings indicate that mental health problems increased among Swedish adolescents between 2014 and 2020, while the prevalence of bullying at school remained stable (< 1% increase), except among girls in year 11, where the prevalence increased by 2.5%. As previously reported [ 5 , 6 ], mental health problems were more common among girls and older adolescents. These findings align with previous studies showing that adolescents who are bullied at school are more likely to experience mental health problems compared to those who are not bullied [ 3 , 4 , 9 ]. This detrimental relationship was observed after adjustment for school-related factors shown to be associated with adolescent mental health [ 10 ].

A novel finding was that boys who had been bullied at school reported a four-times higher prevalence of mental health problems compared to non-bullied boys. The corresponding figure for girls was 2.5 times higher for those who were bullied compared to non-bullied girls, which could indicate that boys are more vulnerable to the deleterious effects of bullying than girls. Alternatively, it may indicate that boys are (on average) bullied more frequently or more intensely than girls, leading to worse mental health. Social support could also play a role; adolescent girls often have stronger social networks than boys and could be more inclined to voice concerns about bullying to significant others, who in turn may offer supports which are protective [ 21 ]. Related studies partly confirm this speculative explanation. An Estonian study involving 2048 children and adolescents aged 10–16 years found that, compared to girls, boys who had been bullied were more likely to report severe distress, measured by poor mental health and feelings of hopelessness [ 22 ].

Other studies suggest that heritable traits, such as the tendency to internalize problems and having low self-esteem are associated with being a bully-victim [ 23 ]. Genetics are understood to explain a large proportion of bullying-related behaviors among adolescents. A study from the Netherlands involving 8215 primary school children found that genetics explained approximately 65% of the risk of being a bully-victim [ 24 ]. This proportion was similar for boys and girls. Higher than average body mass index (BMI) is another recognized risk factor [ 25 ]. A recent Australian trial involving 13 schools and 1087 students (mean age = 13 years) targeted adolescents with high-risk personality traits (hopelessness, anxiety sensitivity, impulsivity, sensation seeking) to reduce bullying at school; both as victims and perpetrators [ 26 ]. There was no significant intervention effect for bullying victimization or perpetration in the total sample. In a secondary analysis, compared to the control schools, intervention school students showed greater reductions in victimization, suicidal ideation, and emotional symptoms. These findings potentially support targeting high-risk personality traits in bullying prevention [ 26 ].

The relative stability of bullying at school between 2014 and 2020 suggests that other factors may better explain the increase in mental health problems seen here. Many factors could be contributing to these changes, including the increasingly competitive labour market, higher demands for education, and the rapid expansion of social media [ 19 , 27 , 28 ]. A recent Swedish study involving 29,199 students aged between 11 and 16 years found that the effects of school stress on psychosomatic symptoms have become stronger over time (1993–2017) and have increased more among girls than among boys [ 10 ]. Research is needed examining possible gender differences in perceived school stress and how these differences moderate associations between bullying and mental health.

Strengths and limitations

Strengths of the current study include the large participant sample from diverse schools; public and private, theoretical and practical orientations. The survey included items measuring diverse aspects of the school environment; factors previously linked to adolescent mental health but rarely included as covariates in studies of bullying and mental health. Some limitations are also acknowledged. These data are cross-sectional which means that the direction of the associations cannot be determined. Moreover, all the variables measured were self-reported. Previous studies indicate that students tend to under-report bullying and mental health problems [ 29 ]; thus, our results may underestimate the prevalence of these behaviors.

In conclusion, consistent with our stated hypotheses, we observed an increase in self-reported mental health problems among Swedish adolescents, and a detrimental association between bullying at school and mental health problems. Although bullying at school does not appear to be the primary explanation for these changes, bullying was detrimentally associated with mental health after adjustment for relevant demographic, socio-economic, and school-related factors, confirming our third hypothesis. The finding that boys are potentially more vulnerable than girls to the deleterious effects of bullying should be replicated in future studies, and the mechanisms investigated. Future studies should examine the longitudinal association between bullying and mental health, including which factors mediate/moderate this relationship. Epigenetic studies are also required to better understand the complex interaction between environmental and biological risk factors for adolescent mental health [ 24 ].

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Acknowledgements

Authors are grateful to the Department for Social Affairs, Stockholm, for permission to use data from the Stockholm School Survey.

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HK conceived the study and analyzed the data (with input from MH). HK and MH interpreted the data and jointly wrote the manuscript. All authors read and approved the final manuscript.

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Principal factor analysis description.

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Källmén, H., Hallgren, M. Bullying at school and mental health problems among adolescents: a repeated cross-sectional study. Child Adolesc Psychiatry Ment Health 15 , 74 (2021). https://doi.org/10.1186/s13034-021-00425-y

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School Bullies: Unmasking The Causes, Effects, and Solutions

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Table of contents

The causes of school bullying, the effects of school bullying, addressing school bullying: potential solutions, the role of cyberbullying, conclusion: a collective responsibility.

• Family Environment: Some bullies come from dysfunctional or abusive households, where they may witness aggressive behavior or experience neglect, leading to a lack of empathy and poor coping mechanisms.
• Peer Influence: Bullying can be perpetuated by peer groups or friends who encourage or reinforce aggressive behavior, creating a culture of harassment within school settings.
• Low Self-Esteem: Some bullies engage in aggressive behavior as a means of boosting their self-esteem or compensating for feelings of insecurity or inadequacy.
• Power Imbalance: Bullying often occurs in situations where there is a perceived power imbalance, such as differences in physical strength, popularity, or social status.
• Media and Technology: Exposure to violent media, cyberbullying through online platforms, and social media can contribute to the normalization of aggressive behavior among young people.
• Psychological Impact: Victims of bullying often experience anxiety, depression, low self-esteem, and an increased risk of developing mental health issues that can persist into adulthood.
• Academic Consequences: Bullying can disrupt a student's ability to concentrate, leading to a decline in academic performance and a reduced enthusiasm for learning.
• Physical Health: Bullying can lead to physical health problems, such as headaches, stomachaches, and sleep disturbances, due to the stress and anxiety it induces.
• Social Isolation: Victims of bullying may withdraw from social activities, resulting in feelings of isolation and a diminished sense of belonging.
• Long-Term Effects: The effects of bullying can persist into adulthood, impacting relationships, career prospects, and overall quality of life.
• Educational Programs: Schools can implement anti-bullying programs that promote empathy, conflict resolution skills, and respect for diversity, fostering a culture of inclusivity.
• Teacher Training: Educators should receive training on recognizing and addressing bullying behavior, creating safe and supportive classroom environments.
• Parental Involvement: Parents can play a crucial role by monitoring their children's online activities, fostering open communication, and actively addressing any signs of bullying.
• Peer Support: Encouraging students to act as allies and report instances of bullying can help create a supportive network within schools.
• Legal Frameworks: Policymakers can enact and enforce anti-bullying legislation, ensuring that schools take appropriate measures to prevent and respond to bullying incidents.
• Mental Health Support: Schools should offer access to counseling services for both victims and perpetrators of bullying to address underlying emotional and psychological issues.
• Digital Literacy Education: Schools should educate students about responsible online behavior, digital etiquette, and the consequences of cyberbullying.
• Reporting Mechanisms: Establish clear channels for reporting cyberbullying incidents and ensure swift and appropriate responses.
• Parental Involvement: Parents should actively engage with their children's online activities, promote responsible internet use, and be vigilant about signs of cyberbullying.
• Platform Responsibility: Social media platforms should enforce anti-cyberbullying policies, respond to user reports, and take steps to prevent online harassment.

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Committee on the Biological and Psychosocial Effects of Peer Victimization: Lessons for Bullying Prevention; Board on Children, Youth, and Families; Committee on Law and Justice; Division of Behavioral and Social Sciences and Education; Health and Medicine Division; National Academies of Sciences, Engineering, and Medicine; Rivara F, Le Menestrel S, editors. Preventing Bullying Through Science, Policy, and Practice. Washington (DC): National Academies Press (US); 2016 Sep 14.

Preventing Bullying Through Science, Policy, and Practice.

• Hardcopy Version at National Academies Press

4 Consequences of Bullying Behavior

Bullying behavior is a serious problem among school-age children and adolescents; it has short- and long-term effects on the individual who is bullied, the individual who bullies, the individual who is bullied and bullies others, and the bystander present during the bullying event. In this chapter, the committee presents the consequences of bullying behavior for children and youth. As referenced in Chapter 1 , bullying can be either direct or indirect, and children and youth may experience different types of bullying. Specifically the committee examines physical (including neurobiological), mental, and behavioral health consequences. The committee also examines consequences for academic performance and achievement and explores evidence for some of the mechanisms proposed for the psychological effects of bullying. When applicable, we note the limited, correlational nature of much of the available research on the consequences of bullying.

• CONSEQUENCES FOR INDIVIDUALS WHO ARE BULLIED

Mounting evidence on bullying has highlighted the detrimental effects of being bullied on children's health and behavior ( Gini and Pozzoli, 2009 ; Lereya et al., 2015 ; Reijntjes et al., 2010 ; Ttofi et al., 2011 ). In this section, the committee reviews the research on physical, psychosocial, and academic achievement consequences for those children and youth who are bullied.

Perspectives from the Field

Being bullied makes young people incredibly insecure: When you're being bullied, you can feel constantly insecure and on guard. Even if you're not actively being bullied, you're aware it could start anytime. It has a big mental and emotional impact—you feel unaccepted, isolated, angry, and withdrawn. You're always wondering how you can do better and how you can escape a bully's notice. You're also stunted because of the constant tension and because maybe you forego making certain friendships or miss out on taking certain chances that could actually help your development.

—Summary of themes from young adults focus group (See Appendix B for additional highlights from interviews.)

Physical Health Consequences

The physical health consequences of bullying can be immediate, such as physical injury, or they can involve long-term effects, such as headaches, sleep disturbances, or somatization. 1 However, the long-term physical consequences of bullying can be difficult to identify and link with past bullying behavior versus being the result of other causes such as anxiety or other adverse childhood events that can also have physical effects into adulthood ( Hager and Leadbeater, 2016 ). In one of the few longitudinal studies on the physical and mental effects of bullying, Bogart and colleagues (2014) studied 4,297 children and their parents from three urban locales: Birmingham, Alabama; 25 contiguous school districts in Los Angeles County, California; and one of the largest school districts in Houston, Texas. Bogart and her team were interested in the cumulative effects of bullying on an individual. They collected data when the cohort was in fifth grade (2004 to 2006), seventh grade (2006 to 2008), and tenth grade (2008 to 2010). Data consisted of responses to the Peer Experience Questionnaire, the Pediatric Quality of Life Inventory with its Psychosocial Subscale and Physical Health Subscale, and a Self-Perception Profile. The Physical Health Subscale measured perceptions of physical quality of life.

Bogart and colleagues (2014) found that children who were bullied experienced negative physical health compared to non-involved peers. Among seventh grade students with the worst-decile physical health, 6.4 percent were not bullied, 14.8 percent had been bullied in the past only, 23.9 percent had been bullied in the present only, and nearly a third (30.2%) had been bullied in both the past and present. These effects were not as strong when students were in tenth grade. Limitations to this study were that physical health was measured by participants' perceptions of their health-related quality of life, rather than by objectively defined physical symptoms. It is critical to understand that this study, or other studies assessing correlations between behavior and events, cannot state that the events caused the behavior. Future research might build on this large multisite longitudinal study and obtain more in-depth evidence on individuals' physical health as a consequence of bullying.

In their study of 2,232 twins reared together and separately as a part of the Environmental Risk (E-Risk) Longitudinal Twin Study, Baldwin and colleagues (2015) found that children who had experienced chronic bullying showed greater adiposity subsequently, but not at the time of victimization. The study revealed that at age 18, these children had a higher body mass index ( b = 1.11, CI [0.33, 1.88]), waist-hip ratio ( b = 0.017, CI [0.008, 0.026]), and were at a higher risk of being overweight ( OR = 1.80, CI [1.28, 2.53]) than their nonbullied counterparts ( Baldwin et al., 2015 ).

An important future direction for research is to gather more information on physical consequences such as elevated blood pressure, inflammatory markers, and obesity in light of work showing effects on these outcome of harsh language by parents and other types of early life adversity ( Danese and Tan, 2014 ; Danese et al., 2007 ; Evans et al., 2007 ; Miller and Chen, 2010 ).

Somatic Symptoms

Most of the extant evidence on the physical consequences—somatic symptoms in particular—of bullying pertains to the individual who is bullied. The emotional effects of being bullied can be expressed through somatic disturbances, which, similar to somatization, are physical symptoms that originate from stress or an emotional condition. Common stress or anxiety-related symptoms include sleep disorders, gastrointestinal concerns, headaches, palpitations, and chronic pain. The relationship between peer victimization and sleep disturbances has been well documented ( Hunter et al., 2014 ; van Geel et al., 2014 ).

For instance, Hunter and colleagues (2014) examined sleep difficulties (feeling too tired to do things, had trouble getting to sleep, and had trouble staying asleep) among a sample of 5,420 Scottish adolescents. The researchers found that youth who were bullied ( OR = 1.72, 95% CI [1.07, 2.75]) and youth who bully ( OR = 1.80, CI [1.16, 2.81]) were nearly twice as likely as youth who were not involved in bullying to experience sleep difficulties. One limitation of this study is that it was based on self-reports, which have sometimes been criticized as being subject to specific biases. Patients with insomnia may overestimate how long it takes them to fall asleep ( Harvey and Tang, 2012 ). Another limitation is that the study included young people at different stages of adolescence. Sleep patterns and sleep requirements vary across the different stages of adolescence.

A recent meta-analysis based on 21 studies involving an international sample of 363,539 children and adolescents examined the association between peer victimization and sleeping problems. A broader focus on peer victimization was used because of the definitional issues related to bullying. The authors defined peer victimization as “being the victim of relational, verbal or physical aggression by peers” ( van Geel et al., 2015 , p. 89). Children and youth who were victimized reported more sleeping problems than children who did not report victimization ( OR = 2.21, 95% CI [2.01, 2.44]). Moreover, the relationship between peer victimization and sleeping problems was stronger for younger children than it was for older children ( van Geel et al., 2015 ). This study was based on cross-sectional studies that varied widely in how peer victimization and sleeping problems were operationalized and thus cannot make any claims about causal relations between peer victimization and sleeping problems.

Knack and colleagues (2011a) posited that bullying results in meaningful biological alterations that may result in changes in one's sensitivity to pain responses. A recent meta-analysis by Gini and Pozzoli (2013) concluded that children and adolescents who are bullied were at least twice as likely to have psychosomatic disturbances (headache, stomachache, dizziness, bedwetting, etc.) than nonbullied children and adolescents ( OR = 2.39, 95% CI [1.76, 3.24] for longitudinal studies; OR = 2.17, 95% CI [1.91, 2.46] for cross-sectional studies). Although the use of self-report measures are very common in bullying research and are usually considered to be valid and reliable (Ladd and Kochenderfer- Ladd, 2002 ), their use requires adequate self-awareness on the part of the respondent, and some children who are bullied may be in denial about their experience of having been bullied.

There is also evidence of gender differences in the physical effects of being bullied. For example, Kowalski and Limber (2013) examined the relation between experiences with cyberbullying or traditional bullying (i.e., bullying that does not involve digital electronic means of communication) and psychological and physical health, as well as academic performance, of 931 students in grades 6 through 12 living in rural Pennsylvania. Students were asked how often in the past 4 weeks they experienced 10 physical health symptoms, with scores across these 10 symptoms averaged to provide an overall health index (higher scores equal more health problems). Traditional bullying was defined as “aggressive acts that are meant to hurt another person, that happen repeatedly, and that involve an imbalance of power” ( Kowalski and Limber, 2013 , p. S15). The authors found that girls who were traditionally bullied reported more anxiety and overall health problems than boys who were bullied (females: M = 1.65, SD = 0.41; males: M = 1.42, SD = 0.38). A limitation of this study is that it is correlational in nature and the authors cannot conclude that being a victim of traditional bullying caused the psychological or physical problems.

In summary, it is clear that children and youth who have been bullied also experience a range of somatic disturbances. There are also gender differences in the physical health consequences of being bullied.

Neuroendocrinology of Stress

Psychological and physical stressors, such as being the target of bullying, activate the stress system centered on the hypothalamic-pituitary-adrenal (HPA) axis ( Dallman et al., 2003 ; McEwen and McEwen, 2015 ). The role of HPA and other hormones is to promote adaptation and survival, but chronically elevated hormones can also cause problems. Stress has ubiquitous effects on physiology and the brain, alters levels of many hormones and other biomarkers, and ultimately affects behavior. Therefore, both a general understanding of stress during early adolescence and, where known, specific links between stress and bullying can provide insight into the enduring effects of bullying.

The levels of the stress hormone cortisol have been shown to change in targets of repeated bullying, with being bullied associated with a blunted cortisol response ( Booth et al., 2008 ; Kliewer, 2006 ; Knack et al., 2011b ; Ouellet-Morin et al., 2011 ; Vaillancourt et al., 2008 ). To the committee's knowledge, no study has examined bidirectional changes in cortisol, although there is evidence to suggest that cortisol is typically elevated immediately following many types of stress and trauma but blunted after prolonged stress ( Judd et al., 2014 ; Miller et al., 2007 ). Kliewer (2006) did find that cortisol increased from pre-task to post-task (i.e., watching a video clip from the film Boyz 'n the Hood followed by a discussion) among youth who had been bullied, and in a more recent study, Kliewer and colleagues (2012) reported, among African American urban adolescents, that peer victimization was associated with greater sympathetic nervous system (fight or flight reaction) reactivity to a stress task (measured using salivary a-amylase, an enzyme that increases in saliva when the sympathetic nervous system is activated). However, in these studies, the immediate effect of being bullied on stress reactivity was not examined. In contrast, Ouellet-Morin and colleagues (2011) and Knack and colleagues (2011b) did not find an increase in cortisol in bullied youth following a psychosocial stress test but rather found a blunted pattern of response after the test had concluded (see Figures 4-1 and 4-2 ). In order to test whether, in the short-term, bullying produces an increase in cortisol, whereas in the long-term it is associated with a blunted cortisol response (as seen with other types of psychosocial stressors; Judd et al., 2014 ; Miller et al., 2007 ), a longitudinal study is needed to examine bullying chronicity and regulation of the HPA axis. The importance of this future work notwithstanding, there is evidence to support a finding that when stress becomes prolonged, the stress hormone system becomes hypofunctional and a blunted stress response results ( McEwen, 2014 ).

Cortisol reactivity for victimized and nonvictimized adolescents during the Trier Social Stress Test. SOURCE: Adapted from Knack et al. (2011b, Fig. 3, p. 5).

Cortisol responses to a psychosocial stress test (PST) in the total sample and according to maltreatment/bullying victimization. SOURCE: Adapted from Ovellet-Morin et al. (2011, Fig. 1, p. 14).

When stress becomes prolonged, the stress hormone system becomes hypofunctional and a blunted stress response results ( Knack et al., 2012a ; McEwen, 2014 ; Vaillancourt et al., 2013a ). That is, the elevation in cortisol in response to stress fails to occur. Scientists are not exactly sure how this happens, but evidence suggests that the stress system has shut itself down through “negative feedback.” Although on the surface this may seem to be beneficial, it is not. Cortisol has many functions and serves to regulate myriad biological systems; a blunted stress response compromises the orchestration of cortisol's biological functions. The critical importance of the massive over-activation of the stress system producing a blunted stress response is clinically relevant since it is associated with posttraumatic stress disorder and other psychiatric disorders ( Heim et al., 1997 ). It is also relevant for understanding an individual's inability to self-regulate and cope with stress.

Prolonged stress also disrupts the circadian or daily rhythm of cortisol, which is normally elevated in the morning and slowly decreases over the day to result in low levels at bedtime ( Barra et al., 2015 ). An altered circadian rhythm results not only in difficulty awaking in the morning but also in difficulty falling asleep at night. It can cause profound disruption in sleep patterns that can initiate myriad additional problems; sleep deficits are associated with problems with emotional regulation, learning, mood disorders, and a heightened social threat detection and response system ( McEwen and Karatsoreos, 2015 ). Recent research suggests that the consolidation of memories 2 one learns each day continues during sleep ( Barnes and Wilson, 2014 ; Shen et al., 1998 ). Sleep disturbances disrupt memory consolidation, and studies in animals suggest stress during learning engages unique neurochemical and molecular events that cause memory to be encoded by some unique mechanism ( Baratta et al., 2015 ; Belujon and Grace, 2015 ; McGaugh, 2015 ; Rau and Fanselow, 2009 ). Although victims of bullying have sleep problems ( Miller-Graff et al., 2015 ), causal relations between bullying, sleep disorders, learning/memory consolidation, and cortisol dysregulation have not been established. Indeed, these correlations between being a target of bullying and physiological problems may highlight important interactions between events and outcome, but it is also likely that unidentified variables might be the critical causal factors.

It is also noteworthy that the HPA axis showed heightened responsiveness during the peak ages of bullying ( Blakemore, 2012 ; Dahl and Gunnar, 2009 ; Romeo, 2010 ; Spear, 2010 ). For example, cortisol response characteristics in children are such that, when cortisol is activated, the hormonal response is protracted and takes almost twice as much time to leave the blood and brain compared to adults ( Romeo, 2010 , 2015 ). The circadian rhythm of cortisol also seems altered during early adolescence, most notably associated with morning cortisol levels, with levels increasing with age and pubertal development ( Barra et al., 2015 ). Animal models suggest that the extended cortisol response begins in pre-puberty and indicate that recovery from stressful events is more challenging during this age range ( Romeo, 2015 ).

Emotional regulation, including a person's ability to recover from a traumatic or stressful event, involves being able to regulate or normalize stress hormone levels. Before adolescence, children's ability to regulate their stress response can be greatly assisted by parents or other significant caregivers—a process referred to as “social buffering” ( Hostinar et al., 2014 ; Ouellet-Morin et al., 2011 , 2013 ). Specifically, it is well documented in the human and animal research literature that a sensitive caregiver or a strong support system can greatly dampen the stress system's response and actually reduce the amount of stress hormone released, as well as shorten the amount of time the stress hormones circulate within the body and brain. This results in dramatic decreases in stress-related behavior ( Gee et al., 2014 ; Hostinar et al., 2014 ). The social cues actually reduce stress by reducing the activation of the stress system, or HPA axis, at the level of the hypothalamus ( Hennessy et al., 2009 , 2015 ; Moriceau and Sullivan, 2006 ). The social stimuli that buffer children as they transition into adolescence appear to begin to have greater reliance on peers rather than on the caregiver ( Hostinar et al., 2015 ).

Other physiological effects of stress include the activation of the immune system by bullying-induced stress ( Copeland et al., 2014 ; McCormick and Mathews, 2007 ), and a cardiovascular blunting among individuals with a history of being bullied ( Newman, 2014 ). Other hormones and physiological mechanisms are also involved in the stress activation response. For example, cortisol is associated with an increase in testosterone, the male sex hormone associated with aggression in nonhuman animals and with dominance and social challenge in humans, particularly among boys and men ( Archer, 2004 ). In fact, in rodents the combined assessment of testosterone and cortisol provides more predictive value of behavioral variability ( McCormick and Mathews, 2007 ) compared to controls ( Márquez et al., 2013 ). In humans, there is increasing evidence supporting an interaction between testosterone and cortisol in the prediction of social aggression (see Montoya et al., 2012 ). In a study of 12-year-olds, Vaillancourt and colleagues (2009) found that testosterone levels were higher among bullied boys than nonbullied boys, but lower among bullied girls than nonbullied girls. The authors speculated that the androgen dynamics were possibly adrenocortical in origin, highlighting the need to examine testosterone and cortisol in consort. To date, researchers have only investigated cortisol response to being bullied ( Kliewer, 2006 ; Knack et al., 2011b ; Ouellet-Morin et al., 2011 ; Vaillancourt et al., 2008 ), and only one study has examined testosterone and peer victimization ( Vaillancourt et al., 2009 ). There are no studies examining these two important hormones together in relation to bullying perpetration or to being bullied.

Together, the research on both humans and animals suggests that stress is beneficial when it is experienced at low-to-moderate levels, whereas prolonged or repeated stress becomes toxic by engaging a unique neural and molecular cascade within the brain that is thought to initiate a different developmental pathway. Indeed, from animal models, brain architecture is altered by chronic stress, with amygdala activity being enhanced, hippocampal function impaired, and medial prefrontal cortex function being reduced, leading to increased anxiety and aggression and decreased capacity for self-regulation, as well as a more labile mood ( Chattarji et al., 2015 ; McEwen and Morrison, 2013 ; McEwen et al., 2015 ). This stress effect on the brain is particularly strong when experienced during adolescence, but it is even more pronounced if combined with early life adversity ( Gee et al., 2014 ; Hanson et al., 2015 ; Richter-Levin et al., 2015 ; Romeo, 2015 ; Sandi and Haller 2015 ). This could produce behavioral responses that become maladaptive by compromising emotional and cognitive functioning or perhaps it could produce adaptive behavior for a dangerous environment that results in socially inappropriate behavior.

Consequences of Bullying on Brain Function

Being a child or youth who is bullied changes behavior, and neuroscience research suggests this experience may also change the brain ( Bradshaw et al., 2012 ; Vaillancourt et al., 2013a ). The major technique used to monitor brain function in humans is functional magnetic resonance imaging (fMRI), which works by monitoring blood flow to indirectly assess the functioning of thousands of brain cells over an area of the brain. This technique has rarely been used on either the perpetrator or target of a bullying incident during this very particular social interaction, and for that reason little is known about whether or not the brain of a child who bullies or of a child who has been bullied is different before these experiences or is changed by them. These very specific studies are required before one can make definitive statements about the brain for this topic or for how this information might help develop novel interventions or prevention.

Additionally, it is important to consider two limitations for understanding fMRI. First, one cannot scan the brain of a child during the action of bullying or being a target of bullying. Instead, one must rely on the child staying perfectly still as the investigator tries to approximate one or two aspects of the complex experience that occur in this complicated behavioral interaction. For example, the fMRI task used during a brain imaging session might mimic social exclusion as one facet of bullying, without the full social and emotional context of the real bullying process. Although this is an important methodology, these results need to be assessed with caution at this time and not directly applied as an accepted scientific interpretation of bullying. Therefore, the examples used below to assess brain function rely not on monitoring actual instances of bullying behavior but on monitoring components of behaviors that are thought to occur during a bullying incident.

Second, fMRI monitors a large brain area, which is composed of many smaller brain areas, each of which is involved in many, many behaviors, many of which are not yet fully understood. Thus, it is difficult to determine why the brain area one is examining changed, since that brain area is involved in hundreds of diverse behaviors. For this reason, the results reviewed below need to be viewed as preliminary and should not be misinterpreted as explaining any aspect of the experience of bullying. Rather, these preliminary results highlight the importance of brain assessment before and after bullying experiences, including developing monitorable tasks that more closely approximate the bullying experience within the physical constraints of an immobile subject during an fMRI brain scan. The value of neuroscience is that it enables exploration of brain mechanisms controlling behavior that are not obvious from behavioral assessment.

Social Pain

Whereas there are no studies directly examining bullying using neural imaging techniques, there are several studies examining how the brain processes social pain. Social pain describes the “feelings of pain that follow the experiences of peer rejection, ostracism, or loss” ( Vaillancourt et al., 2013a , p. 242). Social pain is consistent with how people describe their feeling about being bullied. For example, one victim of bullying described the emotional toll of his experience by saying, “I feel like, emotionally, they [his bullies] have been beating me with a stick for 42 years” ( Vaillancourt et al., 2013a , p. 242).

Researchers have demonstrated that when people experience social pain, they activate regions in their brain similar to those activated when they experience physical pain ( Eisenberger, 2012 ; Eisenberger and Lieberman, 2004 ; Eisenberger et al., 2003 ; Kross et al., 2011 ; Vaillancourt et al., 2010a ). Specifically, the dorsal anterior cingulate cortex, which is part of the prefrontal cortex, seems to be implicated in the processing of both physical and social pain. The fact that physical and social pain have overlapping neural systems might explain why people tend to use physical pain metaphors (e.g., “It broke my heart when she called me ugly.”) when describing their experiences with being humiliated, oppressed, or rejected ( Eisenberger, 2012 ). Eisenberger and Leiberman (2004) noted that these fMRI results are correlations between pain and the anterior cingulate cortex and could reflect other functions of that brain region, such as detecting conflict or errors, different ideas or goals about the task, or individual differences in the task difficulty. In a recent fMRI study by Rudolph and colleagues (2016) , adolescent girls were socially excluded during a laboratory task (i.e., cyberball; Williams et al., 2000 ). Results indicated that activation of the social pain network—the dorsal anterior cingulate cortex, subgenual anterior cingulate cortex, and anterior insula—was associated with internalizing symptoms. Of note, this effect was particularly pronounced among adolescent girls with a history of peer victimization. 3

In addition to studies on social pain, there are some studies examining how the brains of children who had been bullied reacted subsequently to different stimuli. Experiences of being bullied can alter an individual's view of the world. While no brain imaging study has directly addressed this issue, a longitudinal study investigating the risk factors of depression found that being a child who was bullied at ages 11 and 12 was associated with a decreased response to reward in the medial prefrontal cortex at age 16, although it was unclear if these brain differences were present before the bullying experiences or developed after them ( Casement et al., 2014 ). The medial prefrontal cortex, which is a brain area involved in memory and learning, was found to be disrupted in children who have been bullied ( Vaillancourt et al., 2011 ). Because it also has countless other functions including decision making, risk taking, and conflict monitoring, disruption of this region compromises one's ability to interpret results with respect to bullying ( Euston et al., 2012 ; Vaillancourt et al., 2011 ).

In another fMRI study involving children, 10-12 years old, who were presented with a task that examined their response to negative feedback stimuli of emotional faces, greater and more extensive brain activation was found in the amygdala, orbitofrontal cortex, and ventrolateral prefrontal cortex of children who had been rejected by their peers, compared with children in a control group who had not been rejected by peers ( Lee et al., 2014 ), a condition that is highly correlated with being bullied by peers ( r = .57; Knack et al., 2012a ). The prefrontal cortex is a very large brain area with many subareas, all of which serve diverse functions in many different behaviors, not just executive function. Indeed, the prefrontal cortex processes pain, self-regulation, stress integration, and safety signals and has been implicated in psychiatric disorders, higher order learning, extinction (active process to suppress a memory), personality, social behavior, planning, decision making, and many other behaviors and percepts including social exclusion, social/physical pain, and empathy ( Casey and Jones, 2010 ; Spear, 2013 ). These few studies are consistent with other imaging studies demonstrating functional brain differences among individuals who were maltreated in childhood ( Lim et al., 2014 , 2015 ). Taken together, this work supports a finding that being exposed to such adversity during maturation has enduring effects on brain function, although additional research is needed to establish the parameters controlling these effects (and qualifying the generalization).

There is also evidence that stressful events, such as might occur with bullying experiences, impact emotional brain circuits, an inference that is supported by changes in amygdala architecture and function described earlier in animal models in adulthood but more robust changes in brain structure are produced by stress during early life and around adolescence ( Chattarji et al., 2015 ; McEwen and Morrison, 2013 ; McEwen et al., 2015 ). This point is critical because the stress system of adolescents seems to have a heightened sensitivity, and experiencing bullying can increase stress hormones ( Romeo, 2010 , 2015 ; Spear, 2013 ; Vaillancourt et al., 2011 ). Human brain scanning experiments suggest the prefrontal cortex is affected by stress through attenuating the connectivity to the hippocampus and amygdala, which are brain areas critical for emotional regulation and emotional memories ( Ganzel et al., 2008 ; Liston et al., 2009 ). Animal research shows that this connectivity loss is caused by stress-induced atrophy of the prefrontal cortex ( Radley et al., 2006 ), although this brain region does show the ability to recover once the stress has terminated ( Liston et al., 2009 ). One aspect of being a target of bullying is that the memory of the experience seems to be enduring; the unique function of the prefrontal cortex and emotional circuits during preadolescence and adolescence may provide insight into the enduring memories of being bullied. Specifically, one function of the prefrontal cortex is to help suppress memories that are no longer important or true. Typically, memories are not simply forgotten or unlearned. Rather, as we update information in our brain, the old memory is suppressed by overlaying a new memory to attenuate the old memory, an active brain process called extinction ( Milaid and Quirk, 2012 ). With respect to memories of trauma, of being bullied, or of experiencing a threat, the prefrontal cortex is important for attenuating (extinguishing) memories in emotional brain areas, such as the amygdala. Importantly, dramatic changes occur in the extinction system during adolescence, where fear extinction learning is attenuated relative to children and adults ( Pattwell et al., 2012 , 2013 ). This learning mode has been modeled in animals to understand how the process occurs in the adolescent brain ( Kim and Richardson, 2010 ; Nair and Gonzalez-Lima, 1999 ; Pattwell et al., 2012 ). The research suggests that around the time of adolescence, it is more difficult to decrease emotionally aversive memories, such as experiences of being bullied, than at other times in the life cycle. Furthermore, anxious teens (anxiety is sometimes comorbid with experience of being bullied) show even greater difficulties with processing extinction of fear memory ( Jovanovic et al., 2013 ).

In conclusion, the available evidence indicates that the brain functioning of individuals who are bullied is altered (see reviews by Bradshaw et al., 2012 ; Vaillancourt et al., 2013a ). However, it is difficult to ascertain fully what it means when fMRI scans detect an alteration in brain activity. In terms of understanding the prolonged and repeated stress associated with bullying, this research suggests that greater experience with being bullied and repeated exposure as a target of bullying produces a neural signature in the brain that could underlie some of the behavioral outcomes associated with being bullied.

Psychosocial Consequences

In this section, the committee examines what is known about the psychosocial consequences of being bullied. A common method of examining mental health issues separates internalizing and externalizing problems ( Sigurdson et al., 2015 ). Internalizing symptoms include problems directed within the individual, such as depression, anxiety, fear, and withdrawal from social contacts. Externalizing symptoms reflect behavior that is typically directed outwards toward others, such as anger, aggression, and conduct problems, including a tendency to engage in risky and impulsive behavior, as well as criminal behavior. Externalizing problems also include the use and abuse of substances.

Psychological problems are common after being bullied (see review by Hawker and Boulton, 2000 ) and include internalizing problems, such as depression, anxiety, and, especially for girls, self-harming behavior ( Kidger et al., 2015 ; Klomek et al., 2009 , 2015 ). There can also be subsequent externalizing problems, especially for boys (see review by McDougall and Vaillancourt, 2015 ). Rueger and colleagues (2011) found consistent concurrent association with timing of peer victimization and maladjustment. Both psychological and academic outcomes were particularly strong for students who experienced sustained victimization over the school year.

“And these are the kids that are at risk for anxiety and depression and bipolar disorder to begin with, and it almost seems like it's a cycle that makes it worse. So they are isolated and they are angry, they are fearful. Many of them end up severely depressed, attempting suicide, utilizing NSSIs [nonsuicidal self-injuries] for comfort. Some turn to gangs because that is the group that would accept them. So that's when we get involved and we have to start working backwards.”

—Quote from community-based provider discussing bullying during focus group (See Appendix B for additional highlights from interviews.)

Internalizing Problems

A robust literature documents that youth who are bullied often have low self-esteem and feel depressed, anxious, and lonely ( Juvonen and Graham, 2014 ). Data from developmental psychopathology research indicate that stressful life events can lead to the onset and maintenance of depression, anxiety, and other psychiatric symptoms and that for many youth, being bullied is a major life stressor ( Swearer and Hymel, 2015 ). Based on sociometric nominations, targets of bullying also are disliked by the general peer group ( Knack et al., 2012b ).

Several meta-analyses have specifically explored the relation between depression and being bullied at school ( Ttofi et al., 2011 ) and victimized by peers 4 ( Hawker and Boulton, 2000 ; Reijntjes et al., 2010 ). Individuals who had been cyberbullied reported higher levels of depression and suicidal ideation, as well as increased emotional distress, externalized hostility, and delinquency, compared with peers who were not bullied ( Patchin, 2006 ; Ybarra et al., 2006 ). Furthermore, severity of depression in youth who have been cyberbullied has been shown to correlate with the degree and severity of cyberbullying ( Didden et al., 2009 ).

Two meta-analyses found that across several different longitudinal studies using different study populations, internalizing emotional problems increases both the risk and the harmful consequences of being bullied ( Cook et al., 2010 ; Reijntjes et al., 2010 ). Internalizing problems can thus function as both antecedents and consequences of bullying ( Reijntjes et al., 2010 ; Vaillancourt et al., 2013b ). Although most longitudinal studies suggest that psychological problems result from being bullied (see review by McDougall and Vaillancourt, 2015 ) and meta-analyses ( Reijntjes et al., 2010 ; Ttofi et al., 2011 ) support this directionality, there is some evidence that for some youth, the temporal pattern begins with mental health problems ( Kochel et al., 2012 ; Vaillancourt et al., 2013b ).

In a large cohort of Canadian children followed every year from grade 5 to grade 8, Vaillancourt and colleagues (2013b) found that internalizing problems in grades 5 and 7 predicted increased self-reported bullying behavior the following year. They noted that these findings provide evidence for the “symptom-driven pathway” across time with increased internalizing problems predicting greater self-reported peer victimization. This “symptom-drive pathway” was noted from grade 5 to grade 6 and again from grade 7 to grade 8 and was consistent with other published work. For instance, Kochel et al. (2012) reported a symptom-driven pathway in which depressive symptoms predicted peer victimization 5 1 year later (grade 4 to grade 5 and grade 5 to grade 6) and argued that this pathway may result from depressed youth displaying “social deficits,” selecting “maladaptive relationships,” and/or displaying a behavioral style that is perceived poorly by the peer group ( Kochel et al., 2012 , p. 638). Vaillancourt and colleagues (2013b) have also argued that depressed youth could be more “treat sensitive.” That is, these youth may select information from their environment that is consistent with their negative self-opinion. The idea that certain individuals may be more sensitive to environmental cues or make more hostile interpretation of ambiguous social data has been well documented in the literature ( Crick and Dodge, 1994 ; Dodge, 1986 ). This work is consistent with studies showing that social information processing differs in children based on their experience with being bullied and that hypersensitivity can impact their interpretation of social behavior and their self-reports of subsequent incidents of being bullied ( Camodeca et al., 2003 ; Smalley and Banerjee, 2013 ).

Most longitudinal studies to date are of relatively short duration (i.e., less than 2 years) and focus on a narrow developmental period such as childhood or adolescence ( McDougall and Vaillancourt, 2015 ). Nevertheless, there are several recently published studies examining the long-term adult outcomes of childhood bullying. These studies indicate that being bullied does affect future mental health functioning, as reviewed in the following paragraphs.

Most long-term studies of childhood bullying have focused on links to internalizing problems in adulthood, demonstrating robust long-standing effects ( Gibb et al., 2011 ; Olweus, 1993b ; Sourander et al., 2007 ; Stapinski et al., 2014 ). For example, Bowes and colleagues (2015) examined depression in a large sample of participants who reported being the target of bullying at age 13 and found higher rates of depression at age 18 compared to peers who had not been bullied. Specifically, they reported that 14.8 percent of participants who reported being frequently bullied in childhood at age 13 were clinically depressed at age 18 ( OR = 2.96, 95% CI [2.21, 3.97]) and that the population attributable fraction was 29.2 percent, suggesting that close to a third of the variance in depression could be explained by being bullied in childhood ( Bowes et al., 2015 ).

In another longitudinal study using two large population-based cohorts from the United Kingdom (the ALSPAC Cohort) and the United States (the GSMS Cohort), Lereya and colleagues (2015) reported that the effects of childhood bullying on adult mental health were stronger in magnitude than the effects of being maltreated by a caregiver in childhood. Being bullied only (and not maltreated) placed individuals at higher risk for mental health difficulties than being maltreated only (and not bullied) ( OR = 1.6, 95% CI [1.1, 2.2] for ALSPAC cohort; OR = 3.8, 95% CI [1.8, 7.9] for GSMS cohort). Children who were bullied were more likely than maltreated children to be anxious ( OR = 4.9, 95% CI [2.0, 12.0] for GSMS cohort), depressed ( OR = 1.7, 95% CI [1.1, 2.7] for ALSPAC cohort), and to engage in self-harming behavior ( OR = 1.7, 95% CI [1.1-2.6] for ALSPAC cohort) in adulthood ( Lereya et al., 2015 ).

Similarly, Stapinski and colleagues (2014) found that adolescents who experienced frequent peer victimization 6 were two to three times more likely to develop an anxiety disorder 5 years later at age 18 than nonvictimized adolescents ( OR = 2.49, 95% CI [1.62, 3.85]). The association remained after adjusting for potentially confounding individual and family factors and was not attributable to diagnostic overlap with depression. Frequently victimized adolescents were also more likely to develop multiple internalizing problems in adulthood ( Stapinski et al., 2014 ). After controlling for childhood psychiatric problems or family hardship, Copeland and colleagues (2013) found that individuals who were bullied continued to have higher prevalence of generalized anxiety ( OR = 2.7, 95% CI [1.1, 6.3]).

These findings suggest that being bullied and internalizing problems such as depression are mutually reinforcing, with the experience of one increasing the risk of the other in a harmful cycle that contributes to the high stability of being both bullied and experiencing other internalizing problems. These studies also suggest that the long-term consequences of being bullied, which extend into adulthood, can be more severe than being maltreated as a child by a caregiver.

Externalizing Problems

Alcohol and drug abuse and dependence have been associated with being bullied as a child ( Radliff et al., 2012 ). A longitudinal study of adolescents found that those who reported being bullied were more likely to report use of alcohol, cigarettes, and inhalants 12 months later ( Tharp-Taylor et al., 2009 ), compared to those who did not report being bullied. More longitudinal research that tracks children through adulthood is needed to fully understand the link between being bullied and substance abuse (see review by McDougall and Vaillancourt, 2015 ).

Several studies show links between being bullied and violence or crime, especially for men ( Gibb et al., 2011 ; McGee et al., 2011 ; Sourander et al., 2007 , 2011 ). A meta-analysis by Reijntjes and colleagues (2011) that included studies with data on 5,825 participants showed that after controlling for externalizing symptoms at baseline, peer victimization—under which they included being the target of teasing, deliberate exclusion, and being the target of physical threats and malicious gossip—was associated over time with exhibiting externalizing problems such as aggression, truancy, and delinquency ( r = .14, 95% CI [.09, .19]). This research team also found that externalizing problems predicted changes in peer victimization over time ( r = .13, 95% CI [.04, .21]) and concluded that there is a bidirectional relationship between peer victimization and externalizing problems.

Psychotic Symptoms

Evidence from the broader research on childhood trauma and stress indicates that earlier adverse life experiences, such as child abuse, are associated with the development of psychotic symptoms later in life ( Institute of Medicine and National Research Council, 2014b ). Until recently, the association between bullying and psychotic symptoms has been understudied ( van Dam et al., 2012 ). Two recent meta-analyses support the association between bullying and the development of psychotic symptoms later in life ( Cunningham et al., 2015 ; van Dam et al., 2012 ). van Dam and colleagues (2012) conducted a meta-analysis of 14 studies to assess whether being bullied in childhood is related to the development of psychotic (either clinical or nonclinical) symptoms. (Nonclinical psychotic symptoms 7 place individuals at risk for the development of psychotic disorders ( Cougnard et al., 2007 ).) Results from the analyses of studies that examined the association between bullying and nonclinical symptoms (six studies) were more definitive (adjusted OR = 2.3; 95% CI [1.5, 3.4]), with stronger associations when there was an increased frequency, severity, and persistence of bullying ( Cougnard et al., 2007 ). Although some research has found this association, a recent longitudinal study from New Zealand found that the link between bullying and the development of psychosis later in life is likely not causal but instead reflects the fact that individuals who display disordered behaviors across childhood and adolescences are more likely to become bullying targets ( Boden et al., 2016 ) An analysis of studies that examined the association between bullying and psychosis in clinical samples was inconclusive ( van Dam et al., 2012 ).

A recent meta-analysis conducted by Cunningham and colleagues (2015) examined ten European prospective studies, four from the Avon Longitudinal Study of Parents and Children. This analysis found that individuals who were bullied were more than twice as likely to develop later psychotic symptoms, compared to those who were not bullied ( OR = 2.1, 95% CI [1.1, 4.0]). These results were consistent in all but one of the studies included in the meta-analysis. More longitudinal research is needed to more fully understand the mechanisms through which trauma such as bullying may lead to the development of psychotic symptoms ( Cunningham et al., 2015 ; van Dam et al., 2012 ). Importantly, this research will need to be prospective and examine the development of bullying and psychotic symptoms in order to truly identify the temporal priority. The inclusion criteria for the Cunningham and colleagues (2015) meta-analysis included that the study had to be prospective and had to include a measure of psychosis and that bullying needed to be reported before the age of 18. Although the authors stated that “bullying appears to cause later development of psychosis,” such a conclusion requires that mental health functioning be assessed early and over time, as it is possible that premorbid characteristics may make individuals targets for poor peer treatment (see Kochel et al., 2012 ; Vaillancourt et al., 2013b , regarding depression leading to peer victimization).

Academic Performance Consequences

A growing literature has documented that targets of bullying suffer diminished academic achievement whether measured by grades or standardized test scores ( Espelage et al., 2013 ; Nakamoto and Schwartz, 2010 ). Cross-sectional research indicates that children who are bullied are at increased risk for poor academic achievement ( Beran, 2009 ; Beran and Lupart, 2009 ; Beran et al., 2008 ; Glew et al., 2005 ; Neary and Joseph, 1994 ; see also meta-analysis by Nakamoto and Schwartz, 2010 ) and increased absenteeism ( Juvonen et al., 2000 ; Kochenderfer and Ladd, 1996 ; Vaillancourt et al., 2013b ).

The negative relation between being bullied and academic achievement is evident as early as kindergarten ( Kochenderfer and Ladd, 1996 ) and continues into high school ( Espinoza et al., 2013 ; Glew et al., 2008 ). In a 2-week daily diary study with ninth and tenth grade Latino students, Espinoza and colleagues (2013) reported that on days when adolescents' reports of being bullied were greater than what was typical for them, they also reported more academic challenges such as doing poorly on a quiz, test, or homework and felt like less of a good student. Thus, even episodic encounters of being bullied can interfere with a student's ability to concentrate on any given day. In a cross-sectional study of more than 5,000 students in grades 7, 9, and 11, Glew and colleagues (2008) found that for every 1-point increase in grade point average (GPA), the odds of being a child who was bullied (versus a bystander) decreased by 10 percent. However, due to the cross-sectional nature of this study, this association does not establish whether lower academic achievement among children who were bullied was a consequence of having been bullied.

Several short-term (one academic year) longitudinal studies indicate that being bullied predicts academic problems rather than academic problems predicting being a target of bullying ( Kochenderfer and Ladd, 1996 ; Schwartz et al., 2005 ). Given the impairments in brain architecture associated with self-regulation and memory in animal models and the currently limited imaging data in human subjects, this is a reasonable inference, although reverse causation is possible. For instance, early life abuse and neglect impair these same abilities, lower self-esteem, and may make an individual more likely to be a target of bullying. In one of the few longitudinal studies to extend beyond one year, Juvonen and colleagues (2011) examined the relation between victimization 8 and academic achievement across the three years of middle school. Academic adjustment was measured by both year-end grades and teacher reports of engagement. These authors found that more self-reported victimization was related to lower school achievement from sixth to eighth grade. For every 1-unit increase in victimization (on a 1-4 scale), GPA declined by 0.3 points.

Other short-term longitudinal studies found similar results. For example, Nansel and colleagues (2003) found that being bullied in a given year (grade 6 or 7) predicted poor academic outcomes the following year, after controlling for prior school adjustment and if they were previously targets of bullying or not. Similarly, Schwartz and colleagues (2005) reported a negative association for third and fourth grade children between victimization 9 and achievement 1 year later. In addition, Baly and colleagues (2014) found that the cumulative impact of being bullied over 3 years from sixth grade to eighth grade had a negative impact on GPA and standardized test scores.

However, other studies have not found such associations. For instance, Kochenderfer and Ladd (1996) found no relation between being bullied and subsequent academic achievement in their study of students assessed in the fall and spring of kindergarten, nor did Rueger and Jenkins (2014) in their study of seventh and eighth graders assessed in the fall and spring of one academic year. Feldman and colleagues (2014) also reported no association between being a target of bullying and academic achievement in their 5-year longitudinal study of youth ages 11-14. Poor academic performance can also be a predictor of peer victimization ( Vaillancourt et al., 2013b ). The authors found that poor writing performance in third grade predicted increased bullying behavior in fifth grade that was stable until the end of eighth grade.

The longitudinal associations between peer victimization and school attendance are also equivocal, with some showing positive associations ( Baly et al., 2014 ; Buhs et al., 2006 ; Gastic, 2008 ; Kochenderfer and Ladd, 1996 ; Smith et al., 2004 ) and others not finding a statistically significant association ( Forero et al., 1999 ; Glew et al., 2008 ; Rueger et al., 2011 ; Vaillancourt et al., 2013b ). 10

In summary, there have been a number of cross-sectional and longitudinal studies that have provided support for a relation between being bullied and increased risk for poor academic achievement. However, given the inconsistent results found with longitudinal studies, more research is warranted in this area to more fully ascertain the relation between being bullied and academic achievement over time.

• CONSEQUENCES FOR INDIVIDUALS WHO BULLY

There is evidence that supports a finding that individuals who bully others have contradictory attributes ( Institute of Medicine and National Research Council, 2014a ; Vaillancourt et al., 2010b ). Research suggests that there are children and adolescents who bully others because they have some form of maladjustment ( Olweus, 1993a ) or, as mentioned in Chapter 3 , are motivated by establishing their status in a social network ( Faris and Ennett, 2012 ; Rodkin et al., 2015 ; Sijtsema et al., 2009 ; Vaillancourt et al., 2003 ). Consequently, the relation between bullying, being bullied, acceptance, and rejection is complex ( Veenstra et al., 2010 ). This complexity is also linked to a stereotype held by the general public about individuals who bully. This stereotype casts children and youth who bully others as being high on psychopathology, low on social skills, and possessing few assets and competencies that the peer group values ( Vaillancourt et al., 2010b ). Although some occurrence of this “stereotypical bully” or “classic bully” is supported by research ( Kumpulainen et al., 2001 ; Olweus, 1993a ; Sourander et al., 2007 ), when researchers consider social status in relation to perpetration of bullying behavior, a different profile emerges. These studies suggest that most children and youth who bully others wield considerable power within their peer network and that high-status perpetrators tend to be perceived by peers as being popular, socially skilled, and leaders ( de Bruyn et al., 2010 ; Dijkstra et al., 2008 ; Peeters et al., 2010 ; Thunfors and Cornell, 2008 ; Vaillancourt et al., 2003 ). High-status bullies have also been found to rank high on assets and competencies that the peer group values such as being attractive or being good athletes ( Farmer et al., 2003 ; Vaillancourt et al., 2003 ); they have also been found to rank low on psychopathology and to use aggression instrumentally to achieve and maintain hegemony (for reviews, see Rodkin et al., 2015 , and Vaillancourt et al., 2010b ). Considering these findings of contrasting characteristics of perpetrators of bullying behavior, it makes sense that the research on outcomes of perpetrating is mixed. Unfortunately, most research on the short- and long-term outcomes of perpetrating bullying behavior has not taken into account this heterogeneity when considering the impact to children and youth who have bullied their peers.

Psychosomatic Consequences

Findings from cross-sectional studies that reported data on individuals who bullied others have shown that these individuals are at risk of developing psychosomatic problems ( Gini, 2008 ; Srabstein et al., 2006 ). Gini and Pozzoli (2009) conducted a meta-analysis to test whether children involved in bullying behavior in any role are at risk for psychosomatic problems. They included studies ( n = 11) that examined the association between bullying involvement and psychosomatic complaints in children and adolescents between the ages of 7 and 16. The studies included in the meta-analysis used self-report questionnaires; reports from peers, parents, or teachers; and clinical interviews that resulted in a clinical rating of the subject's behaviors and health problems. The included studies also had enough information to calculate effect sizes. An analysis of six studies that met the selection criteria revealed that children who bully had a higher risk ( OR = 1.65, 95% CI [1.34, 2.04]) of exhibiting psychosomatic problems than their uninvolved peers.

This meta-analysis was limited because of its inclusion of cross-sectional and observational studies. Such studies do not allow firm conclusions on cause and effect; hence, the association between bullying perpetration and psychosomatic problems may be difficult to interpret. The methodologies used in the studies make them susceptible to bias and misclassification due to the reluctance of individuals who bully to identify themselves as perpetrators of bullying behavior. Also, the different forms of victimization included in the underlying studies were not reported in this meta-analysis. Additional research is needed to examine the involvement in perpetrating bullying behavior and its short- and long-term psychosomatic consequences.

Psychotic Problems

Using a population-based cohort study, Wolke and colleagues (2014) examined whether bullying perpetration and being a target of bullying in elementary school predicted psychotic experiences 11 in adolescence. The authors assessed 4,720 individuals between the ages of 8 and 11 who were involved in bullying either as perpetrators or targets. At age 18, suspected or definite psychotic experiences were assessed using semistructured interviews. After controlling for the child's gender, intelligence quotient at age 8, and childhood behavioral and emotional problems, the researchers found that both individuals who are bullied (child report at age 10: OR = 2.4, 95% CI [1.6, 3.4]; mother report: OR = 1.6, 95% CI [1.1, 2.3]) and individuals who bullied others (child report at age 10: OR = 4.9, 95% CI [1.3, 17.7]; mother report: OR = 1.2, 95% CI [0.46, 3.1]) had a higher prevalence of psychotic experiences at age 18. The authors concluded that “involvement in any role in bullying may increase the risk of developing psychotic experiences in adolescence” ( Wolke et al., 2014 , p. 2208).

In summary, several studies have focused on the consequences of bullying for individuals who are bullied and have also reported more broadly on consequences for perpetrators of aggressive behavior (see Gini and Pozzoli, 2009 ; Lereya et al., 2015 ; Reijntjes et al., 2010 ; Ttofi et al., 2011 ), but the consequences of bullying involvement for individuals who perpetrate bullying behavior have been rarely studied to date. That is, although there is a rich literature on aggressors and the outcomes of being aggressive, there are few studies examining bullying perpetration specifically, taking into account the power imbalance, repetition, and intentionality that differentiates aggression from bullying from other forms of peer aggression. As discussed in Chapter 2 , the available research on the prevalence of bullying behavior focuses almost entirely on the children who are bullied. More research, in particular longitudinal research, is needed to understand the short- and long-term physical health, psychosocial, and academic consequences of bullying involvement on the individuals who have a pattern of bullying others, when those individuals are distinguished from children who engage in general aggressive behavior.

• CONSEQUENCES FOR INDIVIDUALS WHO BULLY AND ARE ALSO BULLIED

Individuals who bully and are also bullied experience a particular combination of consequences that both children who are only perpetrators and children who are only targets also experience, such as comorbidity of both externalizing and internalizing problems, negative perception of self and others, poor social skills, and rejection by the peer group. However, at the same time this combination of roles in bullying is negatively influenced by the peers with whom they are interacting ( Cook et al., 2010 ). After controlling for adjustment problems existing prior to incidents of bullying others or being bullied, a nationally representative cohort study found that young children who have been both perpetrators and targets of bullying tended to develop more pervasive and severe psychological and behavioral outcomes than individuals who were only bullied ( Arseneault et al., 2006 ).

Adolescents who were involved in cyberbullying as both perpetrators and targets have been found to be most at risk for negative mental and physical health consequences, compared to those who were only perpetrators, those who were only targets, or those who only witnessed bullying ( Kowalski and Limber, 2013 ; Nixon, 2014 ). For example, the results from a study by Kowalski and Limber (2013) that examined the relation between children's and adolescents' experiences with cyberbullying or traditional bullying and outcomes of psychological health, physical health, and academic performance showed that students who were both perpetrators and targets had the most negative scores on most measures of psychological health, physical health, and academic performance, when compared to those who were only perpetrators, only targets, or only witnesses of bullying incidents.

Wolke and colleagues (2001) examined the association of direct and relational bullying experience with common health problems and found that students ages 6-9 who bullied others and were also bullied by others had more physical health symptoms than children who were only perpetrators or were not involved in bullying behavior. Hunter and colleagues (2014) evaluated whether adolescents who were involved in bullying experienced sleep difficulties more than adolescents who were not involved. They analyzed surveys that were originally collected on behalf of the UK National Health Service and had been completed by adolescents ages 11-17. Controlling for gender, school-stage, socioeconomic status, ethnicity, and other factors known to be associated with sleep difficulties—alcohol consumption, tea or coffee consumption, and illegal drug use—the authors found that individuals who were both perpetrators and targets in bullying incidents were almost three times more likely ( OR = 2.90, 95% CI [1.17, 4.92]) to experience these sleep difficulties, compared to uninvolved young people. Additional research is needed to identify the mechanisms underlying short- and long-term physical health outcomes of individuals who bully and are also bullied.

There is evidence that individuals who are both perpetrators and targets of bullying have the poorest psychosocial profile among individuals with any involvement in bullying behavior; their psychosocial maladjustment, peer relationships, and health problems are similar to individuals who are only bullied, while their school bonding and substance use is similar to individuals who are only perpetrators ( Graham et al., 2006 ; Nansel et al., 2001 , 2004 ). Individuals who both bully and are also bullied by others experience a greater variety of both internalizing and externalizing symptoms than those who only bully or those who are only bullied ( Kim et al., 2006 ).

Some meta-analyses have examined the association between involvement in bullying and internalizing problems in the school-age population and concluded that that individuals who are both perpetrators and targets of bullying had a significantly higher risk for psychosomatic problems than individuals who were only perpetrators or who were only targets ( Gini and Pozzoli, 2009 ; Reijntjes et al., 2010 ). In their meta-analysis, Gini and Pozzoli (2009) reviewed studies that examined the association between involvement in bullying and psychosomatic complaints in children and adolescents. Analysis of a subgroup of studies ( N = 5) that reported analyses for individuals who bully and are also bullied by others showed that these individuals have a significantly higher risk for psychosomatic problems than uninvolved peers ( OR = 2.22, 95% CI [1.77, 2.77]).

Studies suggest that individuals who bully and who are also bullied by others are especially at risk for suicidal ideation and behavior, due to increased mental health problems (see Holt et al., 2015 , and Box 4-1 ).

Suicidality: A Summary of the Available Meta-Analyses.

Similar to individuals who bully, individuals who bully and are also bullied by others often demonstrate heightened aggression compared with non-involved peers. Compared to these other groups, they are by far the most socially ostracized by their peers, most likely to display conduct problems, and least engaged in school, compared with those who are either just perpetrators or just targets; they also report elevated levels of depression and loneliness ( Juvonen et al., 2003 ). Additional research is needed that examines the unique consequences of those children and youth characterized as “bully-victims” because often they are not separated out from “pure victims” (those who are bullied only) in studies. School shootings are a violent externalizing behavior that has been associated with consequences of bullying behavior in the popular media (see Box 4-2 for additional detail).

Bullying and School Shootings.

Several studies have examined the associations between bullying involvement in adolescence and mental health problems in adulthood and have found that individuals who have bullied others and have also been bullied had increased risk of high levels of critical symptoms of psychosis compared to non-involved peers ( Gini, 2008 ; Sigurdson et al., 2015 ). Research is limited in this area, and the topic warrants further investigation.

• CONSEQUENCES OF BULLYING FOR BYSTANDERS

Bullying cannot be viewed as an isolated phenomenon; it is intertwined within the particular peer ecology that emerges, an ecology constituted of social processes that serve particular functions for the individual and for the group ( Rodkin, 2004 ). Bullying frequently occurs in the presence of children and youth who are bystanders or witnesses. Research indicates that bullying can have significant adverse effects on these bystanders ( Polanin et al., 2012 ).

Bystanders have reported feelings of anxiety and insecurity ( Rigby and Slee, 1993 ) which stemmed, in part, from fears of retaliation ( Musher-Eizenman et al., 2004 ) and which often prevented bystanders from seeking help ( Unnever and Cornell, 2003 ). In a study to explore the impact of bullying on the mental health of students who witness it, Rivers and colleagues (2009) surveyed 2,002 students, ages 12-16 and attending 14 schools in the United Kingdom, using a questionnaire that included measures of bullying at school, substance abuse, and mental health risk. They found that witnessing bullying significantly predicted elevated mental health risks even after controlling for the effect of also being a perpetrator or victim (range of = .07 to .15). They also found that being a witness to the bullying predicted elevated levels (= .06) of substance use. Rivers and Noret (2013) found that, compared to students who were not involved in bullying, those who observed bullying reported more symptoms of interpersonal sensitivity (e.g., feelings of being hurt or inferior), helplessness, and potential suicide ideation.

In conclusion, there is very limited research available on the consequences of witnessing bullying for those children and youth who are the bystanders. Studies of bystander behavior have traditionally sought to understand their motives for participation in bullying ( Salmivalli, 2010 ), their roles ( Lodge and Frydenberg, 2005 ; Salmivalli et al., 1996 ), their behavior (either reinforcing the bully or defending the victim) in bullying situations ( Salmivalli et al., 2011 ), and why observers intervene or do not intervene ( Thornberg et al., 2012 ) from a social dynamic perspective, without exploring the emotional and psychological impact of witnessing bullying. More research is needed to understand these consequences.

MULTIPLE EXPOSURES TO VIOLENCE 12

One subpopulation of school-aged youth that may be at increased risk for detrimental short- and long-term outcomes associated with bullying victimization is poly-victims. Finkelhor and colleagues (2007) coined the terms “poly-victim” and “poly-victimization” to represent a subset of youth who experience multiple victimizations of different kinds—such as exposure to (1) violent and property crimes (e.g., assault, sexual assault, theft, burglary), (2) child welfare violations (child abuse, family abduction), (3) the violence of warfare and civil disturbances, and (4) being targets of bullying behavior—and who manifest high levels of traumatic symptomatology. The identification of a poly-victim is grounded not only in the frequency of the victimization but also in victimization across multiple contexts and perpetrators ( Finkelhor et al., 2007 , 2009 ).

Ford and colleagues (2010) determined that poly-victims were more likely to meet criteria for psychiatric disorder, including being two times more likely to report depressive symptoms, three times more likely to report posttraumatic stress disorder, up to five times more likely to use alcohol or drugs, and up to eight times more likely to have comorbid disorders, compared to youth that did not meet criteria for poly-victimization. Poly-victims often engaged in delinquent behavior, associated with deviant peers ( Ford et al., 2010 ), and were entrenched within the juvenile justice system ( Ford et al., 2013 ). Students who were poly-victims in the juvenile justice system reported higher levels of traumatic symptomatology ( Finkelhor et al., 2005 ). However, it is currently unclear whether being bullied plays a major or minor role in poly-victimization.

• MECHANISMS FOR THE PSYCHOLOGICAL EFFECTS OF BULLYING

In the following sections, the committee describes five potential mechanisms for the psychological effects of bullying behavior for both the children who are bullied and children who bully. These include self-blame, social cognition, emotional dysregulation, genetic predisposition to mental health outcomes and bullying, and telomere erosion. 13

One important mechanism for the psychological effects of bullying is how the targets of bullying construe the reason for their plight ( Graham, 2006 ). For example, a history of bullying and the perception of being singled out as a target might lead an individual to ask “Why me ?” In the absence of disconfirming evidence, some might come to blame themselves for their peer relationship problems. Self-blame and accompanying negative affect can then lead to many negative outcomes, including low self-esteem, anxiety, and depression ( Graham and Juvonen, 1998 ).

The adult rape literature (another form of victimization) highlights a correlation between experiencing rape and self-attributions that imply personal deservingness, labeled characterological self-blame, since they may lead to the person thinking of themselves as chronic victims ( Janoff-Bulman, 1979 ). From an attributional perspective, characterological self-blame is internal and therefore reflects on the self; it is stable and therefore leads to an expectation that harassment will be chronic; and it is uncontrollable, suggesting an inability to prevent future harassment. Attributing negative outcomes to internal, stable, and uncontrollable causes leads individuals to feel both hopeless and helpless ( Weiner, 1986 ). In contrast, behavioral self-blame (e.g., “I was in the wrong place at the wrong time”) implies a cause that is both unstable (the harassment is not expected to occur again) and controllable (there are responses in one's repertoire to prevent future harassment). Several researchers in the adult literature have documented that individuals who make characterological self-blaming attributions for negative outcomes cope more poorly, feel worse about themselves, and are more depressed than individuals who make attributions to their behavior (see Anderson et al., 1994 ). Research with early adolescents also revealed that characterological self-blame for academic and social failure resulted in heightened depression ( Cole et al., 1996 ; Tilghman-Osborne et al., 2008 ).

In the first attribution study focused specifically on bullying, Graham and Juvonen (1998) documented that sixth grade students with reputations as targets made more characterological self-blaming attributions for harassment than behavioral self-blaming attributions. Characterological self-blame, in turn, partly mediated the relationship between victim status and psychological maladjustment as measured by depression and social anxiety. Many studies since then have documented the relation between being targets of bullying, characterological self-blame, and maladjustment ( Graham et al., 2006 , 2009 ; Perren et al., 2012 ; Prinstein et al., 2005 ). Furthermore, bullied youth who endorsed characterological self-blame were likely to develop negative expectations about the future, which may also increase risk for continued bullying. For example, Schacter and colleagues (2014) reported that characterological self-blame endorsed in the fall of sixth grade predicted increases in reports of being bullied in the spring of sixth grade. Self-blame can then instigate psychological distress over time as well as increases in experiences of being bullied.

Such findings have implications for interventions targeted at bullied youth. The goal would be to change targets' maladaptive thoughts about the causes of their plight. For example, one could seek more adaptive attributions that could replace characterological self-blame. In some cases, change efforts might target behavioral explanations for being bullied (e.g., “I was in the wrong place at the wrong time”). In such cases, the goal would be to help targeted youth recognize that they have responses in their repertoire to prevent future encounters with harassing peers—that is, the cause is unstable and controllable ( Graham and Bellmore, 2007 ). External attributions also can be adaptive because they protect self-esteem ( Weiner, 1986 ). Knowing that others are also victims or that there are some aggressive youth who randomly single out unsuspecting targets can help lessen the tendency to self-blame ( Graham and Bellmore, 2007 ; Nishina and Juvonen, 2005 ). This approach of altering dysfunctional thoughts about oneself to produce changes in affect and behavior has produced a rich empirical literature on attribution therapy in educational and clinical settings (see Wilson et al., 2002 ). The guiding assumption of that research can be applied to alleviating the plight of targets of bullying.

Social Cognition

The most commonly cited models of social cognitive processes often connect back to work by Bandura (1973) , as well as to more recent conceptualizations by Crick and Dodge (1994) . These models have been applied to understanding aggressive behavior, but there has been less research applying these models to bullying behavior specifically. Related research by Anderson and Bushman (2002) on their general aggression model allows for a more focused understanding of the thoughts, feelings, and behaviors that contribute to the development of the negative outcome. This framework characterizes the inputs, the routes, the proximal processes, and the outcomes associated with aggressive behavior and either being targeted by or perpetrating bullying behavior ( Kowalski and Limber, 2013 ; Vannucci et al., 2012 ). Although these theories pertain to aggressive behavior more broadly, given that bullying is considered by most researchers to be a specific form of aggressive behavior, these broader theories may also improve understanding of the etiology and development of bullying. For example, research on hostile attribution bias suggests that aggressive youth are particularly sensitive to ambiguous and potentially hostile peer behaviors. Similar hypersensitivity to threat is also likely present in youth who bully.

Another particular element of social cognitive processes that has been linked with aggressive behavior is normative beliefs about aggressive retaliation ( Crick and Dodge, 1994 ; Huesmann and Guerra, 1997 ). Such beliefs include the belief that aggressive retaliation is normative, acceptable, or justified, given the context of provocation. There has been exploration of links between these beliefs and both reactive and proactive aggression. However, there has been relatively limited research specifically focused on bullying behavior. Yet, the available literature suggests that although it may seem as if targets of bullying would most likely endorse such attitudes, it is the perpetrators of bullying, including those who are involved in bullying as both a perpetrator and a target, who are mostly likely to support aggressive retaliation ( Bradshaw et al., 2009 , 2013 ; O'Brennan et al., 2009 ).

Emotion Dysregulation

Attempts to identify mechanisms linking bullying to adverse outcomes have largely focused on social-cognitive processes ( Dodge et al., 1990 ) as described above. More recently, researchers have begun to examine emotion dysregulation as an additional mechanism that explains associations between peer victimization and adverse outcomes. Emotion regulation refers to the strategies that people use to “increase, maintain, or decrease one or more components of an emotional response” ( Gross, 2001 , p. 215). One's choices among such strategies have implications not only for how robustly one responds to a stressor but also for how quickly one can recover from a stressful experience. Several studies have shown that emotion regulation difficulties—also called emotion dysregulation —increase youths' risk of exposure to peer victimization ( Hanish et al., 2004 14 ) and to bullying ( Mahady Wilton et al., 2000 ). However, it is important to understand whether peer victimization itself causes emotion regulation difficulties, which in turn predict the adverse outcomes that result from peer victimization (e.g., depression, aggressive behaviors).

Several lines of evidence support the hypothesis that emotion dysregulation may account for the relationship between peer victimization and adverse outcomes among adolescents. First, constructs that are related to peer victimization—including social exclusion ( Baumeister et al., 2005 ) and stigma ( Inzlicht et al., 2006 )—impair self-regulation. Second, chronic stress during childhood and adolescence leads to deficits in emotion regulation ( Repetti et al., 2002 ). Bullying has been conceptualized as a chronic stressor for children who are the perpetrators and the targets ( Swearer and Hymel, 2015 ), which in turn may disrupt emotion regulation processes. Third, laboratory-based studies have indicated that peer victimization is associated with emotion dysregulation (e.g., self-directed negative emotion, emotional arousal and reactivity) in the context of a novel peer interaction ( Rudolph et al., 2009 ) and in a contrived play-group procedure ( Schwartz et al., 1993 ). Over time, the effort required to manage the increased arousal and negative affect associated with peer victimization 15 may eventually diminish individuals' coping resources and therefore their ability to understand and adaptively manage their emotions, leaving them more vulnerable to adverse outcomes ( McLaughlin et al., 2009 ).

Several studies have provided empirical support for emotion dysregulation as a mediator of the association between peer victimization and adverse outcomes among adolescents. In one of the first longitudinal demonstrations of mediation, McLaughlin and colleagues (2009) , using data from a large, prospective study of adolescents (ages 11-14), showed that peer victimization at baseline predicted increases in emotion dysregulation four months later, controlling for initial levels of emotion dysregulation. In turn, emotion dysregulation predicted subsequent psychological distress (depressive and anxious symptoms), thereby mediating the prospective relationship between peer victimization (relational and reputational forms) and internalizing symptoms ( McLaughlin et al., 2009 ). Subsequent research from this same sample of adolescents showed that emotion dysregulation also mediated the prospective relationship between peer victimization and subsequent aggressive behavior ( Herts et al., 2012 ).

There is also emerging evidence that emotion regulation mediates relationships between bullying and adverse outcomes. In one example of this work, Cosma et al. (2012) examined associations between bullying and several emotion regulation strategies, including rumination, catastrophizing, and other-blaming, in a sample of adolescents. Although bullying was predictive for each of these emotion regulation strategies, only one (catastrophizing) mediated the relationship between being a target of bullying and subsequent emotional problems. Thus, while more research is needed, existing evidence suggests that both social-cognitive and emotion regulation processes may be important targets for preventive interventions among youths exposed to peer victimization and bullying.

Genetic Predisposition to Mental Health Outcomes and Bullying

Longitudinal research suggests that being the victim or perpetrator of bullying does not lead to the same pathological or nonpathological outcomes in every person ( McDougall and Vaillancourt, 2015 ). There are many factors that contribute to how a person responds to the experience of being victimized, with very strong links already established with life experiences, as reviewed above. Most studies examining heterogeneity in outcomes associated with bullying have focused on environmental characteristics, such as individual, family, and school-level features to explain why some individuals fare better or worse when involved with bullying ( Vaillancourt et al., in press ). For example, the moderating role of the family has been examined with results indicating that bullied children and youth with better home environments tend to fare better than those living with more complicated families ( Flouri and Buchanan, 2003 ; also see Chapter 3 of this report). Far fewer studies have examined the role of potential genetic influences as mediators between life experiences such as bullying and mental health outcomes. Identifying potential genetic influences is critical for improving understanding of the rich behavioral and epidemiological data already gathered. At the present time, evidence-based understanding of physiology and neuroscience is very limited, and insufficient data have been gathered to produce informed hypothesis testing.

There is a growing body of literature examining the relative role of genes' interaction with the environment in relation to experiences with trauma. However, there are fewer studies exploring potential relations between genes and being the target or perpetrator of bullying. At first glance these studies may appear to suggest that a person's involvement with bullying is predetermined based on his/her genetic profile. Yet, it is important to bear in mind that heritable factors are also associated with specific environments—meaning it is difficult to separate genetic effects from environmental effects. This is a phenomenon termed gene-environment correlations , abbreviated as rGE ( Brendgen, 2012 ; Plomin et al., 1977 ; Scarr and McCartney, 1983 ). For example, aggression, which is highly heritable ( Niv et al., 2013 ), can be linked to the selection of environments in different ways (for review, see Brendgen, 2012 ). Aggressive children may choose friends who are similar in their genetically influenced behavioral characteristic of being aggressive, and this type of selection influences the characteristics of their peer group ( Brendgen, 2012 , p. 420). This is an example of selective rGE. A child's genetically influenced characteristic to be aggressive can also produce a negative reaction from others, such as being disliked. This environmental variable of being rejected now “becomes correlated with the aggressive genotype” ( Brendgen, 2012 , p. 421). This is an example of evocative rGE. Another way that a person's genetic predisposition can be correlated with their environment is through a more passive process, called a passive rGE ( Brendgen, 2012 ). For example, aggressive parents may be more likely to live in high-crime neighborhoods, which influence the probability that their child will be associating with antisocial peers. These important rGE processes and confounds of interaction notwithstanding, it is worth mentioning that the research on the genetics of being a target or perpetrator of bullying is still in its infancy, and caution is needed when evaluating the results, as replication is much needed in this area. Before considering these studies, the committee first reviews the concept of how genetic differences influence behavior because it is important to clarify new concepts in this burgeoning area of science (see Box 4-3 ).

How Do Genes Influence Behavior?

With this backdrop in mind, the committee focused on twin studies of familial (family environment) versus genetic influence, gene by environment interaction, and a newer area of inquiry, epigenetics: the study of cellular and physiological phenotypic trait variations caused by external or environmental factors.

Twin Studies

Twin studies are routinely used to examine the relative influence of genetics and the environment on a particular phenomenon, such as being the target or perpetrator of bullying. In these studies, the causes of phenotypic variation (for example the variation in being a target or perpetrator of bullying) is separated into three components: (1) the additive genetic component or the heritable factor; (2) the shared environment component or the aspect of the environment twins share such as poor family functioning; and (3) the nonshared environment component or the aspect of the environment that is unique to each twin, such as the classroom if twins are in different classes.

Studies that decompose the unique effects of the environment and genetics on bullying behavior are best illustrated by two examples. Using data from the Environmental Risk (E-Risk) Longitudinal Twin Study, a study of high-risk 16 British twins reared together and apart, Ball and colleagues (2008) examined children's involvement in bullying and the genetic versus environmental contributions associated with their involvement. The twins in this study were assessed at ages 7 and 10 on their experiences with bullying, using teacher and parent reports. Results indicated that 73 percent of the variation in being the target of bullying and 61 percent of the variation in bullying perpetration were accounted for by genetic factors. In another study of Canadian twins reared together and assessed at age 7, using teacher and peer reports to assess peer victimization and aggression, Brendgen and colleagues (2008) found that for girls, 60 percent of the variation in aggression was accounted for by genetic factors and for boys, the variation estimate was 66 percent. For peer victimization, the Canadian study found that genetics did not play a role in the prediction of being targeted by peers. In fact, almost all of the variance was accounted for by environmental factors—29 percent of the variance in peer victimization was from the shared environment and 71 percent from the nonshared environment. The authors concluded that “genetic modeling showed that peer victimization is an environmentally driven variable that is unrelated to children's genetic disposition” ( Brendgen et al., 2008 , p. 455).

These two studies address the role genetics might play in the expression of aggressive behavior but conflict on the heritability of being a target of bullying. Most studies examining the heritability of externalizing problems, which includes studies on perpetrating aggression and bullying, report high heritability estimates. In fact, a recent meta-analysis found that aggression and rule-breaking were highly influenced by genetics, estimating the heritability rate at 41 percent ( Niv et al., 2013 ). Moreover, studies have found that the heritability estimates tend to be higher for more serious forms of antisocial behavior. For example, the heritability of psychopathy in 7-year-old British twin children reared together and apart and studied in the Twins Early Development Study was reported to be 81 percent ( Viding et al., 2005 ). However, estimates of the heritability of peer victimization vary across studies, as illustrated by the above results from Ball and colleagues (2008) contrasted with those from Brendgen and colleagues (2008) , and even within studies ( Brendgen et al., 2008 , 2013 ).

Brendgen and colleagues have since revised their assessment about the role genetics play in the prediction of being the target of bullying. In a more recent study, following the same children highlighted in the 2008 paper ( Brendgen et al., 2008 ) across three assessment periods (kindergarten, grade 1, and grade 4), Boivin and colleagues (2013) reported that at each grade, among twins who were reared together and apart, genetic factors accounted for a notable percentage of the variance in children's difficulties with peers. Peer difficulties were assessed as a latent factor derived from self-, teacher-, and peer-reports of peer victimization 17 and peer rejection. Specifically, in kindergarten and grade 1, 73 percent of the variance was accounted by genetic factors and in grade 4, genetic factors account for 94 percent of the variance in peer rejection and victimization.

There are several reasons for discrepancies between and within studies of the genetic contribution to bullying behavior. One reason is related to how peer victimization is assessed. Parent-, teacher-, peer-, and self-reports of bullying victimization have been shown to vary considerably across reporters ( Ostrov and Kamper, 2015 ; Patton et al., 2015 ; Shakoor et al., 2011 ); thus, the method used to assess involvement with bullying may lead to different results. Another reason for the differences may be related to development. The influence of the environment is expected to change as children age. Young children are particularly sensitive to family influences, while the influence of peers tends to matter more during adolescence ( Harris, 1995 ). Moreover, the type of environment a person is exposed to (i.e., harsh or nurturing) interacts with genes to produce a brain that is tailored to deal with the particular demands of that environment.

Taken together, the genetic studies reviewed suggest that aggression, which characterizes the perpetrator role in bullying ( Vaillancourt et al., 2008 ), might have heritable components, but the findings on being the target of bullying or other aggressive behavior are mixed. Thus, the role of genetic influences on both perpetrating and being a target of bullying requires more empirical attention before conclusions can be drawn.

Gene-by-Environment Interactions

Researchers also question whether specific genotypic markers of vulnerability (e.g., candidate genes) influence developmental outcomes in the face of adversity (i.e., environment). Importantly, there is some indication that genetics influences the mental health issues related to bullying highlighted above, such as depression and heightened aggression. For example, in gene-environment studies, candidate genes have been examined as moderators of the exposure to a toxic stressor such as child maltreatment and health outcomes such as depression. When the body experiences repeated bouts of stress that fail to resolve quickly, the heightened state of vigilance and preparedness depletes it of resources and the stress hormone cortisol begins to produce adverse effects. Specifically, prolonged stress disrupts brain functions and results in compromised decision making, faulty cognitive assessment, compromised learning and memory, and a heightened sense of threat that alters behavior ( Lupien et al., 2005 ; McEwen, 2014 ). There is evidence that the impact of changes in cortisol (either too high or too low) on learning may contribute, in part, to bullied children's decline in academic performance ( Vaillancourt et al., 2011 ), overeating/metabolic disorder, or emotional dysregulation, but this research is relatively new and needs to be explicitly explored within the context of bullying ( McEwen, 2014 ).

A paradigmatic example of this type of study is one by Caspi and colleagues (2003) , in which the moderating role of a functional polymorphism in the promoter region of the serotonin transporter gene 5-HTTLPR was examined in relation to exposure to maltreatment in childhood and depression in adulthood. Results indicated that depression rates were far greater among abused individuals if they had two copies of the short allele. 18 Among individuals with a long allele, depression rates were lower, suggesting that the long allele was protective, while the short allele was a risk factor for depression in the face of adversity. Although the exact role of this serotonin-related gene has been a subject of controversy, a meta-analysis concluded that overall, the results are consistent across studies ( Karg et al., 2011 ). Nevertheless, skepticism and controversy remain regarding studies of gene-environment interactions ( Dick et al., 2015 ; Duncan, 2013 ; Duncan and Keller, 2011 ; Duncan et al., 2014 ). This important debate notwithstanding, there is evidence that variations in genotype might moderate the relation between exposure to being bullied and health outcomes. For example, Sugden and colleagues (2010) found that bullied children who carried two short versions of the 5-HTTLPR gene were more likely to develop emotional problems than bullied children who carried the long allele. Importantly, this moderating effect was present even when pre-victimization emotional problems were accounted for statistically. In addition to this study, three other studies have demonstrated the moderating effect of the 5-HTTLPR gene in the bullying-health link ( Banny et al., 2013 ; Benjet et al., 2010 ; Iyer et al., 2013 ), with depression being worse for carriers of the short/short genotype (both alleles are the short version) than carriers of the short/long and long/long genotypes.

Although the evidence suggests that genotypes moderate the relation between being a target of bullying and poorer mental health functioning like depression, it is important to acknowledge that this relation is more complex. Indeed, some individuals may be particularly biologically sensitive to negative environmental influences such as being bullied, but this genetic vulnerability can also be linked to better outcomes in the context of a more supportive and enriched environment (see Vaillancourt et al., in press ). This phenomenon is termed differential susceptibility ( Belsky and Pluess, 2009 ; Boyce and Ellis, 2005 ). For example, in their study of 5 and 6-year old children, Obradovic and colleagues (2010) found that high stress reactivity as measured using respiratory sinus arrhythmia and salivary cortisol was linked to poorer socioemotional behavior in the context of being in an environment that was high in family adversity. In a context characterized by lower adversity, high stress-reactive children had more adaptive outcomes.

To the committee's knowledge, there are no studies that have examined bullying perpetration in relation to serotonin transporter polymorphisms, although there are studies that have examined this polymorphism in aggressive and non-aggressive children. For example, Beitchman et al. (2006) examined 5-HTTLPR in clinically referred children between the ages of 5 and 15 and found a positive association between the short/short genotype and aggression. In other studies, the short allele has been associated with problems with impulse control that includes the use of aggression ( Retz et al., 2004 ).

The moderating role of different candidate genes has also been examined in relation to exposure to childhood adversity and poorer developmental outcomes (see review by Vaillancourt et al., in press ). With respect to bullying, only a few studies have examined gene-environment interactions. In one study by Whelan and colleagues (2014) , harsh parenting was associated with increased peer victimization and perpetration, but this effect was not moderated by the Monoamine Oxidase A (MAOA) genotype. 19 In another longitudinal study, Kretschmer and colleagues (2013) found that carriers of the 4-repeat homozygous variant of the dopamine receptor D4 gene were more susceptible to the effects of peer victimization 20 on delinquency later in adolescence than noncarriers of this allele. Finally, in a large sample of post-institutionalized children from 25 countries, VanZomeren-Dohm and colleagues (2015) examined the moderating role of FKBP5 rs1360780 21 in the relation between peer victimization 22 and depression symptoms. In this study, gender was also found to be a moderator. Specifically, girls who had the minor genotype (TT or CT) were more depressed at higher levels of peer victimization, but less depressed at lower level of peer victimization than girls who had CC genotype. For boys, the CC genotype was associated with more symptoms of depression than girls with the same CC genotype who had been bullied.

It is clear that genetics influences how experiences contribute to mental and physical well-being, although the specifics of these gene-environment interactions are complex and not completely understood. Even though genes appear to modulate humans' response to being a target or a perpetrator of bullying behavior, it is still unclear what aspects of these experiences are interacting with genes and which genes are implicated to produce the variability in outcomes. Human genes and environment interact in a very complex manner: what biological events a particular gene influences can change at different stages of development. That gene therefore interacts with the environment in unique ways across the development timeline. These gene-environment interactions can be subtle and are under constant flux ( Lake and Chan, 2015 ). Knowing both the genes involved and the specific environment conditions is critically important to understanding these interactions; a simplistic view of either the genetic or environmental component, especially when considered in isolation from the behavioral literature, is unlikely to be productive.

Epigenetic Consequences

It is clear from the research reviewed here that there are a variety of pathways leading to adaptive and maladaptive endpoints and that these pathways can also vary within the “system” along with other conditions and attributes ( McDougall and Vaillancourt, 2015 , p. 300), including a person's genetic susceptibility. In this section, the committee focuses on studies examining how genetic susceptibility can make certain individuals more sensitive to negative environmental influences.

Although a person's DNA is fixed at conception (i.e., nonmalleable), environment can have a strong effect on how some genes are used at each of the stages of development. One way such changes in gene use and expression can occur is through an epigenetic effect, in which environmental events alter the portions of the genome that control when gene replication is turned on or off and what parts of a gene get transcribed ( McGowan et al., 2009 ; Roth, 2014 ). That is, while an individual's genetic information is critically important, the environment can help to increase or decrease how some genetic information is used by indirectly turning on or off some genes based on input received by somatic cells from the environment. Such epigenetic alterations have been empirically validated in several animal studies. For example, in one line of epigenetic studies, infant rat pups are raised with either low- or high-nurturing mothers or with mothers that treated the pups harshly. The researchers found that the type of maternal care received in infancy had a notable effect on the rats' subsequent ability to deal with stress ( McGowan et al., 2011 ; Roth and Sweatt, 2011 ; Weaver et al., 2004 ). The behavioral effects were correlated with changes in DNA methylation. 23 Epigenetic changes associated with gene-environment interactions is a new and exciting research area that provide a direct link between how our genes are read and is thought to enable us to pass our experiences to the next generations. It is helpful to think of genes as books in a library and epigenetics as placing a barrier in front of a book to decrease the chances it is read or providing easy access to the book. Thus far, research has found that certain epigenetic mechanisms are strongly correlated with different neurobehavioral developmental trajectories, including changes in vulnerability and resilience to psychopathology. How epigenetics relates to individual responses to being a target or perpetrator of bullying is not clear, but the research in related areas of behavior highlights an important emerging area for investigation.

Various epigenetic processes appear to interact with many changes in the brain produced by early life experiences, including not only the number and shape of brain cells but also how these cells connect to one another at synapses ( Hanson et al., 2015 ).

Regarding bullying, the committee identified only one study that has examined epigenetic changes. Specifically, Ouellet-Morin and colleagues (2013) found an increase in DNA methylation of the serotonin transporter gene for children who had been bullied by their peers but not in children who had not been bullied. These researchers also found that children with higher serotonin DNA methylation had a blunted cortisol response to stress, which they had previously shown changes as a consequence of poor treatment by peers ( Ouellet-Morin et al., 2011 ). That is, their 2011 study of twin children assessed at ages 5 and 10 found that being bullied was correlated with a change in how the body responds to stress. Bullied children displayed a blunted cortisol response to a psychosocial stress test. Because the design of the study involved an examination of identical twins who were discordant with respect to their experiences of being bullied (one twin was bullied while the other one was not), Ouellet-Morin and colleagues (2011) concluded that the effect could not be attributed to “variations in either genetic makeup, family environment, or other concomitant factors, nor could they be attributed to the twins' perceptions of the degree of stress experienced during the task” ( Vaillancourt et al., 2013a , p. 243).

In summary, it is important to note that there is no gene for being a perpetrator or a target of bullying behavior. Based on current knowledge of the genetics of complex social behavior, such as bullying, the genetic component of individual response is likely to involve multiple genes that interact with the environment in a complex manner. The current understanding of genetics and complex behaviors is that genes do not cause a behavior; gene-by-environment studies do not use the word “environment” the same way it is used in everyday language or even in traditional social psychology (as in Chapter 3 ). Rather, it is a construct used in a model to estimate how much variability exists in a given environment. This means that the same gene placed in different environments would yield very different percentages for gene-environment interactions. It is unclear how this information would inform our understanding of bullying.

Telomere Erosion Consequences

Epigenetic research has found that negative life experiences can alter the expression of a gene, which in turn, can confer a risk for poor outcomes. Research also suggests that the experience of being bullied is associated with telomere erosion. The end of each chromatid has been found to shorten as people age; this telomere “tail” also erodes as a function of engaging in unhealthy behavior such as smoking or being obese. Telomere erosion is also associated with certain illnesses such as cancer, diabetes, and heart disease ( Blackburn and Epel, 2012 ; Kiecolt-Glaser et al., 2011 ; Vaillancourt et al., 2013a ). Given these associations, scientists are now examining telomere erosion as a biomarker of stress exposure ( Epel et al., 2004 ), including the stress of being bullied by peers.

A recent longitudinal study by Shalev and colleagues (2013) examined telomere erosion in relation to children's exposure to violence, 24 a significant early-life stressor that is known to have long-term consequences for health. They found that exposure to violence, including being a target of bullying, was associated with telomere erosion for children assessed at age 5 and again at age 10. The sample for this study included 236 children recruited from the Environmental-Risk Longitudinal Twin Study ( Moffitt, 2002 ), 42 percent of whom had one or more exposures to violence. The study found that cumulative exposure to violence 25 is positively associated with accelerated telomere erosion in children, from baseline to follow-up, with potential impact for life-long health ( Shalev et al., 2013 ).

In this chapter, the committee reviewed and critically analyzed the available research on the physical health, psychosocial, and academic achievement consequences for children and youth who are bullied, for those who bully, for those who are both bullied and bullies, and for those who are bystanders to events of bullying. It also examined the potential mediating mechanisms of, and the genetic predisposition to, mental health outcomes associated with childhood and youth experiences of bullying behavior. Most studies are cross-sectional and thus provide only associations suggestive of a possible causal effect. This problem is most acute for studies based on anonymous self-report, in which both the independent variable (experience of bullying in one or more roles) and dependent variables (such as emotional adjustment) are data collected at the same time from sources subject to various forms of bias.

The limited amount of data from longitudinal and experimental research designs limits the ability to draw conclusions with respect to causality. Additional longitudinal studies, for example, could help establish that the negative consequences attributed to bullying were not present before the bullying occurred. But even this does not prove a causal effect, since bullying and the associated impairments might be products of some third factor. Below, the committee summarizes what is known about associations and consequences and identifies key conclusions that can be drawn from this evidence base.

• FINDINGS AND CONCLUSIONS

Finding 4.1: Individuals who both bully and are also bullied by others experience a greater variety of both internalizing and externalizing symptoms than those who only bully or are only bullied. Finding 4.2: Individuals who bully others are likely to experience negative emotional, behavioral, and mental health outcomes, though most research has not distinguished perpetration of bullying from other forms of peer aggression. Finding 4.3: A large body of research indicates that individuals who have been bullied are at increased risk of subsequent mental, emotional, and behavioral problems, especially internalizing problems. Finding 4.4: Studies of bystander behavior in bullying have rarely examined the emotional and psychological impact of witnessing bullying. Finding 4.5: Children and youth who are bullied subsequently experience a range of somatic disturbances. Finding 4.6: Social-cognitive factors (e.g., self-blame) and unsuccessful emotion regulation (i.e., emotion dysregulation) mediate relationships between bullying and adverse outcomes. Finding 4.7: There is evidence that stressful events, such as might occur with experiences of being bullied, alter emotional brain circuits. This potential outcome is critically in need of further investigation. Finding 4.8: Genetics influences how experiences contribute to mental and physical well-being, although the nature of this relationship is complex and not completely understood. Finding 4.9: Emerging evidence suggests that repeated exposure to bullying may produce a neural signature that could underlie some of the behavioral outcomes associated with being bullied. Finding 4.10: There are limited data on the physical health consequence of bullying for those individuals who are involved in bullying as targets, perpetrators, as both targets and perpetrators, and as bystanders. Finding 4.11: Poly-victims (individuals who are targets of multiple types of aggression) are more likely to experience negative emotional, behavioral, and mental health outcomes than individuals targeted with only one form of aggression. Finding 4.12: The long-term consequences of being bullied extend into adulthood and the effects can be more severe than other forms of being maltreated as a child. Finding 4.13: Individuals who are involved in bullying (as perpetrators, targets, or both) in any capacity are significantly more likely to contemplate or attempt suicide, compared to children who are not involved in bullying. It is not known whether bystanders are at increased risk of suicidal ideation or suicide attempts. Finding 4.14: There is not enough evidence to date to conclude that being the target of bullying is a causal factor for multiple-homicide targeted school shootings, nor is there clear evidence on how experience as a target or perpetrator of bullying, or the mental health and behavior issues related to such experiences, contribute to school shootings.

Conclusions

Conclusion 4.1: Further research is needed to obtain more in-depth evidence on the physical health consequences of being the target of bullying including neural consequences. Conclusion 4.2: Additional research is needed to examine mediators of short- and long-term physical health outcomes of individuals who are bullied. Evidence is also needed regarding how these outcomes vary over time for different groups of children and youth, why individuals with similar experiences of being bullied might have different physical health outcomes, and how physical and emotional health outcomes intersect over time. Conclusion 4.3: Although the effects of being bullied on the brain are not yet fully understood, there are changes in the stress response systems and in the brain that are associated with increased risk for mental health problems, cognitive function, self-regulation, and other physical health problems. Conclusion 4.4: Bullying has significant short- and long-term internalizing and externalizing psychological consequences for the children who are involved in bullying behavior. Conclusion 4.5: The data are unclear on the role of bullying as one of or a precipitating cause of school shootings. Conclusion 4.6: Individuals who both bully others and are themselves bullied appear to be at greatest risk for poor psychosocial outcomes, compared to those who only bully or are only bullied and to those who are not bullied. Conclusion 4.7: While cross-sectional studies indicate that children who are bullied are at increased risk for poor academic achievement relative to those who are not bullied, the results from longitudinal studies are inconsistent and warrant more research. Conclusion 4.8: Existing evidence suggests that both social-cognitive and emotion regulation processes may mediate the relation between being bullied and adverse mental health outcomes. Conclusion 4.9: Although genes appear to modulate humans' response to being either a target or a perpetrator of bullying behavior, it is still unclear what aspects of these experiences are interacting with genes and which genes are implicated to produce the variability in outcomes. Examining the role of genes in bullying in the context of the environment is essential to providing meaningful information on the genetic component of individual differences in outcomes from being a target or a perpetrator of bullying behavior.

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Somatization is “a syndrome of physical symptoms that are distressing and may not be fully explained by a known medical condition after appropriate investigation. In addition, the symptoms may be caused or exacerbated by anxiety, depression, and interpersonal conflicts, and it is common for somatization, depression, and anxiety to all occur together” ( Greenberg, 2016 ).

Consolidation of memory is a biological process where the information one learns is stabilized within neural circuits and placed into long-term memory through a complex orchestration of molecular-level change and gene activation within neurons.

Peer victimization was measured with a 21-item revised version of the Social Experiences Questionnaire. The measure assesses overt and relational victimization and frequency of different acts of victimization ( Rudolph et al., 2016 ).

Reijntjes and colleagues (2010, p. 244) defined peer victimization as taking “various forms, including direct bullying behaviors (e.g., teasing, physical aggression) as well as more indirect manifestations such as group exclusion or malicious gossip.” Hawker and Boulton (2000, p. 441) defined peer victimization as “the experience among children of being a target of the aggressive behavior of other children, who are not siblings and not necessarily age-mates.”

Peer victimization was measured using peer, self-, and teacher reports, including peer nominations, a four-item self-report victimization scale, and a six-item teacher report victimization scale ( Kochel et al., 2012 ).

Stapinski et al. (2014) used a modified version of the Bullying and Friendship Interview Schedule to assess self-reported peer victimization. This measure includes items on overt victimization, such as threats, physical violence, and relational victimization.

Nonclinical psychotic symptoms are symptoms that do not meet the clinical definition for those psychotic disorders associated with such symptoms.

Peer victimization was measured using a modified six-item version of the Peer Victimization Scale, which asks students to select a statement that is most like them. Higher scores indicated higher levels of peer victimization ( Juvonen et al., 2011 ).

Peer victimization was measured using a 16-item peer nomination interview and a teacher-completed Social Behavior Rating Scale ( Schwartz et al., 2005 ).

Peer victimization is used here to include the broader category of bullying, peer victimization, and bullying behavior.

Psychotic experiences included hallucinations (visual and auditory), delusions (spied on, persecution, thoughts read, reference, control, grandiosity), and experiences of thought interference (broadcasting, insertion, and withdrawal), and any unspecified delusions.

This section is adapted from Rose (2015 , pp. 18-21).

A telomere is the “segment at the end of each chromosome arm which consists of a series of repeated DNA sequences that regulate chromosomal replication at each cell division.” See http://ghr ​.nlm.nih.gov/glossary=telomere [December 2015]. Telomeres are associated with “chromosomal stability” and the regulation of “cells' cellular replicative lifespan” (Kiecolt-Glaser et al., 2011, p. 16).

Peer victimization was measured by a teacher-reported seven-item measure with items measuring broader peer victimization (Hanish et al., 2004).

Peer victimization was measured using the Revised Peer Experiences Questionnaire, which assesses overt, relational, and reputational victimization by peers (McLaughlin et al., 2009).

High risk was defined as a mother who had her first child at age 20 or younger ( Moffitt, 2002 ).

Peer victimization was assessed through teacher, peer, and self-ratings. Children were asked to circle photographs of two classmates who get called names by other children and who are often pushed or hit by other children.

An allele is an alternate form of the same gene. Except for the XY chromosomes in males, human chromosomes are paired, so a cell's genome usually has two alleles for each gene.

The MAOA genotype has been called the “warrior” gene because of its association with aggression in studies using surveys and observations ( McDermott et al., 2009 ).

Peer victimization was measured using a teacher-report 3-item scale that assessed relational victimization in the classroom ( Kretschmer et al., 2013 ).

The FKBP5 rs1360780 gene is associated with a number of different psychological disorders ( Wilker et al., 2014 ).

VanZomeren-Dohm and colleagues (2015 measured peer victimization using the MacArthur Health and Behavior Questionnaire Parent-Form, version 2.1, in which parents reported on their children's experiences of overt peer victimization.

DNA methylation is a heritable epigenetic mark involving the covalent transfer of a methyl group to the C-5 position of the cytosine ring by DNA methyltransferases (a family of enzymes that act on DNA). Cytosine is one of the four bases that occur in varying sequences to form the “code” carried by strands of DNA ( Robertson, 2005 ).

Exposure to violence included domestic violence, bullying victimization, and physical abuse by an adult.

Cumulative violence exposure was measured by an index that summed each type of violence exposure.

• Cite this Page Committee on the Biological and Psychosocial Effects of Peer Victimization: Lessons for Bullying Prevention; Board on Children, Youth, and Families; Committee on Law and Justice; Division of Behavioral and Social Sciences and Education; Health and Medicine Division; National Academies of Sciences, Engineering, and Medicine; Rivara F, Le Menestrel S, editors. Preventing Bullying Through Science, Policy, and Practice. Washington (DC): National Academies Press (US); 2016 Sep 14. 4, Consequences of Bullying Behavior.
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Preventing Bullying Through Science, Policy, and Practice (2016)

Chapter: 1 introduction, 1 introduction.

Bullying, long tolerated by many as a rite of passage into adulthood, is now recognized as a major and preventable public health problem, one that can have long-lasting consequences ( McDougall and Vaillancourt, 2015 ; Wolke and Lereya, 2015 ). Those consequences—for those who are bullied, for the perpetrators of bullying, and for witnesses who are present during a bullying event—include poor school performance, anxiety, depression, and future delinquent and aggressive behavior. Federal, state, and local governments have responded by adopting laws and implementing programs to prevent bullying and deal with its consequences. However, many of these responses have been undertaken with little attention to what is known about bullying and its effects. Even the definition of bullying varies among both researchers and lawmakers, though it generally includes physical and verbal behavior, behavior leading to social isolation, and behavior that uses digital communications technology (cyberbullying). This report adopts the term “bullying behavior,” which is frequently used in the research field, to cover all of these behaviors.

Bullying behavior is evident as early as preschool, although it peaks during the middle school years ( Currie et al., 2012 ; Vaillancourt et al., 2010 ). It can occur in diverse social settings, including classrooms, school gyms and cafeterias, on school buses, and online. Bullying behavior affects not only the children and youth who are bullied, who bully, and who are both bullied and bully others but also bystanders to bullying incidents. Given the myriad situations in which bullying can occur and the many people who may be involved, identifying effective prevention programs and policies is challenging, and it is unlikely that any one approach will be ap-

propriate in all situations. Commonly used bullying prevention approaches include policies regarding acceptable behavior in schools and behavioral interventions to promote positive cultural norms.

STUDY CHARGE

Recognizing that bullying behavior is a major public health problem that demands the concerted and coordinated time and attention of parents, educators and school administrators, health care providers, policy makers, families, and others concerned with the care of children, a group of federal agencies and private foundations asked the National Academies of Sciences, Engineering, and Medicine to undertake a study of what is known and what needs to be known to further the field of preventing bullying behavior. The Committee on the Biological and Psychosocial Effects of Peer Victimization:

Lessons for Bullying Prevention was created to carry out this task under the Academies’ Board on Children, Youth, and Families and the Committee on Law and Justice. The study received financial support from the Centers for Disease Control and Prevention (CDC), the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Health Resources and Services Administration, the Highmark Foundation, the National Institute of Justice, the Robert Wood Johnson Foundation, Semi J. and Ruth W. Begun Foundation, and the Substance Abuse and Mental Health Services Administration. The full statement of task for the committee is presented in Box 1-1 .

Although the committee acknowledges the importance of this topic as it pertains to all children in the United States and in U.S. territories, this report focuses on the 50 states and the District of Columbia. Also, while the committee acknowledges that bullying behavior occurs in the school

environment for youth in foster care, in juvenile justice facilities, and in other residential treatment facilities, this report does not address bullying behavior in those environments because it is beyond the study charge.

CONTEXT FOR THE STUDY

This section of the report highlights relevant work in the field and, later in the chapter under “The Committee’s Approach,” presents the conceptual framework and corresponding definitions of terms that the committee has adopted.

Historical Context

Bullying behavior was first characterized in the scientific literature as part of the childhood experience more than 100 years ago in “Teasing and Bullying,” published in the Pedagogical Seminary ( Burk, 1897 ). The author described bullying behavior, attempted to delineate causes and cures for the tormenting of others, and called for additional research ( Koo, 2007 ). Nearly a century later, Dan Olweus, a Swedish research professor of psychology in Norway, conducted an intensive study on bullying ( Olweus, 1978 ). The efforts of Olweus brought awareness to the issue and motivated other professionals to conduct their own research, thereby expanding and contributing to knowledge of bullying behavior. Since Olweus’s early work, research on bullying has steadily increased (see Farrington and Ttofi, 2009 ; Hymel and Swearer, 2015 ).

Over the past few decades, venues where bullying behavior occurs have expanded with the advent of the Internet, chat rooms, instant messaging, social media, and other forms of digital electronic communication. These modes of communication have provided a new communal avenue for bullying. While the media reports linking bullying to suicide suggest a causal relationship, the available research suggests that there are often multiple factors that contribute to a youth’s suicide-related ideology and behavior. Several studies, however, have demonstrated an association between bullying involvement and suicide-related ideology and behavior (see, e.g., Holt et al., 2015 ; Kim and Leventhal, 2008 ; Sourander, 2010 ; van Geel et al., 2014 ).

In 2013, the Health Resources and Services Administration of the U.S. Department of Health and Human Services requested that the Institute of Medicine 1 and the National Research Council convene an ad hoc planning committee to plan and conduct a 2-day public workshop to highlight relevant information and knowledge that could inform a multidisciplinary

___________________

1 Prior to 2015, the National Academy of Medicine was known as the Institute of Medicine.

road map on next steps for the field of bullying prevention. Content areas that were explored during the April 2014 workshop included the identification of conceptual models and interventions that have proven effective in decreasing bullying and the antecedents to bullying while increasing protective factors that mitigate the negative health impact of bullying. The discussions highlighted the need for a better understanding of the effectiveness of program interventions in realistic settings; the importance of understanding what works for whom and under what circumstances, as well as the influence of different mediators (i.e., what accounts for associations between variables) and moderators (i.e., what affects the direction or strength of associations between variables) in bullying prevention efforts; and the need for coordination among agencies to prevent and respond to bullying. The workshop summary ( Institute of Medicine and National Research Council, 2014c ) informs this committee’s work.

Federal Efforts to Address Bullying and Related Topics

Currently, there is no comprehensive federal statute that explicitly prohibits bullying among children and adolescents, including cyberbullying. However, in the wake of the growing concerns surrounding the implications of bullying, several federal initiatives do address bullying among children and adolescents, and although some of them do not primarily focus on bullying, they permit some funds to be used for bullying prevention purposes.

The earliest federal initiative was in 1999, when three agencies collaborated to establish the Safe Schools/Healthy Students initiative in response to a series of deadly school shootings in the late 1990s. The program is administered by the U.S. Departments of Education, Health and Human Services, and Justice to prevent youth violence and promote the healthy development of youth. It is jointly funded by the Department of Education and by the Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration. The program has provided grantees with both the opportunity to benefit from collaboration and the tools to sustain it through deliberate planning, more cost-effective service delivery, and a broader funding base ( Substance Abuse and Mental Health Services Administration, 2015 ).

The next major effort was in 2010, when the Department of Education awarded $38.8 million in grants under the Safe and Supportive Schools (S3) Program to 11 states to support statewide measurement of conditions for learning and targeted programmatic interventions to improve conditions for learning, in order to help schools improve safety and reduce substance use. The S3 Program was administered by the Safe and Supportive Schools Group, which also administered the Safe and Drug-Free Schools and Communities Act State and Local Grants Program, authorized by the

1994 Elementary and Secondary Education Act. 2 It was one of several programs related to developing and maintaining safe, disciplined, and drug-free schools. In addition to the S3 grants program, the group administered a number of interagency agreements with a focus on (but not limited to) bullying, school recovery research, data collection, and drug and violence prevention activities ( U.S. Department of Education, 2015 ).

A collaborative effort among the U.S. Departments of Agriculture, Defense, Education, Health and Human Services, Interior, and Justice; the Federal Trade Commission; and the White House Initiative on Asian Americans and Pacific Islanders created the Federal Partners in Bullying Prevention (FPBP) Steering Committee. Led by the U.S. Department of Education, the FPBP works to coordinate policy, research, and communications on bullying topics. The FPBP Website provides extensive resources on bullying behavior, including information on what bullying is, its risk factors, its warning signs, and its effects. 3 The FPBP Steering Committee also plans to provide details on how to get help for those who have been bullied. It also was involved in creating the “Be More than a Bystander” Public Service Announcement campaign with the Ad Council to engage students in bullying prevention. To improve school climate and reduce rates of bullying nationwide, FPBP has sponsored four bullying prevention summits attended by education practitioners, policy makers, researchers, and federal officials.

In 2014, the National Institute of Justice—the scientific research arm of the U.S. Department of Justice—launched the Comprehensive School Safety Initiative with a congressional appropriation of $75 million. The funds are to be used for rigorous research to produce practical knowledge that can improve the safety of schools and students, including bullying prevention. The initiative is carried out through partnerships among researchers, educators, and other stakeholders, including law enforcement, behavioral and mental health professionals, courts, and other justice system professionals ( National Institute of Justice, 2015 ).

In 2015, the Every Student Succeeds Act was signed by President Obama, reauthorizing the 50-year-old Elementary and Secondary Education Act, which is committed to providing equal opportunities for all students. Although bullying is neither defined nor prohibited in this act, it is explicitly mentioned in regard to applicability of safe school funding, which it had not been in previous iterations of the Elementary and Secondary Education Act.

The above are examples of federal initiatives aimed at promoting the

2 The Safe and Drug-Free Schools and Communities Act was included as Title IV, Part A, of the 1994 Elementary and Secondary Education Act. See http://www.ojjdp.gov/pubs/gun_violence/sect08-i.html [October 2015].

3 For details, see http://www.stopbullying.gov/ [October 2015].

healthy development of youth, improving the safety of schools and students, and reducing rates of bullying behavior. There are several other federal initiatives that address student bullying directly or allow funds to be used for bullying prevention activities.

Definitional Context

The terms “bullying,” “harassment,” and “peer victimization” have been used in the scientific literature to refer to behavior that is aggressive, is carried out repeatedly and over time, and occurs in an interpersonal relationship where a power imbalance exists ( Eisenberg and Aalsma, 2005 ). Although some of these terms have been used interchangeably in the literature, peer victimization is targeted aggressive behavior of one child against another that causes physical, emotional, social, or psychological harm. While conflict and bullying among siblings are important in their own right ( Tanrikulu and Campbell, 2015 ), this area falls outside of the scope of the committee’s charge. Sibling conflict and aggression falls under the broader concept of interpersonal aggression, which includes dating violence, sexual assault, and sibling violence, in addition to bullying as defined for this report. Olweus (1993) noted that bullying, unlike other forms of peer victimization where the children involved are equally matched, involves a power imbalance between the perpetrator and the target, where the target has difficulty defending him or herself and feels helpless against the aggressor. This power imbalance is typically considered a defining feature of bullying, which distinguishes this particular form of aggression from other forms, and is typically repeated in multiple bullying incidents involving the same individuals over time ( Olweus, 1993 ).

Bullying and violence are subcategories of aggressive behavior that overlap ( Olweus, 1996 ). There are situations in which violence is used in the context of bullying. However, not all forms of bullying (e.g., rumor spreading) involve violent behavior. The committee also acknowledges that perspective about intentions can matter and that in many situations, there may be at least two plausible perceptions involved in the bullying behavior.

A number of factors may influence one’s perception of the term “bullying” ( Smith and Monks, 2008 ). Children and adolescents’ understanding of the term “bullying” may be subject to cultural interpretations or translations of the term ( Hopkins et al., 2013 ). Studies have also shown that influences on children’s understanding of bullying include the child’s experiences as he or she matures and whether the child witnesses the bullying behavior of others ( Hellström et al., 2015 ; Monks and Smith, 2006 ; Smith and Monks, 2008 ).

In 2010, the FPBP Steering Committee convened its first summit, which brought together more than 150 nonprofit and corporate leaders,

researchers, practitioners, parents, and youths to identify challenges in bullying prevention. Discussions at the summit revealed inconsistencies in the definition of bullying behavior and the need to create a uniform definition of bullying. Subsequently, a review of the 2011 CDC publication of assessment tools used to measure bullying among youth ( Hamburger et al., 2011 ) revealed inconsistent definitions of bullying and diverse measurement strategies. Those inconsistencies and diverse measurements make it difficult to compare the prevalence of bullying across studies ( Vivolo et al., 2011 ) and complicate the task of distinguishing bullying from other types of aggression between youths. A uniform definition can support the consistent tracking of bullying behavior over time, facilitate the comparison of bullying prevalence rates and associated risk and protective factors across different data collection systems, and enable the collection of comparable information on the performance of bullying intervention and prevention programs across contexts ( Gladden et al., 2014 ). The CDC and U.S. Department of Education collaborated on the creation of the following uniform definition of bullying (quoted in Gladden et al., 2014, p. 7 ):

Bullying is any unwanted aggressive behavior(s) by another youth or group of youths who are not siblings or current dating partners that involves an observed or perceived power imbalance and is repeated multiple times or is highly likely to be repeated. Bullying may inflict harm or distress on the targeted youth including physical, psychological, social, or educational harm.

This report noted that the definition includes school-age individuals ages 5-18 and explicitly excludes sibling violence and violence that occurs in the context of a dating or intimate relationship ( Gladden et al., 2014 ). This definition also highlighted that there are direct and indirect modes of bullying, as well as different types of bullying. Direct bullying involves “aggressive behavior(s) that occur in the presence of the targeted youth”; indirect bullying includes “aggressive behavior(s) that are not directly communicated to the targeted youth” ( Gladden et al., 2014, p. 7 ). The direct forms of violence (e.g., sibling violence, teen dating violence, intimate partner violence) can include aggression that is physical, sexual, or psychological, but the context and uniquely dynamic nature of the relationship between the target and the perpetrator in which these acts occur is different from that of peer bullying. Examples of direct bullying include pushing, hitting, verbal taunting, or direct written communication. A common form of indirect bullying is spreading rumors. Four different types of bullying are commonly identified—physical, verbal, relational, and damage to property. Some observational studies have shown that the different forms of bullying that youths commonly experience may overlap ( Bradshaw et al., 2015 ;

Godleski et al., 2015 ). The four types of bullying are defined as follows ( Gladden et al., 2014 ):

• Physical bullying involves the use of physical force (e.g., shoving, hitting, spitting, pushing, and tripping).
• Verbal bullying involves oral or written communication that causes harm (e.g., taunting, name calling, offensive notes or hand gestures, verbal threats).
• Relational bullying is behavior “designed to harm the reputation and relationships of the targeted youth (e.g., social isolation, rumor spreading, posting derogatory comments or pictures online).”
• Damage to property is “theft, alteration, or damaging of the target youth’s property by the perpetrator to cause harm.”

In recent years, a new form of aggression or bullying has emerged, labeled “cyberbullying,” in which the aggression occurs through modern technological devices, specifically mobile phones or the Internet ( Slonje and Smith, 2008 ). Cyberbullying may take the form of mean or nasty messages or comments, rumor spreading through posts or creation of groups, and exclusion by groups of peers online.

While the CDC definition identifies bullying that occurs using technology as electronic bullying and views that as a context or location where bullying occurs, one of the major challenges in the field is how to conceptualize and define cyberbullying ( Tokunaga, 2010 ). The extent to which the CDC definition can be applied to cyberbullying is unclear, particularly with respect to several key concepts within the CDC definition. First, whether determination of an interaction as “wanted” or “unwanted” or whether communication was intended to be harmful can be challenging to assess in the absence of important in-person socioemotional cues (e.g., vocal tone, facial expressions). Second, assessing “repetition” is challenging in that a single harmful act on the Internet has the potential to be shared or viewed multiple times ( Sticca and Perren, 2013 ). Third, cyberbullying can involve a less powerful peer using technological tools to bully a peer who is perceived to have more power. In this manner, technology may provide the tools that create a power imbalance, in contrast to traditional bullying, which typically involves an existing power imbalance.

A study that used focus groups with college students to discuss whether the CDC definition applied to cyberbullying found that students were wary of applying the definition due to their perception that cyberbullying often involves less emphasis on aggression, intention, and repetition than other forms of bullying ( Kota et al., 2014 ). Many researchers have responded to this lack of conceptual and definitional clarity by creating their own measures to assess cyberbullying. It is noteworthy that very few of these

definitions and measures include the components of traditional bullying—i.e., repetition, power imbalance, and intent ( Berne et al., 2013 ). A more recent study argues that the term “cyberbullying” should be reserved for incidents that involve key aspects of bullying such as repetition and differential power ( Ybarra et al., 2014 ).

Although the formulation of a uniform definition of bullying appears to be a step in the right direction for the field of bullying prevention, there are some limitations of the CDC definition. For example, some researchers find the focus on school-age youth as well as the repeated nature of bullying to be rather limiting; similarly the exclusion of bullying in the context of sibling relationships or dating relationships may preclude full appreciation of the range of aggressive behaviors that may co-occur with or constitute bullying behavior. As noted above, other researchers have raised concerns about whether cyberbullying should be considered a particular form or mode under the broader heading of bullying as suggested in the CDC definition, or whether a separate defintion is needed. Furthermore, the measurement of bullying prevalence using such a definiton of bullying is rather complex and does not lend itself well to large-scale survey research. The CDC definition was intended to inform public health surveillance efforts, rather than to serve as a definition for policy. However, increased alignment between bullying definitions used by policy makers and researchers would greatly advance the field. Much of the extant research on bullying has not applied a consistent definition or one that aligns with the CDC definition. As a result of these and other challenges to the CDC definition, thus far there has been inconsistent adoption of this particular definition by researchers, practitioners, or policy makers; however, as the definition was created in 2014, less than 2 years is not a sufficient amount of time to assess whether it has been successfully adopted or will be in the future.

THE COMMITTEE’S APPROACH

This report builds on the April 2014 workshop, summarized in Building Capacity to Reduce Bullying: Workshop Summary ( Institute of Medicine and National Research Council, 2014c ). The committee’s work was accomplished over an 18-month period that began in October 2014, after the workshop was held and the formal summary of it had been released. The study committee members represented expertise in communication technology, criminology, developmental and clinical psychology, education, mental health, neurobiological development, pediatrics, public health, school administration, school district policy, and state law and policy. (See Appendix E for biographical sketches of the committee members and staff.) The committee met three times in person and conducted other meetings by teleconferences and electronic communication.

Information Gathering

The committee conducted an extensive review of the literature pertaining to peer victimization and bullying. In some instances, the committee drew upon the broader literature on aggression and violence. The review began with an English-language literature search of online databases, including ERIC, Google Scholar, Lexis Law Reviews Database, Medline, PubMed, Scopus, PsycInfo, and Web of Science, and was expanded as literature and resources from other countries were identified by committee members and project staff as relevant. The committee drew upon the early childhood literature since there is substantial evidence indicating that bullying involvement happens as early as preschool (see Vlachou et al., 2011 ). The committee also drew on the literature on late adolescence and looked at related areas of research such as maltreatment for insights into this emerging field.

The committee used a variety of sources to supplement its review of the literature. The committee held two public information-gathering sessions, one with the study sponsors and the second with experts on the neurobiology of bullying; bullying as a group phenomenon and the role of bystanders; the role of media in bullying prevention; and the intersection of social science, the law, and bullying and peer victimization. See Appendix A for the agendas for these two sessions. To explore different facets of bullying and give perspectives from the field, a subgroup of the committee and study staff also conducted a site visit to a northeastern city, where they convened four stakeholder groups comprised, respectively, of local practitioners, school personnel, private foundation representatives, and young adults. The site visit provided the committee with an opportunity for place-based learning about bullying prevention programs and best practices. Each focus group was transcribed and summarized thematically in accordance with this report’s chapter considerations. Themes related to the chapters are displayed throughout the report in boxes titled “Perspectives from the Field”; these boxes reflect responses synthesized from all four focus groups. See Appendix B for the site visit’s agenda and for summaries of the focus groups.

The committee also benefited from earlier reports by the National Academies of Sciences, Engineering, and Medicine through its Division of Behavioral and Social Sciences and Education and the Institute of Medicine, most notably:

• Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research ( Institute of Medicine, 1994 )
• Community Programs to Promote Youth Development ( National Research Council and Institute of Medicine, 2002 )
• Deadly Lessons: Understanding Lethal School Violence ( National Research Council and Institute of Medicine, 2003 )
• Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities ( National Research Council and Institute of Medicine, 2009 )
• The Science of Adolescent Risk-Taking: Workshop Report ( Institute of Medicine and National Research Council, 2011 )
• Communications and Technology for Violence Prevention: Workshop Summary ( Institute of Medicine and National Research Council, 2012 )
• Building Capacity to Reduce Bullying: Workshop Summary ( Institute of Medicine and National Research Council, 2014c )
• The Evidence for Violence Prevention across the Lifespan and Around the World: Workshop Summary ( Institute of Medicine and National Research Council, 2014a )
• Strategies for Scaling Effective Family-Focused Preventive Interventions to Promote Children’s Cognitive, Affective, and Behavioral Health: Workshop Summary ( Institute of Medicine and National Research Council, 2014b )
• Investing in the Health and Well-Being of Young Adults ( Institute of Medicine and National Research Council, 2015 )

Although these past reports and workshop summaries address various forms of violence and victimization, this report is the first consensus study by the National Academies of Sciences, Engineering, and Medicine on the state of the science on the biological and psychosocial consequences of bullying and the risk and protective factors that either increase or decrease bullying behavior and its consequences.

Terminology

Given the variable use of the terms “bullying” and “peer victimization” in both the research-based and practice-based literature, the committee chose to use the current CDC definition quoted above ( Gladden et al., 2014, p. 7 ). While the committee determined that this was the best definition to use, it acknowledges that this definition is not necessarily the most user-friendly definition for students and has the potential to cause problems for students reporting bullying. Not only does this definition provide detail on the common elements of bullying behavior but it also was developed with input from a panel of researchers and practitioners. The committee also followed the CDC in focusing primarily on individuals between the ages of 5 and 18. The committee recognizes that children’s development occurs on a continuum, and so while it relied primarily on the CDC defini-

tion, its work and this report acknowledge the importance of addressing bullying in both early childhood and emerging adulthood. For purposes of this report, the committee used the terms “early childhood” to refer to ages 1-4, “middle childhood” for ages 5 to 10, “early adolescence” for ages 11-14, “middle adolescence” for ages 15-17, and “late adolescence” for ages 18-21. This terminology and the associated age ranges are consistent with the Bright Futures and American Academy of Pediatrics definition of the stages of development. 4

A given instance of bullying behavior involves at least two unequal roles: one or more individuals who perpetrate the behavior (the perpetrator in this instance) and at least one individual who is bullied (the target in this instance). To avoid labeling and potentially further stigmatizing individuals with the terms “bully” and “victim,” which are sometimes viewed as traits of persons rather than role descriptions in a particular instance of behavior, the committee decided to use “individual who is bullied” to refer to the target of a bullying instance or pattern and “individual who bullies” to refer to the perpetrator of a bullying instance or pattern. Thus, “individual who is bullied and bullies others” can refer to one who is either perpetrating a bullying behavior or a target of bullying behavior, depending on the incident. This terminology is consistent with the approach used by the FPBP (see above). Also, bullying is a dynamic social interaction ( Espelage and Swearer, 2003 ) where individuals can play different roles in bullying interactions based on both individual and contextual factors.

The committee used “cyberbullying” to refer to bullying that takes place using technology or digital electronic means. “Digital electronic forms of contact” comprise a broad category that may include e-mail, blogs, social networking Websites, online games, chat rooms, forums, instant messaging, Skype, text messaging, and mobile phone pictures. The committee uses the term “traditional bullying” to refer to bullying behavior that is not cyberbullying (to aid in comparisons), recognizing that the term has been used at times in slightly different senses in the literature.

Where accurate reporting of study findings requires use of the above terms but with senses different from those specified here, the committee has noted the sense in which the source used the term. Similarly, accurate reporting has at times required use of terms such as “victimization” or “victim” that the committee has chosen to avoid in its own statements.

4 For details on these stages of adolescence, see https://brightfutures.aap.org/Bright%20Futures%20Documents/3-Promoting_Child_Development.pdf [October 2015].

ORGANIZATION OF THE REPORT

This report is organized into seven chapters. After this introductory chapter, Chapter 2 provides a broad overview of the scope of the problem.

Chapter 3 focuses on the conceptual frameworks for the study and the developmental trajectory of the child who is bullied, the child who bullies, and the child who is bullied and also bullies. It explores processes that can explain heterogeneity in bullying outcomes by focusing on contextual processes that moderate the effect of individual characteristics on bullying behavior.

Chapter 4 discusses the cyclical nature of bullying and the consequences of bullying behavior. It summarizes what is known about the psychosocial, physical health, neurobiological, academic-performance, and population-level consequences of bullying.

Chapter 5 provides an overview of the landscape in bullying prevention programming. This chapter describes in detail the context for preventive interventions and the specific actions that various stakeholders can take to achieve a coordinated response to bullying behavior. The chapter uses the Institute of Medicine’s multi-tiered framework ( National Research Council and Institute of Medicine, 2009 ) to present the different levels of approaches to preventing bullying behavior.

Chapter 6 reviews what is known about federal, state, and local laws and policies and their impact on bullying.

After a critical review of the relevant research and practice-based literatures, Chapter 7 discusses the committee conclusions and recommendations and provides a path forward for bullying prevention.

The report includes a number of appendixes. Appendix A includes meeting agendas of the committee’s public information-gathering meetings. Appendix B includes the agenda and summaries of the site visit. Appendix C includes summaries of bullying prevalence data from the national surveys discussed in Chapter 2 . Appendix D provides a list of selected federal resources on bullying for parents and teachers. Appendix E provides biographical sketches of the committee members and project staff.

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Bullying has long been tolerated as a rite of passage among children and adolescents. There is an implication that individuals who are bullied must have "asked for" this type of treatment, or deserved it. Sometimes, even the child who is bullied begins to internalize this idea. For many years, there has been a general acceptance and collective shrug when it comes to a child or adolescent with greater social capital or power pushing around a child perceived as subordinate. But bullying is not developmentally appropriate; it should not be considered a normal part of the typical social grouping that occurs throughout a child's life.

Although bullying behavior endures through generations, the milieu is changing. Historically, bulling has occurred at school, the physical setting in which most of childhood is centered and the primary source for peer group formation. In recent years, however, the physical setting is not the only place bullying is occurring. Technology allows for an entirely new type of digital electronic aggression, cyberbullying, which takes place through chat rooms, instant messaging, social media, and other forms of digital electronic communication.

Composition of peer groups, shifting demographics, changing societal norms, and modern technology are contextual factors that must be considered to understand and effectively react to bullying in the United States. Youth are embedded in multiple contexts and each of these contexts interacts with individual characteristics of youth in ways that either exacerbate or attenuate the association between these individual characteristics and bullying perpetration or victimization. Recognizing that bullying behavior is a major public health problem that demands the concerted and coordinated time and attention of parents, educators and school administrators, health care providers, policy makers, families, and others concerned with the care of children, this report evaluates the state of the science on biological and psychosocial consequences of peer victimization and the risk and protective factors that either increase or decrease peer victimization behavior and consequences.

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What Is a Good Thesis Statement About Bullying?

Unfortunately, bullying is still part of our society despite civilization and technology. But, that does not mean the issue cannot be addressed and fixed. It is the responsibility of parents, teachers, and institutions to find a way to reduce the blow of bullying in our society for everyone to be safe and happy. Are you concerned about bullying and want to be a part of the solution? One of the ways to do this is by writing an interesting essay that educates about bullying and its effects. As a part of the project, you will need a thesis statement for a bullying essay that stands out.

As much as you want to address the nasty effects of bullying, you also need to pass your exams. That is why you need to get a thesis about bullying that will impress your professor. Let us learn more here.

What’s a Bullying Thesis Statement?

• How to Write a Thesis Statement about Bullying?

What Is a Good Thesis Statement For Bullying?

Interesting examples on thesis statement for bullying research paper, straightforward thesis statement for bullying essay examples, exciting thesis statement on cyberbullying homework, our writing services guarantees good thesis statement.

A bullying thesis statement helps you address an issue about bullying. It needs to include the topic of the research paper you are writing about and the claim you have about the bullying topic. Your thesis statement determines whether your paper will stand out.

Which Of The Following Statements About Bullying Is True?

Most people are oblivious to cyberbullying and its effect. So you need first to understand what bullying is to develop a great thesis statement for bullying. Below are four statements that you can read to determine the truth about bullying.

• Bullying is a growing phase that children will grow out of.
• Bullying does not have to be physical; it can also be cyberbullying, verbal, and emotional.
• Bullying is not harmful.
• As children mature, they will learn positive behavior on their own.

What do you think is the correct answer? All the above statements are false except b. Bullying is not limited to the physical like fighting and hitting. Cyberbullying, verbal and emotional abuse are all bullying, and they all have devastating effects on the individual or group of people getting bullied.

How to Write a Thesis Statement About Bullying?

The thesis on bullying should be under the introduction. Most students prefer writing a statement when they complete their introduction. But the best way to write a thesis is by finishing your research.

Note that the thesis statement needs to be a summary of your research. You will have a better idea of what your essay is all about once you have completed your project. Ensure that the subject is exciting and as per your tutor’s instruction.

A good thesis statement on bullying needs to be a great impression so that it can hook your instructor or any other person who will read your thesis statement. It needs to be the hook to your essay and motivate the readers. The bullying essay thesis statement needs to be;

• An interpretation of the subject
• Precise, forceful, and confident
• It should challenge the readers

Bullying Thesis Statement Examples

If you have a hard time creating a thesis statement about bullying that will make your essay stand out, worry no more. Our team of experts has combined a list of thesis statements on cyberbullying you can use in your essay to impress your professors. Here we go!

You can make your essay research paper interesting by choosing the right thesis statement about bullying to use. In case you are not sure, here is a list you can choose from.

• Bullying and its effects on youth, and some possible solutions to the problem it causes.
• There are several ideas and concepts that most institutes have come up with to help stop bullying, but the challenge is the implementation of these policies.
• International progress can be hasted by the eradication of bully in and so government bodies should cultivate solutions to address the matter.
• Corporate bullying could push individuals into isolation, leading to depression and suicide.
• Bullying has been ignored for a long time, even though it has been a problem in the school system; people have only recently started discussing it.

A bullying thesis does not have to be complex. In fact, at times keeping the thesis statement on bullying essay simple could help capture the attention of your tutor and help improve your grade. Here is a look at the straightforward statements about bullying.

• The effects of physical bullying are depression, stress, withdrawal, physical, and emotional problems, which could destroy a child’s life.
• Parents and tutors should always be on the lookout for any bullying so they can fix the problem before it gets out of control.
• Most bullies have emotional or physical abuse, so they turn to bullies to help them feel in a position of power.
• Bullying could affect the mental health of the person being bullied, affecting their everyday life.
• Bullies have a hard time following the regulations, caring for other people, and having self-control.

Cyberbullying is often underestimated, and it makes people feel as though they are not good enough and do not deserve to live. Use these examples in your homework.

• School violence and cyberbullying attacks affect everyone who attends the school and compromise students’ safety.
• Cyberbullying is not new and can be used in many ways to bring individuals or a group down, yet not much is being done to address the issue.
• Proper measures should be implemented to help better predict communication during cyberbullying episodes.
• As technology advances, teens have become more prone to the internet’s dangers like cyberbullying.
• A look at the similarities and differences between bullying and cyberbullying and the best way to handle both situations.

Are you still wondering what’s a good thesis statement for bullying is? Reach out to our writing service today. We have skilled writers to help you get the best bullying thesis for a research paper. We can also write the research paper for you and ensure you attain the best grades. So get in touch with us today.

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Effects of Bullying

Bullying can affect everyone—those who are bullied, those who bully, and those who witness bullying. Bullying is linked to many negative outcomes including impacts on mental health, substance use, and suicide. It is important to talk to kids to determine whether bullying—or something else—is a concern.

Kids Who are Bullied

Kids who are bullied can experience negative physical, social, emotional, academic, and mental health issues. Kids who are bullied are more likely to experience:

• Depression and anxiety, increased feelings of sadness and loneliness, changes in sleep and eating patterns, and loss of interest in activities they used to enjoy. These issues may persist into adulthood.
• Health complaints
• Decreased academic achievement—GPA and standardized test scores—and school participation. They are more likely to miss, skip, or drop out of school.

A very small number of bullied children might retaliate through extremely violent measures. In 12 of 15 school shooting cases in the 1990s, the shooters had a history of being bullied.

Kids Who Bully Others

Kids who bully others can also engage in violent and other risky behaviors into adulthood. Kids who bully are more likely to:

• Abuse alcohol and other drugs in adolescence and as adults
• Get into fights, vandalize property, and drop out of school
• Engage in early sexual activity
• Have criminal convictions and traffic citations as adults 
• Be abusive toward their romantic partners, spouses, or children as adults

Kids who witness bullying are more likely to:

• Have increased use of tobacco, alcohol, or other drugs
• Have increased mental health problems, including depression and anxiety
• Miss or skip school

The Relationship between Bullying and Suicide

Media reports often link bullying with suicide. However, most youth who are bullied do not have thoughts of suicide or engage in suicidal behaviors. 

Although kids who are bullied are at risk of suicide, bullying alone is not the cause. Many issues contribute to suicide risk, including depression, problems at home, and trauma history. Additionally, specific groups have an increased risk of suicide, including American Indian and Alaskan Native, Asian American, lesbian, gay, bisexual, and transgender youth. This risk can be increased further when these kids are not supported by parents, peers, and schools. Bullying can make an unsupportive situation worse.

154 Bullying Topics & Bullying Essay Examples

Looking for an exciting research topic about bullying? This problem is very controversial, sensitive, and definitely worth studying

🏆 Top 10 Bullying Topics for Research Papers

📃 bullying essay: writing tips, 🏆 best bullying topics to write about, ⚡ most shocking bullying topics to write about, ✅ simple & easy shocking bullying essay titles, ✍️ bullying essay topics for college, ❓ research questions about bullying.

Examples of bullying can be found everywhere: in schools, workplaces, and even on the Internet (in the form of cyberbullying).

In this article, we’ve collected top bullying research paper topics and questions, as well as bullying essay samples and writing tips. Get inspired with us!

• Direct and indirect bullying: compare & contrast
• The causes of bullying
• Classroom bullying and its effects
• Social isolation as a form of bullying
• Bullying and academic performance
• Passive and active victims of bullying: compare and contrast
• The role of social agencies in bullying prevention
• Public policy for bullying and aggression
• Bullying behavior and psychological health
• Aggressive children and their family background

A bullying essay is a popular assignment in various subjects, including psychology, sociology, and education. Writing an excellent paper on the matter requires more than just in-depth research and planning. Don’t worry; there are some tips that will make writing an essay on bullying much easier:

• Choose a topic that allows analyzing and interpreting the problem. Instead of merely describing what bullying is, try to dig deeper into its causes, consequences, and solutions. If your professor didn’t suggest any topics, you may research bullying essay topics online and select one that would be exciting for you to explore.
• Read sample articles and papers online to see how other students approached the subject. Notice the bits that work and don’t work, and write them out to make the process of creating your essay easier. If you’re struggling with finding enough examples online, you may want to expand your search to discrimination essay topics and materials.
• Research what scholars say about bullying. Articles in scholarly journals are an excellent source of information because they are usually trustworthy. If you’re still in school, your ability to navigate the library or online databases will also impress your tutor. As you start researching, you will find that there is a great variety of studies, and it’s challenging to find the relevant ones. Narrowing down your search would help you to do that. For instance, if you are writing a cyber bullying essay, try searching for social media bullying or online anti-bullying services.
• Include real-life experiences where relevant. Unfortunately, bullying is a common problem in many institutions, and if you haven’t experienced it, your friends or family members probably have. If your tutor allows personal input, explore real-life experiences with bullying. Note the effects, preventive measures that worked or didn’t work, and what a person used to cope with bullying. If personal input is not allowed, you could ask your friends or relatives for ideas and then find high-quality sources that discuss similar problems.
• If you can, be creative about it! A powerful bullying essay example draws from a variety of sources to present material in a creative way and engage readers. Hence, this might be an excellent opportunity for you to include images or graphs in your paper. For example, anti-bullying posters could complement the sections of your work that talks about solutions to the problem. Quotes about bullying coming from famous persons would also be influential, especially if you include them at the beginning of your piece. If you like drawing or painting, you could try to put some of your ideas in graphic form – this will definitely earn you some extra marks! Just make sure to check with your tutor to see whether or not creative input is allowed.
• Structure your paper well to avoid gaps or inconsistencies. It would be beneficial to create a detailed bullying essay outline before you start working. A typical essay should include an introduction, two to three main paragraphs, and a conclusion. The first paragraph of your work should consist of some background information, whereas the last one should restate the points and close up the paper. A good bullying essay introduction should also feature a thesis statement that shows what the piece is about.

These tips will help you to write top-notch essays on bullying, as well as on related subjects. Don’t forget to browse our blog some more to find other helpful materials, including essay titles!

• The Problem of Bullying and Possible Solutions In general, bullying is a critical and complex issue prevailing among children; thus, it is essential to adopt different solutions to tackle it.
• School Bullying and Moral Development The middle childhood is marked by the development of basic literacy skills and understanding of other people’s behavior that would be crucial in creating effective later social cognitions. Therefore, addressing bullying in schools requires strategies […]
• Bullying and Its Effects in Society Secondary research is critical in the development of a background to the research, which helps in determining the validity of the problem and suggested research methodologies.
• Cyber Bullying Issue Therefore, the goal of this paper is to analyse who the victims of cyber bullying are and the influence it has on them.
• Bullying and Child Development Bullying is one of the common vices in schools that influences a lot of growth and development of children. Bullying also affects the ability of children to concentrate in school because they are always on […]
• The Effects of Cyber-Bullying and Cyber-Stalking on the Society In particular, one should focus on such issues as the disrespect for a person’s autonomy, the growing intensity of domestic violence and deteriorating mental health in the country.
• Is Cyber Bullying Against Teenagers More Detrimental Than Face-To-Face Bullying? Social networking has also contributed greatly to the issue of cyber bullying especially in making it more harmful as compared to face-to-face bullying.
• Verbal Bullying at School: How It Should Be Stopped This paper highlights some of the best practices that can be used by teachers in order to address this problem. So, this information can be of great benefit to them.
• Nature of Bullying In this paper, central focus is going to be on the nature of bullying of children in my hometown, Orlando Florida, how it can be solved, and most importantly; establishing the importance of having knowledge […]
• Bullying and Cyberbullying in Modern Society Cyberbullying among adolescents and teenagers is defined as the purposeful and repetitive harm done by one or more peers in cyberspace as a result of using digital devices and social media platforms.
• Social Influence on Bullying in Schools The theory helps us to understand why the stronger members of the school population are likely to “rule” over the weaker members of the school as described in the social hierarchy concept in the theory.
• Bullying on Social Media Platforms It is consistent and repeating, taking advantage of the Internet’s anonymity with the main goal to anger, scare, or shame a victim.
• Bullying Through Social Media: Research Proposal The hypothesis of the study is as follows: the role of adolescents in a cyberbullying situation is interconnected with their psychological characteristics.
• Social Psychological Concepts of Bullying and Its Types Some of the factors that contribute to bullying include poor parenting, economic challenges, lack of mentorship, and jealousy among others. One of the main concepts used to explain bullying is that of parenting roles and […]
• The Impact of Workplace Bullying The negative impacts of bullying in the workplace develop as a result of ignorance among employees regarding the vice, unreported cases, as well as the negligence of organizational leaders.
• Workplace Bullying and Its Impact on Performance Workplace bullying refers to a deliberate, repeated, and continuous mistreatment of a worker or a group of workers by one or more colleagues in the workplace.
• The ABC Model of Crisis: Bullying at School The next step is the identification of the nature of the crisis, and thus questions are as follows: Who is bullying you?
• Workplace Bullying and Its Impact on People and Society The paper follows a traditional structure with the introduction and body paragraphs that provide essential information devoted to the problem, and improve the understanding of the concept of bullying.
• Cyber-Bullying Is a Crime: Discussion It is easy to see the effects of cyber-bullying but it is hard to find out who is the bully making it hard for authorities to pin the blame on the perpetrator of a crime […]
• Fights and Bullying Among Middle School Learners Alongside the positivist philosophy, the research adopted the survey strategy that involved the use of self-administered questionnaires to collect from the participants.
• Bullying: Violence in Children and Adolescents Bullying is one of the most common manifestations of peer violence in children and adolescents. Prevention of bullying, cyberbullying included, has to occur in accordance with the IBSE Standards of social and emotional learning.
• Bullying, Its Forms, and Counteractions In addition, it is necessary to support those at the center of this bullying, as this can protect them from harmful effects and consequences.
• Incivility, Violence, and Bullying in the Healthcare Workplace The following step is to gather the team and communicate the necessity of change, assigning some individuals for the positions related to the change, in other terms, a support team.
• Effective Ways to Deal With Bullying in US Schools Teachers should ensure the bully is aware of the improper behavior, why it is improper, and the repercussions of the behavior.
• Network Bullying: School Policy Framework The first step is to have a careful conversation with the student and an assessment by the school psychologist to ensure that there is a fright.
• How to Reduce Bullying in Senior Facilities One of the main reasons an individual may commit suicide due to bullying is because it may make an individual develop a negative self-image after the bullying incident. Some of the major bullying incidences that […]
• Active Shooter and Nursing Bullying Nurses should lock all doors and use tables and other objects to reinforce them to prevent any possibility of the active shooter getting to the patients’ room.
• Racist Bullying Among Black Students in US Universities This research focuses on the impact of bullying and racism among African American students in the country. What are the impacts of bullying and racism among Black students in U.S.universities?
• Bullying and Autism Spectrum Disorder In fact, bullying as a social phenomenon can be characterized as a social and interaction issue; therefore, it is possible to analyze the connection between autism and acts of bullying and inappropriate behavior.
• Eliminating the Problem of Online Bullying Eliminating the problem of online bullying is vital for improving the mental health of adolescents and young adults and allowing them to build their lives free of adverse external influences. It is possible to see […]
• Sexual Bullying in Schools and Its Influence The author states the difference in the mental and physical maturation of girls and boys as one of the core roots of the issue.
• Bullying and Harassment in the Healthcare Workplace This paper is written to explore the origins of discrimination and harassment in the healthcare workplace. Bullying begins early in medical college and residencies; it has been referred to as an element of the learning […]
• Queer (LGBT) Teenage Bullying at School The importance of this source to the research is associated with the significant role that youth organizations have to play towards minimizing bullying among LGBT students.
• Bullying of Children: Misconceptions and Preventive Measures As a result, the density of shows and articles devoted to bullying creates an illusion that this event appears more often than it does in reality.
• Bullying Behavior and Impact of Hegemonic Masculinity Rosen and Nofziger applied a quantitative research design to explore the relationships between students’ bullying experiences and race, age, and socioeconomic status and identify the frequency of bullying.
• Bullying and Incivility in Clinical Setting The problem of bullying and incivility in a clinical setting can negatively affect the quality of care provided, so it needs to be managed.
• Bullying and Its Influences on a Person It is common for victims of bullying to develop mental health issues, as they were placed in stressful situations and had a constant fear along with depression in some cases. Making friends is one of […]
• “Bullying in Schools”: The Aspects of Bullying In their article, Menesini and Salmivalli examine the current state of knowledge on the topic and thoroughly discuss all of the aspects of bullying.
• Moral Development and Bullying in Children The understanding of moral development following the theories of Kohlberg and Gilligan can provide useful solutions to eliminating bullying in American schools.
• Analysis of Bullying and Parenting Style Since the given topic usually refers to children and adolescents, it is evident that their parents hold a portion of responsibility because the adults affect the growth and development of young individuals.
• Hate Crimes – Bullying More than two-thirds of children and adolescents experience bullying and more than one-fourth of them report extreme forms of coercion.
• Bullying Management: Mass Awareness Program Bulletin.”Teachers, trained to help to rebuild trust, confidence, growth, and commitment through mass awareness to arrest bullying in high schools”. The proposed mass action program is meant to promote awareness on the need to stop […]
• An Anti-Bullying Program Integrated With PRAISE by Ackerman I chose to describe bullying because of the importance of the topic and due to my personal interest in it. Education will eliminate most of the reasons for bullying and provide students with the E […]
• Bullying Through Social Media: Methods An Informed Consent Document will be provided to participants prior to the research, explaining the purpose of the study and promising to protect their identity.
• Bullying Through Social Media In particular, inequality in the position of the persecutor and the victim is evident – the aggressor can be anonymous, and there can be many of them.
• Bullying of Nurses During the COVID-19 Pandemic Then, the principles of adult learning will be used to develop and implement an information product to improve the nursing workforce’s bullying awareness and the knowledge of healthy conflict resolution in the workplace.
• Bullying in Healthcare Organizations: Impact on Nursing Practice Bullying in business entities is a common phenomenon, but the extent of its influence on the “production process” in healthcare and medicine institutions is only beginning to be recognized.
• Workplace Bullying Among Nurses in the Acute Setting Since the onset of the COVID-19 pandemic, the frequency of conflicts between nurses and their colleagues and managers has increased significantly in my workplace.
• Bullying Perpetration Among School-Aged Children Mucherah et al.examined how the school climate and teachers’ sanctions against bullying relate to the risk of becoming a victim or perpetrator of bullying.
• Programming for a Year 5 Class on Bullying As a result, in Lesson 6, they will offer their project addressing bullying behaviour and present it to their class, which is the main aim of the Unit Plan.
• Injury and Violence Prevention: – Bullying The aim of preventing injury and violence from bullying is to enable the student to have a healthy social and physical life that will enable them to perform well in their studies and live healthily.
• Cyber-Bullying vs. Traditional Bullying: Its Psychological Effects The researchers presented the recent statistics in order to illustrate the negative social and psychological effects of cyber-bullying in contrast to the traditional bullying in schools.
• Bullying in the Workplace Old Nurse to New Nurse This unvoiced scourge in nursing is characteristically encouraged by the need of bullies to have a total control of a person. Resignation of nurses due to bullying can lead to shortage of nurses in hospitals.
• Bullying and Peer Abuse Especially at work, targets fear coming to work and this will have an adverse result in the efficiency of the staff in the hospital.
• Bullying in the Nursing Workplace Bullying in the nursing workplace, in this case, causes the one bullied to have a feeling of defenselessness and takes away the nurses’ right to dignity at his or her workplace.
• Cyber Bullying and Positivist Theory of Crime Learning theory approaches to the explanation of criminal behavior have been associated with one of the major sociological theories of crime, the differential association theory.
• Cyberbullying and Bullying: Similarities While deciding on fitting and balanced sanctions, it is vital to reflect on the ways in which cyberbullying events differ in effect in comparison to other forms of bullying.
• Protection From Bullying: Methods That Work Because of this, it is vital that parents, teachers, and guardians educate themselves on the nature of bullying and work together to develop effective methods and strategies that would help to overcome the problem.
• Psychology: Social Media and Bullying The purpose of this paper is to discuss the issue of social media and bullying and express the author’s opinion on the matter.
• “Bullying Behavior Among Radiation Therapists” by Johnson and Trad The literature review encompassed a considerable number of sources pertinent to the study and recent enough to be relevant; all the publications were dated within the last fifteen years.
• Human Rights Issues in Australia: Bullying Among School-Going Age and Young People The focus of the topic of the day is on bullying. It is used to prevent or avoid the occurrence of a bullying experience.
• Bullying and Worker’s Harassment in Western Australia In most of the armed services in Australia, new recruits and women are commonly the victims of bullying and harassment despite the fact that it is unacceptable.
• Behaviour Management: Bullying The typical behaviors which I saw in the child who got bullied are: The victim of this bullying is physically weak and a soft-natured one.
• Conflict Resolution Tactics and Bullying This study is interesting to the extent that it shows how the social environment impacts the development of a child and how it shapes his or her conflict resolution techniques.
• School Bullying: Case Analysis Even today there is no generally accepted definition of bullying but it is thought that when an individual is for a long period of time is exposed to repeat negative actions and behavior by one […]
• Bullying in the Workplace as a Psychological Harassment Another form of bullying in the workplace is physical assault in the sense that if the workers are not at ease with each other and when the rules and regulations are not at all observed, […]
• “Adolescents’ Perception of Bullying” by Frisen et al. The second and the third aims of the study were “to describe how adolescents perceive bullies” and “to describe what adolescents believe to be important in order to stop bullying”, respectively.
• The Long Term Effects of Bullying in Elementary School Wolke and Lereya argue that the problem is that the majority of studies on bullying are cross-sectional and only use follow-ups after a short period of time.
• Workplace Bullying, Salivary Cortisol and Long-Term Sickness Absence The purpose of this cohort-based study was to investigate the extent to which cortisol levels were associated with sickness absence and the relationships between workplace bullying and sickness absence through the prism of cortisol use.
• Workplace Bullying in Australia It is possible to offer several recommendations that can reduce the risk of bullying in organisations. In this case, more attention should be paid to the absence of mechanisms that can protect the victims of […]
• Domestic Violence and Bullying in Schools It also states the major variables related to bullying in schools. They will confirm that social-economic status, gender, and race can contribute to bullying in schools.
• The “Bully-Free” Initiative: Bullying in Education The students need to have a clear idea that bullying goes against the rules of the school and which actions may be considered bullying.
• Free Speech vs. Bullying Laws One of the topical aspects of modern democracy is the freedom of speech expressed in an ability to come up with personal ideas and the lack of restrictions on the right of expression through publicity.
• Gender and Bullying Issues in Nursing A lack of tolerance for workplace harassment and bullying is likely to lead to the deterioration of the situation and further misunderstanding and tension in an organization.
• Bullying and Cyberbullying Among Peers They are facing the dilemma of how to react, whether they have to fight a superior force of the enemy or to complain to teachers and parents, undermining their reputation.
• Bullying in Schools and Its Major Reasons As of now, the most important goal in research studies covering the topic of bullying in schools is to understand the mechanisms behind bullying promotion and prevention.
• Bullying in Schools: Worldwide Study and Survey The parents were asked to rate the frequency of the bullying that their children experience and to describe the experience of bullying that their children went through.
• Bullying Prevention Programs Some teachers and professors claim that their students cannot show their potential in their hobbies due to the limitations they experience because of bullies around them. As it is mentioned above, educators do not control […]
• Bullying and Its Impact Thus, the current paper is dedicated to the issue of bullying and its effects as well as anti-bullying practices as related to peer victimization.
• Dealing With Workplace Bullying According to the report presented by the University of Louisville, workplace bullying is a repeated action of one employee or a group of employees towards another individual or group. Dealing with bullying in the workplace […]
• Bullying Policies in Walton School District and Georgia University The sample bullying policy language in Walton School District is very similar to the language in the policy of the University of Georgia.
• Amanda Todd’s Bullying and Suicide Story She was fifteen years old, and her story created a major uproar in the press, as it showed the true nature of bullying and the effects it has on the person.
• Bullying in America: Causes and Prevention That is why it is important to pay attention to the reasons why bullying occurs and ways in which it can be reduced.
• Bullying, Facts and Countermeasures Whether it is the bully or the bullied, the parents will need to do a lot to see to it that their children are brought up in the best of the behaviors.
• Bullying as Social and Criminal Deviance The most important step in the student’s guide to research that I would need to analyze bullying is defining the topic.
• Bullying and Legislation in Australian Workplace According to the authors of the article, workplace bullying can be characterized as internal violence. According to the authors of the article, bullying is a widespread phenomenon and is a common attribute of many organizations.
• Bullying at Australian School: Causes and Solution The technological breakthrough that was witnessed in the late 90s and the early 2000s also contributed to the development of the phenomenon, sparking the concepts such as cyberbullying and online bullying.
• Workplace Bullying in The Playground Never Ends The primary reason for becoming a bully is primarily seen in fear to lose authority or formal positions in an organization and have more institutional power than that of the targets.
• College Students: Suicide and Bullying-Methods The analysts used this tool to report the mood of the participants by posting quizzes, which the students answered while filling the questionnaire.
• Girl-To-Girl Bullying and Mean Stinks Program The positive results can be achieved by the implementation of the multiple educational programs, the increase in public awareness, and promotion of the values of the healthy relationships.”Mean Stinks” is exactly the program with the […]
• Association of Parenting Factors With Bullying The lack of the parental support is the main cause of students’ deviant behaviors at school, including the cases of bullying, and those parents who pay much attention to developing their career cannot provide the […]
• The Problem of Workplace Bullying In particular, this paper will include the discussion of the research articles, reports and case studies that describe the causes of workplace bullying and the strategies used by companies in an effort to overcome it.
• College Students: Suicide and Bullying The misconception that bullying is a minor issue among college students has contributed to the high number of students who suffer because of bullying.
• Homosexual Students and Bullying Specifically, the section addresses the prevalence of bullying in schools and the level of bullying in bisexuals, gay males, and lesbians.
• Social Psychology of Violence and Bullying in Schools Bullying is a common phenomenon in schools and it is reported that it results in violence in learning institutions in the end.
• Bullying and Suicide: The Correlation Between Bullying and Suicide Nonetheless, the extensive research shows that the correlation exists and bullying is one of the risk factors for development of suicidal ideas in adolescents.
• Cyber Bullying Reduction Program Table of Activities Activity Significance Assembling parents/guardians, students and teachers to announce and explain the program in the institution To enlighten parents/guardians, students and teachers about the rules and regulation enacted due to the threat […]
• Cyber Bullying Prevention in Learning Institutions: Systematic Approach To start with, the students are provided with ways of reporting their concern to the educational institution, and when the staff members of the institution receive the report, they evaluate the information together with the […]
• Discouraging and Eliminating Cyber Bullying Resources Role of the resource/input Statement forms To facilitate information transfer to the staff Counseling Personnel To arm students against the problem Bullying report system To create efficient internet enhance report system Regulation implementation documents […]
• School Bullying: Methods for Managing the Problem The investigation of relevant studies on the methods for stopping school bullying reveals that the most effective ways of eliminating this type of behavior include providing training for teachers, encouraging students to participate in the […]
• High School Bullying Effective Responses Emphasis will also be made on the kind of audience to read this article because the contents of this study need to be at par with other similar articles in the journal to be selected.
• Bullying and Suicide Among Teenagers Specific objectives Analyze the causes of bullying among teenagers in the country Analyze the effects of bullying among victims, perpetrators and by-standers Analyze the relationship between bullying in school and suicide among teenagers in the […]
• Bullying as a Relational Aggression This resistance has been one of the obstacles to eliminating the cyber bullying in the schools. Schools and districts have been involved in the Challenge Day activities where children are advised on how to handle […]
• Bullying in the Workplace Organizational leaders have an ethical obligation to ensure that they deal with cases of bullying within the workplace in a professional manner that demonstrates equality, honesty, and high sensitivity to the needs of others.
• Social Bullying in Jeff Cohen’s “Monster Culture” It is clear that his part of character is mostly dominant in the childhood stages, as children are not able to develop a sense of morality and predict the consequences of their actions.
• Cyber Bullying and Its Forms The difference between the conventional way of bullying and cyber bullying is that in conventional bullying, there is contact between the bully and the victim.
• Problem of Workplace Bullying Authority intervention should occur when the employees fail to respond to awareness intervention, and thus decide to continue with their behaviors.
• Problem of Childhood Bullying in Modern Society To begin with, the family which is the basic and the most important unit in the society as well as the primary socializing agent plays a major role in shaping behavior of children include bullying.
• Problem of the Managing Bullying and Harassment in the Workplace Employees in an organization have a specific role that they are supposed to play and this means that there might be shortcomings which should not lead to bullying.
• School Bullying: Causes and Police Prevention It is for this reason that there has been need for the intervention of the community and the government to address the issue of bullying schools lest the school environment becomes the worst place to […]
• Cyber Bullying as a Virtual Menace The use of information and communication technologies to support a deliberate and most of the time repeated hostile behavior by an individual or groups of people with the sole intention of harming others, one is […]
• Does Bullying Cause Emotional Problems? However, the current study was relevant because of this design, for the scope of the study covered as well as the results were accurate, and the conclusions drawn were correct.
• Ban High School Bullying A number of stakeholders contribute to the high prevalence of bullying in American schools. Schools that ignore bullying are a big part of the problem and they need to be held accountable.
• The Problem of Bullying While most states in the United States of America have laws to protect people from bullying, the federal government is yet to enact an anti-bullying law.
• Ethical Case: Facebook Gossip or Cyberbullying? The best option to Paige is to apologize publicly and withdraw her comments. The final stage is to act and reflect the outcome of the choice made.
• Bullying on the Rise: Should Federal Government Enact Federal-Bullying Laws? This paper will thus use both primary and secondary data to discuss the prevalence of bullying in schools and whether the federal govern should enact federal laws to curb the social vice at school.
• Bullying in School Face-to-face bullying is an interesting area of study because it clearly demonstrates bullying in school. Students consider bullying as a school culture even though it is contrary to the school rules and regulations of schools.
• Character Traits of Bullying Despite the fact that such characteristics may differ from child to child, it is the common feature of difference that makes the target children get noticed by the bullies.
• Bullying in the Schools Furthermore, the law states that training should be done to the teachers as well as the other members of staff on how to deal with bullying and the law also needs the schools to report […]
• The Issue of Bullying in the Schools It gives me joy to know that the issue of bullying is now a pubic affair since bullying stories were unheard of when I was growing up.
• Troubled Adolescent due to Bullying His lowered self-esteem would make him to observe the common behaviours of the older boys quietly and accept the situation as a cultural practice.
• Workplace bullying: does it exist?
• What are the three key elements of bullying?
• How does bullying affect those who observe it?
• Direct and indirect bullying: what is the difference?
• What families do bullies typically come from?
• Aggressive children: what is their future?
• How to prevent bullying in schools?
• School bullying and domestic violence: is there a connection?
• Cyberbullying: how to prevent it?
• What can parents do to prevent their children from bullying?
• Children’s Rights Research Ideas
• Equality Topics
• Homophobia Topics
• School Violence Ideas
• Respect Essay Topics
• Social Inequality Paper Topics
• Suicide Topics
• Youth Violence Research Topics
• Chicago (A-D)
• Chicago (N-B)

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ORIGINAL RESEARCH article

Effect of offline bullying on online unethical behavior among college students: the mediating roles of relative deprivation and anger rumination.

• 1 School of Education, Guangzhou University, Guangzhou, China
• 2 Institute of Entrepreneurship, Guangdong Women's Polytechnic, Guangzhou, China
• 3 School of Management, University of Electronic Science and Technology of China, Zhongshan Institute, Zhongshan, China

This research delves into the correlation between offline bullying and online unethical behavior among college students; and examines the potential mediating influences of anger rumination and perceived relative deprivation. The findings suggest that anger rumination, perceived relative deprivation, offline bullying, and online unethical behavior exhibit significant positive correlations with each other. Offline bullying is a strong predictor of online unethical behavior among college students, with the dual mediating effects of perceived relative deprivation and anger rumination on the relationship between offline bullying and online unethical behavior. This suggests that offline bullying directly influences college students' online unethical behavior and also influences it indirectly through anger rumination and perceived relative deprivation.

1 Introduction

Online unethical behavior is generally considered as any behavior that violates moral norms or principles in the context of online interactions ( Ullrich et al., 2020 ), including cyberbullying, violation of privacy, spreading misinformation, etc.

The subject of online unethical behavior has its roots in the real experiences of individuals, and their actions in the virtual space of the internet are still influenced by their offline experiences. General Strain Theory proposes that when individuals encounter aggression or negative experiences, these incidents can lead to antisocial behaviors or misbehavior ( Agnew, 1992 ). The General Model of Aggression suggests that individuals who are bullied in real life are also vulnerable to online bullying and tend to show more aggression and hostility after experiencing online bullying ( Kowalski et al., 2014 ). Individuals who hid in the online space often feel more braver and powerful to resist and retaliate against bullying, which may lead them to commit unethical act online to maintain their psychological balance and regain their self-confidence ( Fan et al., 2023 ). Those who reported experiencing severe bullying were significantly more likely to engage in academic cheating, plagiarism, and visiting inappropriate websites compared to their peers who were not bullied ( Doe et al., 2019 ).

Offline bullying can serve as a risk factor for later online unethical behavior. Individuals who are bullied offline often perceive themselves as being in a lower status ( Mummendey et al., 1999 ), leading to feelings of injustice and dissatisfaction. These negative emotions can encourage violent behavior ( Kunst and Obaidi, 2020 ), which arises from a feeling of relative deprivation. Relative deprivation results in a cognitive distortion in the way individuals perceive their circumstances, and this distortion serves as a catalyst for the emergence of angry thoughts ( Mummendey et al., 1999 ).

After being bullied offline, individuals often dwell on past negative events and stressful experiences, which will leading to persistent feelings of anger and anxiety ( Borders, 2020 ), their anger rumination will be reinforced ( Hamer and Konijn, 2016 ). It also awakens the individual's sense of aggression and puts them in a state of anger and resentment causing the individual to develop a state of aggressive and inappropriate behavior repeatedly ( Pedersen et al., 2011 ), leading to increased aggressive behavior ( Watkins and Roberts, 2020 ; Camacho, 2021 ).

Anger rumination is understood as the tendency to continuously think about and relive anger-inducing events ( Sukhodolsky et al., 2001 ), which leads to more enduring and extensive harm to individuals, consequently resulting in an increase in unethical behaviors. Onlinespace presents the features of reproducibility, persistence, and all-weather accessibility ( Kiesler et al., 1984 ; Kowalski et al., 2014 ), intensify anger rumination ( Jose and Vierling, 2018 ). Research by Love H. et al. (2023) further emphasizes that individuals who experience frequent bullying are likely to exhibit higher levels of anger rumination.

Whether in cyberspace or offline real space, the decision-making process of ethical behavior is always based on the individual in real society as the subject of ethical behavior. The topic of online unethical behavior lives in real space, but also on the Internet for interpersonal communication, learning and life in the network. The environment in which the problem of online unethical behavior is located must consider both the real space and the cyberspace in which the individual lives, and the moral events that take place between the two will influence each other.

How stressful events in the offline space affect an individual's online ethical behavior in the online space is worthy of research and requires further study. How does offline bullying behavior as a typical negative event affect individuals' online ethical behavior? By examining the connection between offline bullying and online unethical behavior, we can gain a deeper understanding of the underlying causes that lead to online unethical behavior. At the same time, it emphasizes the continuity between the real-world and the digital space, provides a basis for a comprehensive understanding of individuals' offline and online misbehavior. Developing more targeted and effective interventions and prevention measures for policy makers, educators, and mental health professionals is critical. Enriches applied research on General Strain Theory (GST) and the General Model of Aggression (GMA) in the field of ethics.

How does offline bullying influence individuals' online unethical behavior? What kind of relationship exists? The hypothetical model proposed in this study is shown in Figure 1 .

Figure 1 . Dual mediation model hypotheses between realistic bullying and online unethical behavior.

2.1 Subject

In this study, stratified sampling was used to select five types of universities in Guangdong Province, such as 985-project universities, 211-project universities, double-first-class construction universities, other public universities, and private universities, and one school was randomly selected from each of them, with a total of five schools for the questionnaire survey. A total of 412 questionnaires were distributed, and invalid questionnaires in the recovered questionnaires were removed based on (1) respondents presenting obvious regularity in answering, such as the cycle of “12,345”; (2) respondents choosing extreme options for all questions, such as choosing the highest score or the lowest score for all of them; and (3) respondents completing the questionnaires in too short a period of time, and 2 min was used as a pre-curated and reasonable answering time in the present study, and data with < 2 min of answering time were removed. Finally, 402 valid questionnaires were obtained. The analysis included 173 male participants, M = 20.48, SD = 1.78, the age range was [19, 22]. Approval for the study was obtained from the university's academic board, and participants voluntarily signed a written informed consent before completing the questionnaire.

2.2 Measure

Participants completed an author-compiled demographic measure, assessing gender (identifying as male, female), age (in years), and grade (identifying as 1st, 2nd, 3rd, 4th).

2.2.1 The bullying behavior scale

The scale consists of 14 items, which include two subscales, verbal bullying and relational buying ( Liu, 2006 ). Participants rated each item on a 5-point Likert scale (1 = never to 5 = always), and higher mean scores indicate more bullying behaviors experienced. The scale has good reliability and the Cronbach's alpha coefficient for the scale in this study was 0.902.

2.2.2 Anger rumination scale

The scale is a 19-items scale that includes four dimensions: anger after the fact, memory of anger, revenge thoughts and understanding the cause ( Luo et al., 2011 ), the Cronbach's alpha coefficient was 0.87. Participants rated each item on a 4-point Likert scale (1 = occasionally or no to 4 = always). In this study, the Cronbach's alpha coefficient was 0.911.

2.2.3 Relative deprivation scale

The 4-items scale ( Ma, 2012 ) is one of the commonly used scales by academic researchers, which is widely recognized by scholars. Participants rated each item on a 6-point Likert scale (1 = strongly disagree to 6 = strongly agree). In this study, the Cronbach's alpha coefficient was 0.825.

2.2.4 Online unethical behavior scale

The scale is a 16-items scale that includes four dimensions, network attack behavior, network infringement, false network information and network pornography, Validated to have good reliability ( Lin and Tang, 2024 ). Participants rated each item on a 5-point Likert scale (1 = Never to 5 = Always). In this study, the Cronbach's alpha coefficient was 0.890.

3 Data analysis and results

3.1 common method deviation.

This study employed Harman's single factor test to examine common method deviation. All items from the four scales were subjected to exploratory factor analysis. The analysis revealed eleven factors with eigenvalues >1, exceeding a single factor. Additionally, the variance explained by the largest factor was 28.71%, which was below the 40% threshold. Therefore, the results indicate that common method deviation is not present in this research.

3.2 Correlation analysis between the various variables

The results of the correlation analysis between the variables are shown in Table 1 , showing significant positive associations between offline bullying, relative deprivation, angry rumination, and online unethical behavior, p < 0.01.

Table 1 . Correlation analysis between the various variables.

Offline bullying was found to be significantly and positively correlated with relative deprivation, anger rumination, and online unethical behaviors ( r = 0.5218, 0.448, and 0.557; p < 0.01). This indicates that the more severe the offline bullying experienced, the higher their levels of relative deprivation, anger rumination, and engagement in online unethical behaviors. Furthermore, relative deprivation was significantly and positively correlated with both anger rumination and online unethical behaviors ( r = 0.577 and 0.636; p < 0.01), suggesting that higher levels of relative deprivation among college students are associated with increased anger rumination and online unethical behaviors. Additionally, angry rumination was significantly and positively correlated with online unethical behaviors ( r = 0.546; p < 0.01), indicating that higher levels of anger rumination are associated with increased online unethical behaviors.

The findings suggest that offline bullying may lead to increased relative deprivation among college students, which in turn may trigger more anger rumination and ultimately result in higher levels of online unethical behaviors. Addressing the issue of offline bullying among college students could help in mitigating the emergence of negative emotions and behavioral problems.

3.3 Analysis of the dual mediation effects of relative deprivation and anger rumination

This study utilized the PROCESS 4.0 plug-in for SPSS software to conduct its analysis, with offline bullying serving as the independent variable, and online unethical behaviors as the dependent variable. Relative deprivation and anger rumination were examined as mediating variables. Model 4 was selected to investigate whether relative deprivation and anger rumination mediate the effect of offline bullying on online unethical behaviors. The bootstrap sampling method was employed for testing, and specific results are presented in Table 2 .

Table 2 . Model test of the mediation effect.

Offline bullying had a significant direct effect on online unethical behavior (R 2 = 0.556, B = 0.524, p < 0.001). This suggests that even after controlling for the effects of relative deprivation and angry rumination, offline bullying still has a significant positive impact on online unethical behavior. Both relative deprivation ( R 2 = 0.518, B = 0.719, p < 0.001) and angry rumination ( R 2 = 0.448, B = 0.317, p < 0.001) are significantly predicted by offline bullying, suggesting that offline bullying contributes to these mediating variables. When considering the combined effect of offline bullying, relative deprivation, and angry rumination on online unethical behavior, the explanatory power of the model increases significantly ( R 2 = 0.714), with all predictors showing significant effects ( B = 0.247 for offline bullying, B = 0.245 for relative deprivation, and B = 0.311 for angry rumination).

Further test for the mediation effect between the variables, as shown in Table 3 , both relative deprivation and angry rumination serve as significant mediators in the relationship between offline bullying and online unethical behaviors. However, the direct effect of offline bullying remains substantial, accounting for nearly half of the total effect. Relative deprivation partially mediates the relationship between offline bullying and online moral anomie behaviors, with a mediation effect value of 0.176. This indicates that 33.65% of the impact of offline bullying on online moral anomie behaviors is due to the mediation effect of relative deprivation. Similarly, angry rumination also plays a partial mediating role in the relationship between offline bullying and online moral anomie behaviors, with a mediation effect value of 0.100, meaning that 19.12% of the impact is mediated by angry rumination. Thus, both relative deprivation and angry rumination partially mediate the relationship between offline bullying and online moral anomie behaviors. Offline bullying influences online moral anomie behaviors through the mediation effects of both relative deprivation and angry rumination.

Table 3 . Mediation effect of relative deprivation and angry rumination.

4 Discussion

4.1 offline bullying is positively correlated with online unethical behavior.

The results of this study demonstrate that offline bullying has a positive correlation with online unethical behavior. This finding is consistent with the research which concluded that students who are often bullied in real life are more likely to exhibit inappropriate behavior on the internet ( Martins, 2021 ; Mazzone et al., 2021 ), indicating a vicious cycle of aggression.

The anonymity of the internet and the lack of moral cues make it easier for individuals who are bullied in the real world to express their anger and other negative emotions online. Victims of bullying often experience feelings of powerlessness, anger, and frustration, which they may channel into the digital realm where they feel less inhibited. The anonymity afforded by the internet plays a crucial role in this transformation. The lack of immediate, real-world consequences allows individuals to express negative emotions more freely and engage in behaviors that they might avoid in face-to-face interactions.

The anonymity of the internet diminishes the perception of accountability, leading to moral disengagement. This cognitive process allows individuals to rationalize unethical behavior by diffusing responsibility. Online platforms often lack clear moral cues, which makes it easier for individuals, especially those with prior experiences of bullying, to justify their unethical acts as retaliation or self-defense.

The internet's structure also facilitates the spread of unethical behaviors. The decentralized distribution of moral information and the bidirectional interaction inherent in digital communication can quickly transform personal grievances or ethical lapses into collective moral participation. This collective dynamic often results in the diffusion of responsibility, where individuals feel less personally accountable for their actions. The presence of a group engaging in similar behaviors reinforces the notion that such actions are acceptable.

Moreover, the phenomenon of moral disengagement is amplified online. Individuals often position themselves on a moral high ground, which leads them to criticize or attack others, modeling the behavior they have observed or experienced in bullying scenarios. The mentality of “if others can do it, so can I” becomes prevalent, further normalizing unethical behavior in the digital sphere.

4.2 The mediating role of relative deprivation

The findings of this study elucidate the mediating effect of relative deprivation on the relationship between offline bullying and online unethical behavior among college students. Relative deprivation intensifies individuals' negative emotions, which then propel them to engage in online deviant behaviors ( Wang et al., 2023 ). Individuals frequently bullied in real life tend to experience higher levels of relative deprivation, making them more prone to exhibiting unethical behavior online ( Li et al., 2023 ).

In the unique context of the internet, such behaviors can become even more uncontrollable. Experiences of offline bullying are intertwined with an escalation in online unethical behavior. Students who endure frequent bullying in real life are more susceptible to higher levels of relative deprivation ( Liang et al., 2023 ). This is because continuous exposure to bullying episodes can lead to a persistent state of perceived injustice and social inferiority. When students find themselves entrapped in these adverse scenarios without feasible escape routes, feelings of despair and failure take root. Their emotional equilibrium is disturbed, leading to heightened feelings of anger, frustration, and helplessness. These emotions can override an individual's self-regulatory mechanisms, causing them to lose control and engage in online unethical behaviors.

In conclusion, the mediating role of relative deprivation provides a new explanatory perspective on the observed link between offline bullying and online unethical behavior among college students. By intensifying negative emotions, relative deprivation acts as a catalyst that propels students from adverse real-life experiences to deviant online behaviors. Understanding this mediating role highlights the need for targeted interventions that address both the immediate consequences of bullying and the underlying feelings of injustice and disadvantage. Such interventions could potentially mitigate the emotional disturbances caused by bullying, thereby reducing the likelihood of subsequent unethical behavior online.

4.3 The mediating role of anger rumination

The findings of this research indicate that anger rumination significantly mediates the relationship between offline bullying and online unethical behavior among college students. Individuals frequently bullied in real life tend to exhibit higher levels of anger rumination ( Love S. et al., 2023 ), When an individual's accumulated anger reaches a boiling point without an outlet, they are highly likely to engage in extreme behaviors online. This phenomenon can be understood through the lens of emotional overflow, the point at which accumulated emotions seek release. This is because the psychological repression, grievances, and anger of those frequently bullied in real life often remain unaddressed in their daily lives, making the internet a more appealing outlet for them. Consequently, they are more prone to engage in unethical behavior online compared to their peers.

The mediating role of anger rumination in the relationship between offline bullying and online unethical behavior underscores the complexity of these interactions. Unresolved anger, psychological repression, and the allure of the online world create a pathway through which bullied individuals express their frustrations. Identifying and addressing anger rumination can serve as a pivotal step in mitigating the transition from victimization to perpetration of unethical behavior online.

4.4 The chain intermediation effect of relative deprivation and anger rumination in offline bullying and online unethical behavior

This study discovered that relative deprivation and anger rumination serve as dual mediators between offline bullying and cyber unethical behavior. Relative deprivation significantly fosters anger rumination, essentially suggesting that “a sense of inferiority leads to greater cynicism.” Anger rumination exacerbates individuals' feelings of anger, which, in turn, may lead to extreme and inappropriate actions online ( Xue et al., 2011 ). Both relative deprivation and anger rumination amplify and sustain negative emotions following bullying and negative events. First, real-life victimization triggers anger rumination, as individuals fixate on the unfair treatment they have experienced. This rumination amplifies negative emotions and leads to a greater sense of perceived deprivation. Second, the heightened perception of deprivation motivates individuals to seek retribution or compensation, which may manifest as online unethical behavior.

Therefore, interventions for online unethical behavior should not only aim at providing immediate emotional relief to those offline bullied, but also require long-term support. This requires the collective attention and participation of families, schools and communities to promote a healthy online environment, establish appropriate norms and rules for online behavior, enhance the monitoring of online activities, reduce the likelihood of bullying among students, and to support them in responding appropriately to online misconduct. From the perspective of the individual college student, colleges and universities should provide anger management training and resources to help individuals regulate their emotions and reduce the tendency to ruminate about anger. Anger can be effectively managed through techniques such as psychocognitive behavioral therapy and positive thinking exercises ( Deffenbacher et al., 2000 ).

5 Perspectives

The study examines the relationship between offline bullying behavior and online unethical behavior, examines the dual mediating roles of angry rumination and relative deprivation in this process, and validates the role of these two moral cognitive factors in this process. The study of the factors influencing individual online unethical behavior is a systematic and complex project, that is subject to the interaction of multiple factors. It is influenced by the individual's personality traits, moral cognition, emotions and feelings, and other internal factors, as well as external factors such as the offline social events in which the individual is involved, the online network events, the individual's family environment and peer relationships. Researchers can further study the following aspects: (1) systematically sort out and integrate intrinsic and extrinsic factors, examine their mechanisms and pathways of action on cyber immoral behavior, and elucidate the status and roles of different levels of factors in the causes of online unethical behavior. (2) Using big data technology to build a decision-making model of online moral behavior from multiple dimensions and levels, to improve the existing moral decision-making theory and enrich the theory of online moral decision-making. By collecting and analyzing the behavioral data of internet users on social media, forums, shopping websites and other platforms, it identifies the key factors that influence online moral decision-making and builds a computational model to predict online moral behavior. Big data analysis can offset the limitations of traditional questionnaire surveys and experimental studies and provide more comprehensive, objective and real-time behavioral insights. (3) Conduct tracking research on individual cybernetic behavior. The individual's online behavior is a dynamic developmental process, and his/her online behavior will continue to change with time, accumulation of experiences and maturity of knowledge. Future research can conduct longitudinal studies to continuously track the course of changes in individual online moral decision-making behavior, examine their developmental patterns, and provide a basis for developing targeted online moral education strategies. (4) Based on the results of the analysis of the influencing factors of network unethical behavior, we will explore diverse and effective intervention methods and means of promoting online ethical behavior, in order to develop a three-dimensional network ethics education strategy and improve the level of individual network ethics in all aspects.

Data availability statement

The data that support the findings of this study are available in the figshare.com ( https://doi.org/10.6084/m9.figshare.26061253 ).

Ethics statement

The studies involving humans were approved by the Academic Ethics Committee of Zhongshan Institute belongs to the Zhongshan Institute of the University of Electronic Science and Technology. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.

Author contributions

YL: Writing – original draft. ZT: Writing – review & editing, Data curation. QX: Writing – review & editing.

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This paper was the result of the stage research “Research on the Influence Mechanism of College Students' Online Moral Demonstration Behavior and Moral Boosting” (No. GD20XJY25), a discipline co-construction project of philosophy and social science of Guangdong Province “13th Five-Year Plan” in 2020; and Guangdong Social Science Planning 2021 Project Construction of the Value-added Evaluation system for Adolescents' Mental Health based on Digitalization (No. GD21CJY12).

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyg.2024.1407157/full#supplementary-material

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Keywords: offline bullying, online unethical behavior, anger rumination, relative deprivation, college student

Citation: Lin Y, Tang Z and Xing Q (2024) Effect of offline bullying on online unethical behavior among college students: the mediating roles of relative deprivation and anger rumination. Front. Psychol. 15:1407157. doi: 10.3389/fpsyg.2024.1407157

Received: 26 March 2024; Accepted: 15 July 2024; Published: 06 August 2024.

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Copyright © 2024 Lin, Tang and Xing. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Zhiwen Tang, 152155784@qq.com ; Qiang Xing, qiang_xingpsy@126.com

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

False accusations surrounding Olympic boxer highlight debate around gender and sports

William Brangham William Brangham

Sam Lane Sam Lane

Joshua Barajas Joshua Barajas

Mekhi Hill Mekhi Hill

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• Copy URL https://www.pbs.org/newshour/show/false-accusations-surrounding-olympic-boxer-highlight-debate-around-gender-and-sports

The 2024 Olympics have garnered tens of millions of viewers with jaw-dropping performances and compelling storylines. But in recent days, controversy surrounding the gender of one boxer has also consumed headlines. William Brangham discussed what this says about the future of women’s sports with Katie Barnes, author of “Fair Play: How Sports Shape the Gender Debates."

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Notice: Transcripts are machine and human generated and lightly edited for accuracy. They may contain errors.

Amna Nawaz:

The 2024 Olympic Games have garnered tens of millions of viewers with jaw-dropping performances and compelling storylines.

But in recent days, controversy surrounding the gender of one boxer has also consumed headlines.

William Brangham has that story.

William Brangham:

Algerian boxer Imane Khelif was triumphant yesterday. She defeated her opponent from Thailand and will now fight for gold on Friday night. On the streets of Paris, Algerian fans rejoiced.

Maya Silarbi, Algerian Supporter (through interpreter):

It was an intense fight. She gave everything. Imane was able to represent her country. She was able to show the world what strong Algerian women are. She came out victorious and we are proud of that.

But Khelif's rise has also put her at the center of an international firestorm. It began last week, when she defeated an Italian boxer here in blue who quit their match after just 46 seconds, saying she was in too much pain from Khelif's punches.

A man from beating a woman to death.

Immediately, social media and cable news was flooded with false accusations that Khelif was male or transgender.

Former President Donald Trump and Harry Potter author J.K. Rowling, both of whom have spoken out against transgender people, lashed out at Khelif's participation.

Sen. J.D. Vance (R-OH), Vice Presidential Candidate: The far left wants to allow biological males to beat the living crap out of women in boxing.

Khelif is not male or transgender, but these recent accusations stemmed in part from her disqualification at last year's world championships.

The International Boxing Association, or IBA, a governing body for the sport, barred Khelif and a Taiwanese boxer after the IBA claimed they failed unspecified gender eligibility tests. The International Olympic Committee, which called the IBA's decision quote, arbitrary and banned the association over corruption concerns last year, decried the vitriol that's been aimed at Khelif.

Mark Adams, Spokesperson, International Olympic Committee:

The Algerian boxer was born female, was registered female, lived her life as a female, boxed as a female, has a female passport. This is not a transgender case.

Amid the attacks, Khelif's father came to his daughter's defense.

Amar Khelif, Father of Imane Khelif (through interpreter): This is our official family document, May 2, 1999, Imane Khelif, a female. It is written here. You can read it. This document doesn't lie. The people who are lying and leading a fierce campaign against her are the enemies of God. The attacks against her are immoral, it is not fair.

Imane is a little girl that has loved sport since she was 6 years old.

Algerian fans have been solidly behind Khelif at the Games, and, this week, she spoke about the toll the criticism has taken.

Imane Khelif, Algerian Boxer (through interpreter):

I send a message to all the people of the world to uphold the Olympic principles, to refrain from bullying all athletes, because this thing has effects, massive effects. It can destroy people. It can kill people's thoughts, spirit and mind.

So that was Imane Khelif a few days ago, describing what these accusations can do to people.

For a deeper look at what we do and do not know, and what this says more broadly about the future of women's sports, we are joined by Katie Barnes, who's been closely following this for ESPN. Katie is also the author of "Fair Play: How Sports Shape the Gender Debates."

Katie Barnes, thank you so much for being here.

There are so many different threads in this story, who governs boxing, who gets to determine, who competes where, all these misconceptions about Imane Khelif herself. But let's start with her to begin with. She's born a female, she's lived her life as a female, she's competed as a female, and yet there's this international boxing association test that allegedly disqualifies her.

What do we know about that test and what it tells us?

Katie Barnes, ESPN:

The nature of the test itself is unclear. The association has said that it was not a testosterone test. In a press conference, they later clarified that it was a blood test.

But what they were testing for and exactly what eligibility standards Khelif did not meet, they have not been specific about. And part of that is due to the fact that this information is private medical information, so they are limited in terms of what they can say publicly without the consent of the fighters.

So, at its core, it seems that there is this discrepancy between what the IBA and the Olympics say about whether or not someone has some unfair characteristics that allow them to compete or not, right? Isn't that the core of this?

Katie Barnes:

Yes, there's the tension around the question of who it should be eligible to compete in the women's category in sports, in this case in boxing.

And there is a disagreement, it would seem, between the IBA and the IOC. And, again, we don't know the specifics of the disagreement, but the IBA has vigorously defended its decision to disqualify Khelif and Lin Yu-ting. And the IOC has vigorously defended its decision to include them both in women's boxing competition in Paris.

How often are these tests used? Have they been used for a long time? What can you tell us about the history of this kind of testing?

I would say that sex verification testing in terms of determining whether or not an athlete who wants to participate in an elite women's category is eligible to do so,that has been around for a very long time, almost since women have been playing sports at the Olympic level, frankly.

And so those tests have taken different forms from visual inspections to cheek swabs that are looking for DNA tests or chromosomes to hormone tests over time. And so they have taken different forms. And in recent years, I would say it's been cyclical in terms of how these tests are performed and under what circumstances.

And so it's an ongoing discussion about how best to regulate the women's category. And it is something that is unique to the women's category. The men's category is not under the same type of scrutiny, largely because of the nature of how women began to get access to sports to begin with.

It's derived from this idea that this is a protected category. And so, therefore, the boundary that is set must be policed from a regulation standpoint. And so how that has happened has changed over time, but it's pretty much always been there.

So what do you make of the whole political firestorm that blew up over Imane's successes?

I really think of it as a consequence of imprecise language.

When people use terms like "biological male — quote, unquote — and — quote, unquote — "man" to describe people who are competing in a women's sporting event, especially a combat sports event like boxing, that tends to bring out a lot of emotion from folks.

And that is also happening in the wake of just a tremendous amount of emotional and legislative energy being put toward addressing some of these issues in the United States in terms of legislation passing around transgender athletes. And so I really think that bred a lot of confusion and brought out a lot of emotions. And sometimes that was used inadvertently and correctly. And sometimes folks, I think, weaponized that in this particular case.

I mean, apart from these larger debates over these — who governs these rules and who sets these standards, as we heard from Imane Khelif herself, the vitriol that was directed at her about — towards an individual has got to be so dispiriting when you're trying to compete at this level.

Yes, I can't speak for her, of course, but judging by what she has said publicly, and also, what — how she just released so much emotion after winning her quarterfinal bout, you know, it's very clear that this has weighed heavily on her.

And other athletes who have been through similar difficulties when they run-up against policy that disqualifies them and that becomes public, I think it's important to acknowledge as members of the public that these are real people who are wrestling with these things and perhaps are learning new information about themselves.

And now that's being parsed publicly and in highly emotional and charged ways. And athletes are human too. And I think we would be — we would do well to remember that.

All right, Katie Barnes of ESPN, thank you so much for helping us wade through all of this.

Thank you for having me.

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William Brangham is an award-winning correspondent, producer, and substitute anchor for the PBS News Hour.

Sam Lane is reporter/producer in PBS NewsHour's segment unit.

Joshua Barajas is a senior editor for the PBS NewsHour's Communities Initiative. He also the senior editor and manager of newsletters.

Mekhi Hill is a production assistant at the PBS NewsHour.

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Biden’s Title IX Rule Goes Into Effect in 24 States as Legal Challenges Continue

The regulations, which broaden sex discrimination to include gender identity and sexual orientation, remain blocked by lawsuits across much of the country.

By Zach Montague

Reporting from Washington

Biden administration Title IX regulations that strengthen protections for L.G.B.T.Q. students went into effect in 24 states on Thursday, but the rule remains blocked in the rest of the country because of legal challenges.

The new regulations broaden the scope of Title IX, the landmark 1972 law that prohibits discrimination based on sex in institutions that receive federal funding. They extend the law’s reach to include discrimination based on sexual orientation and gender identity, as well as unequal treatment of pregnant students, significantly expanding the scope of complaints schools must investigate.

The partial implementation on Thursday was a significant, if incomplete, breakthrough for the Biden administration, which has fought to enforce stronger Title IX regulations after former President Donald J. Trump’s administration gave more protections to students accused of sexual misconduct.

“These regulations make crystal clear that everyone has the right to schools that respect their rights and offer safe, welcoming learning environments,” Miguel A. Cardona, the secretary of education, said on Thursday. “They clarify that Title IX’s prohibition of sex discrimination includes all forms of sex discrimination.”

He added: “It’s unacceptable that any student has to give up on their dreams of a college degree because they’re pregnant, and it’s unacceptable that any student face discrimination or bullying simply because of who they are.”

Republican attorneys general have challenged the regulations in 10 lawsuits, preventing them from taking effect in 26 states.

Last week, the Biden administration asked the Supreme Court to resolve the confusing legal landscape by allowing provisions that were not challenged to take effect while it appeals decisions blocking the rule, but the court has not yet agreed to weigh in.

“It’s a very fluid legal environment,” Catherine Lhamon, the Education Department’s assistant secretary for civil rights, said during a call with reporters on Thursday.

The rule sidestepped one of the most contentious topics in educational policy by not mandating whether transgender athletes must be allowed on sex-separated sports teams.

On the call on Thursday, Ms. Lhamon stressed that the Education Department was still pursuing a separate regulation to address that issue, but the current rule only covered any form of discrimination “separate and apart from on which team an athlete plays in a school.”

Some Republican lawmakers on Thursday nevertheless conflated the regulation’s stated aims with misleading claims about sports team participation.

“Thank God the Biden-Harris rewrite of Title IX will not go into effect in Alabama today,” Senator Tommy Tuberville of Alabama wrote on X. “Men don’t belong in women’s sports. It’s dangerous, it’s unfair, and it’s WRONG.”

Given the evolving legal landscape that emerged on Thursday, the Education Department urged students and those school administrators who will now be required to enforce the rule to check its status on the department’s website .

Zach Montague is a Times reporter covering the U.S. Department of Education, the White House and federal courts. More about Zach Montague