Bullies and Victims: Boys will be boys or a symptom of distress?

Several months ago I reported on a series of studies regarding the long term effects of bullying. See for example a discussion on factors that are associated with being a victim or a bully, or this discussion on the effects of bullying on children with special needs. I also reported on a very interesting study that examine the long term consequences of bullying. Data from that study showed  that being a victim of bullying in middle childhood almost double the odds of having psychotic symptoms during adolescence. In that post I discussed one major limitation of that study. While the data seem to imply that experiencing bullying could play a role (‘a causative’ role) in the eventual emergence of psychotic symptoms, it was also possible that those “children who were on path to developing psychotic disorders also engaged in behaviors during early childhood that made them more likely to be victims of bullying.”

This morning I read a study published in a recent issue of the prestigious Archives of General Psychiatry that can help us clarify this issue. The study examined data from the 1981 Finish Birth Cohort study. The study included 5,813 children born in Finland in 1981 and contained data on psychiatric symptoms at age 8, history of bullying at age 8 (from teacher, parents, and self reports), and psychiatric outcomes (hospital treatment,  psychiatric medication use, etc) at age 13 to 24. The authors of the present report were interested in examining whether bullying behaviors at age 8 predicted psychiatric outcomes in adolescents and young adulthood after controlling for psychiatric symptoms at age 8.

Children were classified into 4 groups based on their bullying behavior at age 8, namely: 1) those who were never victims or bullies; 2) those who were bullies only; 3) those who were victims only; 4) those who were both victims and bullies.

The Results:

1. Among females, being a victim (but not a bully) was associated with a significant increase in the risk for later psychiatric hospitalization and psychiatric medication use. Most importantly however, this association was significant even after controlling for the girls’ psychiatric symptoms at age 8. That is, the association between being a victim of bullying and negative psychiatric outcomes could not be accounted for by the presence of psychiatric symptoms in middle childhood.

2. Among males, being a victim (whether alone or when the child is also a bully) was associated with a significant increase in the risk for later psychiatric hospitalization. Further, being both a victim and a bully was associated with an increase in the risk for later psychiatric medication use. However, when the authors controlled for psychiatric symptoms at age 8, being a victim of bullying no longer predicted psychiatric hospitalizations or medication use.

In sum, this study suggests that bullying may play a role in the development of psychiatric problems during adolescence and young adulthood, but only among females. In contrast, being a victim of bullying among males may reflect concurrent psychiatric problems that may place the boys at a higher risk for being victims. Therefore, it is possible that among boys, it is not being a victim of bullying that predicts later psychopathology, but it is the reasons behind why these kids become victims in the first place (for example underlying anxiety, depression, or pre-psychotic symptoms) that signal the eventual emergence of more severe psychiatric difficulties. There is a clear implication for parents and providers. The data suggest that when confronted with a boy who is the victim of bullying we should be attuned to, and if necessary address,  the possible symptoms that may have placed the boy at a greater risk for becoming the victim of bullying.

The Reference: Sourander, A., Ronning, J., Brunstein-Klomek, A., Gyllenberg, D., Kumpulainen, K., Niemela, S., Helenius, H., Sillanmaki, L., Ristkari, T., Tamminen, T., Moilanen, I., Piha, J., & Almqvist, F. (2009). Childhood Bullying Behavior and Later Psychiatric Hospital and Psychopharmacologic Treatment: Findings From the Finnish 1981 Birth Cohort Study Archives of General Psychiatry, 66 (9), 1005-1012 DOI: 10.1001/archgenpsychiatry.2009.122

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