Childhood bullying may raise the risk of eating disorder symptoms not only for victims but also for those who bully others, according to new research.
Researchers from Duke Medicine and the University of North Carolina School of Medicine analyzed data from 1,420 young people and found that those who acted as bullies were significantly more likely to show signs of bulimia—behaviors such as binge eating followed by purging—compared with children not involved in bullying. The results were published in the International Journal of Eating Disorders.
Lead author William Copeland, Ph.D., associate professor of psychiatry and behavioral sciences at Duke University School of Medicine, said the findings challenge the stereotype that bullies are uniformly resilient and immune to psychological harm. “There has been a perception that bullies are more robust and able to navigate social situations without consequence,” he said. “But our findings suggest bullying others may be associated with later body-image concerns and disordered eating behaviors. Teasing might reflect or amplify dissatisfaction with one’s own body, or bullies might later experience remorse that contributes to bingeing and compensatory behaviors.”
The study used data from the Great Smoky Mountains Study, a long-term community-based project that followed participants who enrolled at age 9. While the sample is not nationally representative, its decade-spanning interviews provide valuable insight into how bullying involvement between ages 9 and 16 relates to symptoms of anorexia and bulimia.
Researchers classified participants into four groups: children not involved in bullying; children who were victims; children who were both victims and instigators (bully-victims); and children who were solely bullies, repeatedly engaging in verbal or physical abuse, social exclusion, and rumor-spreading without themselves being victimized.
As expected, children who were victimized by peers faced elevated risks for eating disorder symptoms. Victims were nearly twice as likely to show symptoms associated with anorexia (11.2 percent prevalence) compared with children not involved in bullying (5.6 percent). They were also more likely to exhibit bulimia symptoms (27.9 percent vs. 17.6 percent among uninvolved peers).
Those who were both bullies and victims had the highest prevalence of anorexia-like symptoms (22.8 percent compared with 5.6 percent for uninvolved children) and also showed higher rates of binge eating (4.8 percent versus less than 1 percent for uninvolved children) and vomiting used to control weight.
Importantly, children identified solely as bullies were also at increased risk. Nearly one-third (30.8 percent) of bullies showed symptoms of bulimia, compared with 17.6 percent of children who were not involved in bullying.
Cynthia M. Bulik, Ph.D., distinguished professor of eating disorders at the UNC School of Medicine and co-author on the paper, emphasized the clinical implications: “People often project onto others the features they dislike most about themselves. Bullies’ taunting may reflect their own body dissatisfaction, and these dynamics point to the need to screen for disordered eating across all roles in bullying—aggressors, victims, and those who are both.”
Although many children who experience bullying go on to lead healthy lives, Copeland said the team is studying why some young people develop persistent problems while others display resilience. The researchers are exploring a range of influences, including socioeconomic outcomes, educational attainment, and possible genetic markers, to better identify who may need targeted support.
“Understanding resilience is essential,” Copeland said. “If we can identify the traits and circumstances that help some children recover without long-term effects, we can better support those who are most vulnerable and design interventions that foster those protective factors.”
The study’s authors include William E. Copeland and Cynthia M. Bulik, with additional contributions from Nancy Zucker, Dieter Wolke, Suzet Tanya Lereya, and Elizabeth Jane Costello.
Funding: Research support came from the National Institute of Mental Health (grants MH63970, MH63671, MH48085, MH080230); the National Institute on Drug Abuse (DA/MH11301); the William T. Grant Foundation; and the Economic and Social Research Council in the United Kingdom (ES/K003593/1).
Source: Duke University. Image credit: Mark Dubowski.
Abstract
Does childhood bullying predict eating disorder symptoms? A prospective, longitudinal analysis
Objective
Bullying is a common childhood experience with lasting psychosocial effects. This study examined whether involvement in bullying increases the risk for symptoms of eating disorders.
Method
Researchers used ten waves of data from the Great Smoky Mountains Study, following 1,420 participants between ages 9 and 25. Structured interviews assessed bullying role (not involved, bully only, victim only, or both bully and victim) and symptoms linked to anorexia nervosa and bulimia nervosa, including related behaviors.
Results
During childhood and adolescence, victims were at higher risk for symptoms consistent with anorexia and bulimia as well as related features, even after accounting for prior symptoms, existing psychiatric conditions, and family adversity. Bullies showed increased risk for bulimia symptoms and associated behaviors, while bully-victims had elevated anorexia symptoms. Victims more frequently reported binge eating, and bully-victims reported both binge eating and use of vomiting to control weight. Effects were similar for boys and girls in this sample. Childhood bullying exposure was not linked to persistent eating-disorder symptoms in adult follow-ups at ages 19, 21, and 25.
Discussion
Bullying involvement predicts eating disorder symptoms in both those who are targeted and those who perpetrate bullying. Assessment and treatment of pediatric eating problems should include evaluation of bullying experiences.
Study citation: William E. Copeland, Cynthia M. Bulik, Nancy Zucker, Dieter Wolke, Suzet Tanya Lereya, and Elizabeth Jane Costello. International Journal of Eating Disorders. Published online September 4, 2015. doi:10.1002/eat.22459