What are the health risks for adolescent bullies and how do they differ for bully-victims?

Bullying perpetration is an increasingly recognized problem in schools and is associated with poor psychosocial functioning, lower academic achievement, substance use, and violent behavior. Bully-victims, perpetrators of bullying who are also victims themselves, may represent a group at particularly high risk. Using self-report data collected in 2003 from a multiethnic sample of 418 9th-11th grade students (56.9 % female, 31% Latino, 26% black, 16% white, 22% other race/ethnicity) in two urban high schools, we examined the health risk profiles for bullies and bully-victims. Multivariable logistic models controlled for sex, race/ethnicity, grade, and school. Compared to students with no bullying involvement, perpetrators of bullying reported lower school connectedness and greater sexual assault victimization, substance use, and eating disorder symptoms. Within the subgroup of students reporting having bullied others, bully-victims were at higher risk across a range of domains. Compared to students who were bullies only, bully-victims were more likely to report depressive symptoms (OR 2.7; 95% CI 1.2-6.4), skipping school because they felt unsafe (OR 6.4; 95% CI 1.3-32.4), having been a victim of forced sexual contact (OR 2.7; 95% CI 1.0-7.3), using drugs other than alcohol or marijuana (OR 4.0; 95% CI 1.3-12.6), and eating disorder symptoms (OR 3.8; 95% CI 1.3-11.1). Bully-victims are a distinct subgroup of bullying perpetrators with a particularly poor health risk profile. While bullies are often referred to the school disciplinary system for intervention, understanding the unique vulnerabilities of bully-victims may be important for developing effective school-based interventions.