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The Adult Impact of Childhood Abuse, Neglect and Bullying

Expansive research with a large U.S. sample sets the stage for change.

According to the CDC in the landmark 2014 report "Bullying Surveillance Among Youths," estimates of bullying prevalence range widely, from 13 to 75 percent. Bullying presents a similar challenge as other forms of abuse and neglect, but is unique in key ways—it is so much a part of our culture, normalized and tolerated, even rewarded and admired as strength and power.

Parents of kids who are bullied will tell you that getting recognition and help is often an uphill battle. Teachers and staff are inconsistently trained, school administrators are loathe to recognize issues, whistle-blowers get scapegoated, families get ostracized, and victims get blamed.

Here's a story a parent shared: After much dismay and a few years of seeing various school counselors, administrators and medical specialists to investigate a variety of issues without getting a solid answer, this family took their son to a renowned pediatric mental health specialist, explicitly to assess for psychological and physical effects of bullying. It had become evident in the preceding months that bullying had been going on, but had been downplayed and dismissed. The expert 1) didn't assess for bullying and 2) gave an individual diagnosis only, highlighting medication treatment even when the specialist had been informed that traumatic experiences were a key part of the picture. How can an expert ignore bullying, even when asked to consider it?


Anti-bullying programs are beginning to get more traction, culture is shifting, and laws and surveillance are becoming more routine.

Beginning with the CDC's definition provides consistency:

"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."

There are two modes of bullying, direct and indirect. Direct includes physical behaviors, like shoving someone, as well as spoken and written aggression. Indirect includes behaviors such as spreading rumors about the target that are of a false, misleading and/or harmful nature. The types of bullying include physical, verbal, relational, and damage to property, including theft. Bullying is repetitive.

A Serious Problem

The consequences of bullying are profound. It can contribute to the development of depression, anxiety, and low self-esteem, alcohol and substance misuse, aggression, and risk for involvement in crime. Bullying can increase emotional distress and suicidal thinking. Research has connected bullying with social anxiety.

Bullying can take a physical toll. In addition to direct injury, bullying is associated with sleep problems, bed-wetting, physical symptoms including stomachaches, headaches, and chronic pain, and somatization disorders—medically unexplained but burdensome physical problems. Amplified Musculoskeletal Pain Syndrome (AMPS) is a recently named syndrome of pain and disability, which worsens with distress and improves when conditions get better.

Bullying can change physiology due to chronic stress, raising cortisol and potentially affecting brain and social/psychological development. It is also associated with decreased academic performance.

Bullying can extend into adult relationships and professional life, where it is often brushed under the rug or worse, becomes a routine part of the day. It often involves bystanders who do nothing to stop it.

Getting Clarity

Authors of the current study, "Associations between exposure to childhood bullying and abuse and adult outcomes in a representative national US sample" (Sweeting, Garfin, Holman and Silver, 2020), designed broad-based research on bullying, abuse, neglect and various outcomes in adulthood.

They surveyed three waves of participants between 2013 and 2015, with over 2,900 finishing the study. Participants were diverse: 52.4 percent women, ages ranging from 18 to 93, average age 46.8 years old, 65.8 percent White, 11 percent Black, 13.5 percent Latino, and 7 percent other non-Hispanic ethnicities, covering broad educational and socioeconomic backgrounds.

The following measures were completed: the Lifetime Stress Inventory, assessing adverse childhood experiences, and exposure to recent negative life events (NLEs), which includes 33 different event types such as violence, loss, and injury.

Other measures included global distress, using the Brief Symptom Inventory, which covers anxiety, depression and somatic symptoms during the prior week; generalized fear of the future, including worry about possible terrorist attacks, disasters, illness, violence, financial issues, etc.; functional impairment using the MOS Short-Form Health Survey (SF-36), covering work and social function the prior week; and mental and physical illnesses as diagnosed by physicians according to CDC National Health Interview.


General: Over 80 percent reported at least one NLE. Over 20 percent reported at least one mental health diagnosis, and nearly 60 percent at least one physical ailment. Over 25 percent reported childhood bullying, 15 percent physical abuse, and 15.5 percent witnessing parental violence. Almost 11.5 percent reported childhood sexual abuse, and more than 8.5 percent childhood parental neglect. Bullying, physical abuse and sexual abuse were associated with a greater number of NLEs.

Global distress: Older participants and those with greater wealth were less distressed. Compared with Whites, other, non-Hispanic ethnicities were more distressed. Participants with more NLEs were more distressed. Bullying, physical abuse, and childhood sexual abuse were all indirectly related to global distress, because they were connected with more NLEs. Bullying alone was directly associated with greater global distress.

Fear of the future: People with more education and higher income reported less fear of the future. Other, non-Hispanic ethnicities, women, and those with more NLEs reported higher future fear. Bullying, physical abuse and childhood sexual abuse indirectly increased future fear via more NLEs. Bullying and witnessing parental violence directed correlated with increased fear of the future.

Functional impairment: Higher income and education were associated with lower functional impairment. NLEs were associated with greater functional impairment. Bullying, physical abuse, and childhood sexual abuse indirectly correlated with functional impairment, again through recent NLEs. Childhood parental neglect and sexual abuse was directly linked to increased functional impairment.

Diagnosed mental and physical ailments: Mental health conditions were associated with bullying, parental neglect, physical abuse and sexual abuse. Bullying and sexual abuse were associated with more physical illnesses.


This research is important because it provides a granular look at how different forms of childhood adversity connect with negative adult outcomes in a diverse sample representing a range of demographic variables, including age, gender, ethnicity, and socioeconomic and educational factors.

Parsing out the potential impact of different forms of childhood adversity and neglect permits more effective screening, prevention, and intervention. This work spells out the scope of the problem more clearly. It helps normalize individual experience and foster resilience by reducing stigma and shame.

These results specifically expand our understanding of bullying. Bullying was directly associated with greater global distress, more fear of the future, and mental and physical health issues, but not directly with functional impairment.

Bullying persists because perpetrators have faith in complicity and complacency. Rather than blaming the victim or letting scapegoats take the hit, bystanders have to learn to see what is happening and do something about it.

The solution is not to punish bullies—as that would perpetuate the cycle and keep those in need from getting help—but to have a compassionate, zero-tolerance attitude toward bullying, and to change attitudes and practices locally and systemically. No one is alone in living with these experiences. Help is available and effective.


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