Estimates suggest one in three students around the world report experiencing school bullying in the past month (Eyuboglu et al., 2021). Bullying is associated with an array of negative consequences, including social maladjustment, internalizing symptoms, and health issues (Andreou et al., 2020; Idsoe et al., 2021; Wolke & Lereya, 2015). Regardless, an ongoing debate in the field remains as to whether bullying should be considered a traumatic event that can result in a diagnosis of posttraumatic stress disorder given that bullying is not life-threatening in most cases (Mol et al., 2005). Despite not typically being life-threatening, studies find evidence of posttraumatic stress (PTS) symptoms after experiencing repeated bullying (Idsoe et al., 2021; Ossa et al., 2019). However, previous studies utilized retrospective reports of bullying and symptom endorsement, which can be less accurate than current reports of ongoing bullying experiences (deLara, 2019; O’Brien, 2019). Alternatively, some studies exclusively used quantitative measures, which limits our understanding of how victims viewed the consequences of being bullied (Ossa et al., 2019). The current study seeks to clarify consequences of bullying using interview data from adolescents from the United States who are currently experiencing bullying. The purpose is to investigate how youth who reported being bullied in the past year view and describe consequences of their being bullied and determine if they endorse posttraumatic stress symptoms as consequences of being bullied. Additionally, the current study explores the demographic and contextual factors associated with PTS symptom endorsement.

Trauma and Posttraumatic Stress Symptoms

Trauma is defined as an “emotionally painful, distressful, or shocking experience that might result in lasting impact[s] on individuals involved in the situation” (Carney, 2008, p. 179). This is in response to a traumatic event, defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) as “exposure to actual or threatened death, serious injury, or sexual violence” (American Psychiatric Association, (2022), p. 302). After such events, individuals may develop (PTS) symptoms, or symptoms caused by experiencing a traumatic event, which have a negative impact on the individual (National Child Traumatic Stress Network [NCTSN], n.d.). These PTS symptoms are diagnostically divided into four categories: intrusion, avoidance, cognition and mood changes, and arousal and reactivity changes (American Psychiatric Association, (2022); NCTSN, n.d.).

The Relationship Between Bullying and Trauma

Some scholars draw a distinction between bullying and a “traumatic event,” primarily because most instances of bullying do not reach the severity of a life-threatening event (Lebrun-Harris et al., 2019; Mol et al., 2005). According to the DSM-5-TR, bullying is listed as a potential traumatic event, but only if it includes a “credible threat of serious harm or sexual violence” (APA, 2022, p. 306). However, other scholars suggest the symptoms and consequences of bullying parallel those of other traumatic events and, therefore, provide evidence for instances of less severe, non-life-threatening bullying to be considered a traumatic event (Andreou et al., 2020; Mynard et al., 2000; Nielsen et al., 2015). Several studies have found evidence for the presence of trauma-specific symptoms in victims of bullying. In fact, data suggest 33.7–61% of victims of bullying score in the clinical range for PTSD (Andreou et al., 2020; Ossa et al., 2019; Steinberg et al., 2013). Ossa and colleagues (2019) found no significant difference in reports of intrusion and arousal symptoms between a severely bullied group (bullied at least once a week for at least 6 months) and a clinically traumatized group (e.g., those who experienced physical or sexual abuse, accident, crime), suggesting a similar profile of symptoms for individuals experiencing a range of events. Further, approximately 50% of the severely bullied group scored within the clinical range for PTSD, even after accounting for previous adverse events (Ossa et al., 2019). The presence of avoidance symptoms among victims of bullying has been documented; in particular, one study found bullying victimization to be a significant predictor of avoidance behaviors (b = 0.211, p < 0.001; Hutzell & Payne, 2012). The development of negative cognitions has also been documented (Calvete et al., 2017; Idsoe et al., 2015). Youth suffering from chronic victimization may change their self-concept by believing the peer group’s narrative that they are deviant, defective, and deserving of bad things happening to them (Braun et al., 2021; Thornberg, 2015). These altered cognitions can contribute to the revictimization cycle and increase the difficulty for victims to escape bullying (Dill et al., 2004). Data also supports the existence of alterations in arousal and reactivity in bullied youth. Research has found children and adolescents experiencing adverse events are more likely than youth who do not experience adverse events to have hypothalamus–pituitary–adrenal (HPA) axis dysregulation, which can lead to the hyper- or hypo-secretion of cortisol (Vaillancourt et al., 2008).

Demographic and Contextual Factors of Bullying Attributed to PTS Symptoms

Previous research has also identified demographic and contextual factors that might affect victims’ likelihood of developing PTS symptoms. In general, cisgender, heterosexual female victims of any type of adverse events are more likely than cisgender heterosexual male victims of adverse events to develop PTS symptoms (Olff, 2017). This finding remains true for bullying-specific adversity, with girls at a higher risk (1.92 times) for developing PTS symptoms after experiencing peer victimization compared to boys (Chen & Elklit, 2018; Idsoe et al., 2012). Additionally, gender non-conforming, sexual minority children who experienced adverse childhood events were found to be at a greater likelihood of developing PTS symptoms after experiencing bullying than their heterosexual cisgender peers (Hinduja & Patchin, 2020).

Perpetrator characteristics have also been associated with PTS symptoms in victims of childhood bullying. In a retrospective study of participants aged 17 to 40, scores on the PTSD hyperarousal subscale were elevated when the perpetrator was older than the victim by a year or more (Andreou et al., 2020). Andreou and colleagues (2020) also found a positive association between the number of perpetrators and victims’ report of re-experiencing intrusion symptoms.

Duration and frequency of bullying have also been explored. In two retrospective studies conducted with college-age participants, duration of being bullied was found to increase the likelihood of developing PTS symptoms such that bullying that lasted “months” (2.19 times more likely), “one year” (4.62 times more likely), and “multiple years” (5.29 times more likely) were significant predictors of PTS symptoms, in young adulthood (Albuquerque & Williams, 2015; Andreou et al., 2020). In a study conducted by Obrdalj et al. (2013), researchers found frequency of bullying predicted bully-victim and victim’s endorsement of PTS symptoms, particularly anxiety symptoms in middle-school students.

Finally, perceived seriousness of the event can contribute to an individual’s likelihood of developing PTS symptoms (Albuquerque & Williams, 2015; Berntsen & Rubin, 2006; Boals, 2018). Another retrospective study with college students found individuals who identified their worst school victimization experiences during childhood as making them “very upset” had an increased likelihood of developing PTS symptoms by 28.33% in childhood (Albuquerque & Williams, 2015). Further, individuals who identified being “very upset” about their worst experience were 5.29 times more likely to develop high levels of PTS symptoms compared to those who reported being only “somewhat upset,” as measured by the Student Alienation and Trauma Survey-R (SATS-R; Albuquerque & Williams, 2015).

Summary of PTS Symptoms After Bullying

Research has found evidence for PTS symptoms occurring in youth who have experienced bullying. Few of these studies have assessed the degree to which bullying is associated with all PTS symptoms. Further, studies assessing development of PTS symptoms in youth after being bullied are commonly compared to clinical or non-bullied samples rather than investigating differences between a sample of students who are bullied and their development of PTS symptoms. While existing research demonstrates some youth who are bullied experience extreme distress after a non-life-threatening event, it does not add to our understanding of how contextual factors surrounding the bullying may impact severity of PTS symptoms. Additionally, although some studies have explored contextual features of bullying associated with greater PTS endorsement, they are not without limitations. Several studies have used retrospective accounts or vignettes to proxy the experience of someone who is victimized (deLara, 2019; O’Brien, 2019), but these are at risk of distortions in accuracy due to the length of time between being bullied and reporting of events (O’Brien, 2019).

Current Study

To date, no study has qualitatively explored adolescents’ perspectives on the consequences of being bullied within the same year bullying occurred. Therefore, the first aim of this study was to explore how adolescents view the consequences of being bullied. The current study hypothesized adolescents’ report of consequences would parallel quantitative reports of psychological, physical, academic, and social consequences of bullying (Hysing et al., 2019).

The second aim was to determine if the consequences adolescents endorsed paralleled those of other traumatic events. It was hypothesized some youth would endorse aspects of the four main trauma symptoms: intrusion, avoidance, changes in cognitions or mood, and arousal and reactivity changes. We hypothesized girls would be more likely than boys to endorse these symptoms, as is supported by previous literature (Chen & Elklit, 2018). Further, we expected contextual factors of bullying instances identified in previous research (e.g., duration and frequency of bullying, number and age of perpetrators, and seriousness; Andreou et al., 2020; Boals, 2018; Carney, 2008) would contribute to endorsement of PTS symptoms.

Method

Participants

Participants were recruited through announcements targeting parents of adolescents who experienced bullying at a Midwestern university. To be eligible for the study, a parent must have provided consent for their adolescent to participate and identified them as being a victim of bullying at least “sometimes” over a period of “weeks” or more in the last year. Participants who did not meet these criteria were excluded from the study. A total of 24 parents completed the initial screening survey. Of these 24 parents, 10 adolescents met criteria and were willing to participate in the interview portion of the study. Participants were between the ages of 11 and 15 and were fluent in English. The average age of the sample was 12 years old (SD = 1.35). The final sample consisted of 50% boys, 90% White (n = 9) and 10% Other/Prefer to self-describe (n = 1) participants. Participants’ grades ranged from 5 to 9th, with a mean grade of 6th (SD = 1.51).

Measures

Parent’s Peer Bullying Items

To determine eligibility, a parent of a child or adolescent answered questions about the frequency, duration, and seriousness of bullying experienced by their child. These items were adapted from the Olweus Bully Victim Questionnaire, a measure used to identify bullying, and were reworded to ask the parent’s perspective of their adolescent’s bullying experience (Kyriakides et al., 2006; Olweus, 2006; Young, 2020). Parents were first presented with a definition of bullying, and then asked how frequently their child experienced relational, physical, or verbal bullying. These questions were rated on a 5-point scale with 1 being (Never) and 5 being (Always). Additionally, parents rated the duration of each form of bullying on a 4-point scale from 1 (My teen was not bullied) to 4 (A year or more). Parents also answered a question about how serious they considered the bullying to be. This question was rated on a 5-point scale from 1 (My teen was not bullied) to 5 (Extremely serious).

Olweus Bully Victim Questionnaire-Revised

The Olweus Bully Victim Questionnaire (OBVQ; Olweus, 2006) is a 39-item measure used to assess youth bullying and victimization experiences in school by focusing on the identification of types of bullying experienced, frequency of being bullied and bullying others, and contextual factors of bullying (e.g., where bullying took place, if anyone was told). The OBVQ has been widely used with diverse samples of children and adolescents and has been found to have satisfactory construct validity and test–retest reliability (Kyriakides et al., 2006; Young, 2020). The OBVQ is analyzed psychometrically by dividing items into two scales, “being victimized” and “bullying others” (Young, 2020). Past studies found these scales to have good internal consistency and acceptable Cronbach alpha values (α > 0.70Kyriakides et al., 2006; Price et al., 2013).

Strengths and Difficulties Questionnaire

The Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997) was administered to both parents and adolescents to assess adolescent internalizing, externalizing, and prosocial behaviors. A total of 25 items are rated on a scale from 0 (Not true) to 2 (Certainly true). These items are separated into scales of Emotional Problems, Hyperactivity Problems, Peer Problems, and Conduct Problems. Five additional questions assess how much impact these behaviors have had on the adolescent over the last 6 months in the domains of total distress, home life, friendships, learning, and leisure activities. Questions are rated on a 4-point scale from 0 (Not at all) to 3 (A great deal). Past studies have found satisfactory interrater and test–retest reliability (α = 0.73) and good convergent validity (Goodman, 2001; Hill & Hughes, 2007; Koskelainen et al., 2000).

Semi-Structured Interview

The semi-structured interview focused on experiences and consequences of being bullied and the contextual factors surrounding the bullying. Before beginning the recording, the researcher asked icebreaker questions to establish rapport with the participant. Then, the researcher asked a series of open-ended questions about the participant’s experiences with bullying. Example questions included, “You said you were bullied this past year, tell me more about what happened?”, “How did you respond to being bullied?”, and “What helped you the most when you were being bullied?” After the child had the opportunity to spontaneously disclose their experiences and outcomes of bullying, the researcher could ask more specific semi-structured interview questions about common PTS symptoms, typically starting with “Do you think being bullied had any long-term effects? If so, like what?” These questions were administered to participants who had not spontaneously discussed their outcomes or who had difficulty understanding what impacts might look like. The researcher had optional follow-up questions such as “Do you ever have trouble sleeping because of being bullied?” and “Do you feel strong feelings in your body when you are reminded of being bullied?” aimed at exploring symptoms of avoidance, intrusion, physiological arousal, and negative cognitive changes. The researcher then tallied the number of symptom endorsements in each symptom category according to the symptom criteria for PTSD in the DSM-5-TR.

Procedure

All study procedures were approved by the university’s institutional review board. To determine eligibility, parents first completed the following forms online: the consent form, child demographics questionnaire, the Parent Peer Bullying Scale, and the Strengths and Difficulties Questionnaire. Parents of eligible adolescents were then contacted to set up a Zoom (n = 6) or in-person interview (n = 4) for their child with a trained researcher. As this study took place during the COVID-19 pandemic, virtual interviews were offered for those who were uncomfortable attending in-person. The youth’s parent did not participate in the study after providing consent for their child and completing the initial survey.

All adolescent participants completed the interview with the researcher while their parent(s) waited in a separate room. The adolescent completed the assent form, demographic questionnaire, the Olweus Bully Victim Questionnaire-Revised, and the Strengths and Difficulties Questionnaire. After completing the measures, they participated in the semi-structured interview, which was audio recorded. After the interview, participants were provided a list of bullying resources as well as community resources for mental health concerns. In exchange for their participation, participants were provided a $25 gift card.

Analytic Plan

SPSS 28 was used to analyze descriptive statistics about the sample’s demographics and scores on study measures (see Tables 1 and 2). Data collected from the interviews were coded using the data-driven model of inductive thematic analysis (Braun & Clarke, 2006). Data collection ended after 10 subjects participated due to saturation in themes occurring and a lack of new information being collected. The author coded the data following the six phases of thematic analysis outlined by Braun and Clarke (2006). In the first phase, Otter.ai, a transcription program, was used to develop the initial transcription of the interviews. The second phase was to generate a list of codes containing relevant information from the interview. All transcripts were coded by the principal investigator. Three of the transcripts were reviewed separately by a trained graduate student with no inconsistencies found between codes. The third phase involved finding reoccurring clusters of codes which formed themes. In the fourth phase, the themes were reviewed and refined to include the most pertinent information. In the fifth phase, themes were defined that described each code cluster. Finally, convergence between themes emerging from the qualitative data and responses on adolescents’ measures was examined in the sixth phase, as were areas of divergence between OBVQ self-report and interview data.

Table 1 Adolescent-report contextual factors reported in OBVQ, SDQ, and semi-structured interview
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Table 2 Descriptive statistics for the adolescent self-report and parent report SDQ (n = 10)
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Results

Aim 1: How do Adolescents View the Consequences of Their Being Bullied?

Six themes emerged that addressed the consequences adolescents experienced after being bullied. These are presented below in order of most commonly endorsed.

Emotional Distress

Nine of ten participants reported at least one negative emotional impact as a consequence of being bullied. This converges with participant scores in the abnormal range on the SDQ Emotional Problems Scale, with most participants falling in the abnormal (n = 6) or borderline (n = 1) category. Participant 10 reported being bullied “made me have a lot more anxiety attacks, and more anxiety than I used to” and Participant 6 reported, “It makes me constantly worried that somebody will pop out of nowhere and start calling me names.” These statements highlight the worry and anxiety participants reported experiencing after being bullied. Some participants reported depressive symptoms and decreased self-esteem. Participant 2 noted, “I was really happy until they showed up…. it’s been really difficult, and I sometimes get depressed.” Participant 5 reported, “I would come home crying from school.” Participant 9 added being bullied “makes me feel not as good about myself.” Other students reported being angry after being bullied. Participant 6 reported, “I get really angry sometimes, like so angry.” Participant 7 reported, “sometimes I get mad when they laugh at me or other things like that.” Participants reported bullying triggered action urges to retaliate. For example, Participant 6’s report of being angry was followed by statements such as, “Sometimes I feel the urge to hit them…. It got so tense one time that I almost did hit the person, but I stopped myself.” Additionally, two participants reported disordered eating as an emotional response to bullying. Participant 2 reported restricted eating to reduce weight and Participant 10 reported symptoms of bulimia. These experiences highlight the drastic range of emotional reactions youth can experience after being bullied.

Avoidance Around School Settings

Eight of ten participants endorsed avoidance of school settings. Specifically, four participants discussed wanting to stay home from school to avoid being bullied, seeing bullies, and because of depressed mood due to being bullied. Participant 8 reported “It made me to the point where I didn’t want to go to school” and “The only reason I went to school is because my mom forced me to.” Participant 5 reported volunteering at a daycare to reduce the time she spent on the bus, a place she is bullied; she stated “…it’s still on the same bus but at least I, like, get off a few minutes earlier, so that’s better.”

Somatic Complaints

Seven of ten participants reported at least one somatic complaint due to being bullied. Participants 2 and 5 reported being unable to catch their breath. Participant 2 and Participant 4 reported having increased heart rate, with Participant 2 saying, “When they’re bullying me, my heart beats really fast.” Participant 6 reported different reactions while being bullied, including “my face turns red and my veins are popping out,” getting “cold sweats,” and having his “blood run cold.” Four participants reported experiencing headaches because of bullying. Three reported nausea and stomachaches because of bullying. This converges with data collected from the SDQ with seven participants reporting experiencing headaches, stomachaches, or sickness.

Disruption Within the Peer Group

Six of ten adolescents discussed disruptions within their peer group, including peer ostracization. Five of ten adolescents reported social isolation. Participant 2 endorsed having several very good friends, but reported instances where the bully attempted to ostracize her and caused arguments between her and her friends. She stated, “I had no one to play with …because the other girl [bully] I guess told her to not be friends with me.” Participant 4 also reported ostracization, saying “They all just kind of either blocked me or just kind of ignored me…. So I didn’t really talk to a lot of people.” These experiences emphasize that regardless of friendship status, individuals may still be impacted by disruptions within their peer groups.

Importance of Social Support

Participants repeatedly mentioned having friendships and adult support were helpful when coping with bullying.

Supportive Peers

Nine of ten participants reported maintaining friendships while being bullied. Six of ten participants reported their friends helped them cope with being bullied. Participant 6 reported his friends “helped me see the bright side of school.” Participant 5 reported her friends “could tell me how to handle it.” Participant 3 reported “hang[ing] out with others who don’t bully me” was most helpful for her. When asked what would help other youth their age also experiencing bullying, six of ten participants reported having a friend to talk to would be most helpful.

Supportive Adults

Three of ten participants reported having the support of a trusted adult (e.g., parent, teacher, school counselor) was helpful for coping with bullying. Participant 4 reported, “At the time, I probably wouldn’t have thought that my parents were by my side, but I definitely realized now they were directly by my side at all times.” When asked about what would help others experiencing bullying, Participant 8 reported, “Never be afraid to tell a teacher, ever.” Although three adolescents reported teacher support as helpful, two of these participants noted opportunities for teachers to be even more supportive. For example, Participant 3 reported, “Teachers need to be a bit more observant, or at least try a bit harder.” Likewise, Participant 10 reported, “I would like the teachers to actually like, be more inclined to help, or like, like, work on situations quicker.”

Impaired School Performance

Three of ten participants reported their bullying experiences caused issues with concentration, focus, attention, and declines in grades. Participant 4 noted, “with everything going on, it just kind of builds up and I have the anxiety and then I just give up on even trying to do work… my grades have gone down a lot further.” Participant 9 reported, “I wasn’t able to, like, concentrate as much on my homework.” This diverged from quantitative reports on the SDQ, as seven participants reported difficulty concentrating and being easily distracted.

Aim 2: Do Consequences Parallel Those of Traumatic Events?

The second aim of this study was to determine if adolescents who had been bullied experienced PTS symptoms. The primary author read interview transcripts and tallied endorsement of PTS symptoms for each of the four PTS symptom clusters defined by the DSM-5-TR: intrusion, avoidance, cognition and mood change, and arousal and reactivity change. Nine of ten participants reported at least one PTS symptom. Girls, on average, endorsed 6.2 total PTS symptoms (range between three and nine symptoms), whereas boys endorsed 1.2 total PTS symptoms (range between zero and three symptoms). Three of ten participants endorsed clinical levels of PTS symptoms associated with PTSD; all three were girls. Interestingly, each of the three participants endorsed recurrent, involuntary thoughts of bullying, avoidance of external reminders of bullying, persistent negative emotional state, and sleep disturbances. All three girls also endorsed experiencing all forms of bullying.

The most endorsed PTS symptom was avoidance (n = 9). Participants reported avoidance of external reminders, specifically, school-related settings and individuals who had bullied them. Participant 2 stated, “I just told my dad that I don’t want to go to school because of them.” Three participants reported faking sick to avoid going to school. Another participant reported avoiding the school bus. Participant 4 reported asking to move seats in class to avoid sitting beside an individual who had bullied her, stating “just because sitting next to her, having her friends right behind me and her right next to me, definitely made my anxiety high so I wouldn’t do any work.” Only one adolescent reported taking extensive amounts of time off school due to bullying.

Five of ten participants endorsed intrusive thoughts about being bullied. Participant 4 reported “It’s been a constant thing on my mind, especially in the back of my head, just a running process in my head.” Participant 2 reported she is “scarred” and elaborated by saying, “It [being bullied] stays with me, like, it isn’t really put behind in my thoughts. It’s like right in the front of it.” When asked if they tried to forget what happened, Participant 5 responded “Sometimes I do because I feel like it would be better if it never happened, it would obviously be a lot better.” Participant 4 responded, “yes, but in the back of my head, I know it’s not ever going to leave.”

Five of ten participants reported changes in physiological arousal and reactivity after experiencing bullying. Sleep disturbance due to worrying about bullying (e.g., bad dreams, difficulty falling asleep or staying asleep) was the most reported issue (n = 4). Participant 5 said “I couldn’t sleep at night because I was really scared about, like, seeing this kid and if he was going to hurt me again.” Participant 10 stated “I like, lay in bed for a little bit. For like an hour, maybe 30 min, I don’t know. And I’m just trying to go to bed. And like, if I can’t, I’ll go upstairs and I’ll get like a melatonin or something, and then I tried to go to bed and that, that still doesn’t do anything.” Participant 2 stated “I have a hard time sleeping because I worry about what they’re gonna do tomorrow.” Participant 2 also reported hypervigilance after being physically bullied, saying, “…when someone walks behind me I kind of look behind because I feel like they’re gonna pull my hair.” Additionally, Participant 2 reported experiencing unprovoked irritable behavior stating, “I just yell at my friends on accident, and I tell them to go away.”

Four of ten participants reported alterations in cognitions and mood after being bullied. Participant 4 reported “I had anxiety and depression before that, but I definitely think it made it a lot worse…. even taking care of myself, self-hygiene and all that, just trying to get the motivation even to roll out of bed just to shower.” Participant 5 reported, “…after that I started like really getting upset and sad and angry and [the symptoms] really affecting me.” She reflected on how her self-image, dress, and behaviors changed as she worried if what the bullies said was true. Participants 2 and 4 reported diminished interests in activities they previously enjoyed, such as playing sports, wearing certain outfits, or doing their hair a certain way after being bullied.

Discussion

This study aimed to qualitatively explore how adolescents in the USA view the consequences of being bullied. Findings showed that most participants reported avoiding school and related settings, which contributed to absenteeism and impaired school performance. This is consistent with previous research suggesting children and adolescents who are bullied may be avoidant of these settings because they are fearful of future bullying incidents (Hutzell & Payne, 2012). Consistent with previous research, adolescents in the current study endorsed internalizing symptoms (e.g., depression, anxiety, anger, loneliness; Eyuboglu et al., 2021) and somatic concerns (e.g., headaches, stomachaches, tense muscles, exhaustion, difficulty breathing, increased heart rate; Mahli & Bharti, 2021; Sansone & Sansone, 2008). Interestingly, despite having changes in cognition (e.g., “after that I started like really getting upset and sad and angry and really affecting me”), adolescents did not spontaneously endorse changes in their self-concept such as feeling like they deserved being bullied. Although previous research suggests chronic victims of bullying may experience this change in self-concept (Calvete et al., 2017), the current study did not have a chronic victimization eligibility requirement, which may suggest individuals who experience shorter instances of bullying do not experience this self-concept change. Although PTS symptoms were endorsed in this study, symptom profiles did not map on to the DSM-5-TR criteria for PTSD as closely as expected. It is clear youth experience emotional and physiological distress after being bullied, but the degree of intrusion experienced is less clear, which could suggest the consequences of bullying may map on better to other emotion-related disorders (e.g., anxiety or depression).

When participants were asked what helped them through bullying and what might help others, the importance of social support emerged from the interviews, which is consistent with previous research identifying social support as a moderator for victimization and subsequent internalizing symptoms (Davidson & Demaray, 2007). Participants consistently endorsed maintaining friendships throughout their bullying experiences, which helped to both decrease bullying and cope with bullying. This is consistent with qualitative research suggesting social outlets and friends provide protection against bullying interactions and is viewed as beneficial from the victim’s perspective (Strindberg & Horton, 2022).

The second aim of this study was to explore whether adolescents’ reported consequences of being bullied paralleled symptom clusters of traumatic events. As hypothesized, at least one PTS symptom was endorsed by nine of ten participants. This finding is important as it shows the endorsement of PTS symptoms is very common among adolescents who experienced bullying in the last year. Three of ten participants endorsed clinical levels of PTS symptoms according to the DSM-5-TR criteria for PTSD. This is lower than some studies, suggesting between 46.2 and 61.5% of bullied students experience clinical levels of PTS symptoms (Nielsen et al., 2015; Ossa et al., 2019), but similar to other studies finding 30 to 40% of bullied students meet clinical criteria for PTSD (Idsoe et al., 2012; Mynard et al., 2000).

Notably, results were mixed in terms of demographic and contextual factors hypothesized to predict more impairment. In this study, the three individuals who met clinical criteria for PTSD were female, experienced physical bullying, were bullied at least once a week for 1 year or more, bullied by numerous students or groups of students, the same age as their perpetrator, and were experiencing bullying that was “quite serious” as reported by their parents. This is consistent with research identifying being female, and greater duration, frequency, and seriousness of bullying to be associated with higher report of overall PTS symptoms (Andreou et al., 2020; Ossa et al., 2019), and the number and age of perpetrators being associated with likelihood of endorsing intrusion and arousal/reactivity symptoms (Andreou et al., 2020). These characteristics were also present for other students who did not report clinical levels of impairment, contributing to Ossa et al.’s idea that thresholds of contextual factors like duration and frequency may impact one’s severity of PTS symptoms experienced after being bullied (2019). In fact, there was no specific pattern separating the adolescents who reported clinical levels of PTS symptoms from those who did not. This may suggest other environmental, protective, and risk factors in addition to the known contextual factors listed previously, impact the severity of an individual’s symptoms after being bullied.

Implications for Practice

The current study as well as previous research (Idsoe et al., 2021) suggests youth are experiencing a variety of symptoms after being bullied (e.g., tiredness, loss of energy, loss of interest in previously enjoyed activities or preferences like clothing items, fixing hair a certain way, being irritable or reacting out of proportion to the situation, or difficulty concentrating on tasks) that are not obviously related to being bullied (e.g., not direct disclosures). Notably, seven of ten participants in the current study endorsed somatic symptoms, suggesting somatic complaints (e.g., headaches, stomachaches, dizziness) may be commonly experienced by victims of bullying. However, these symptoms may be misinterpreted by adults as general anxiety about school or an adolescent’s busy school schedule. Additionally, previous research suggests children may not openly disclose bullying to an adult for a variety of reasons (e.g., liking or trusting the adult, believing in the adult’s ability to assist, confidentiality; Wojcik & Rzenca, 2021). This suggests parents, teachers, and other adults frequently interacting with youth may benefit from education related to PTS symptom identification in addition to general bullying identification (e.g., behavioral reports at school, lack of friends) to identify victimization more effectively without a direct disclosure.

The presence of PTS symptoms among youth experiencing chronic bullying suggests youth may need tailored support to reduce the negative impacts of bullying. Although teachers intervening when bullying occurs is helpful, it does not address PTS internalizing symptoms experienced by the victim. Bullying prevention programs such as the Olweus Bullying Prevention Program, while beneficial for reducing instances of bullying, do not focus on the internalized experience of victims (Olweus & Limber, 2010). Rather, the programs focus on behavior changes from both peers and adults to reduce bullying behaviors and promote prosocial behaviors. To address PTS symptoms experienced after bullying, it may be beneficial for bullying prevention and intervention programs to include components aimed at addressing PTS symptoms in addition to behavioral changes. For example, the Sanctuary Model is an evidence-based trauma-informed template for organizations like schools to integrate that promote trauma recovery in different domains like autonomy, safety, and emotion regulation (Rivard et al., 2003). Integrating this type of model with established and efficacious bullying prevention programs like the Olweus Bullying Prevention Program (Blitz & Lee, 2015; Olweus & Limber, 2010) could be beneficial because youth would not only receive training on the prosocial skills necessary to build better relationships, but they would also receive interventions related to aspects of post-traumatic healing to decrease their negative psychological impacts (Blitz & Lee, 2015). Due to symptom severity variation, the types of interventions to support youths may be better assessed on an individual basis. Some youth who do not endorse as many negative symptoms may benefit from psychosocial bullying interventions (see Fraguas et al., 2021). For youth with increased internalizing symptoms and suicidal ideation (Benatov et al., 2022), it may be beneficial for interventions to focus on building emotion-regulation skills.

Results of the study highlight the importance of peer, teacher, and parent relationships in helping victims cope with PTS symptoms after experiencing bullying. Previous research suggests positive teacher-student relationships not only reduce instances of bullying, but also reduce negative psychosocial outcomes associated with being bullied (Huang et al., 2018). Interventions such as the Establish-Maintain-Restore method can improve teacher-student relationships. This method includes steps of the teacher establishing a one-on-one relationship with the student, then maintaining the relationship by frequent interactions (e.g., greetings at the classroom door), and finally restoring relationships when negative situations arise by involving students in the problem-solving process to encourage open communication between teacher and student (Cook et al., 2018). To promote positive peer interactions, teachers can implement strategies such as establishing a safe classroom environment and using cooperative learning instructional strategies (Van Ryzin & Roseth, 2019). Other classroom factors facilitated by the teacher (e.g., promoting egalitarian peer relationships versus social hierarchies) can provide student support without the student needing to disclose their experiences (Karlsson et al., 2014). There is also support for trauma-informed practices within the classroom to improve feelings of safety and comfortability such as alternative lighting, reduced sound levels and seating dispersed throughout the classroom (e.g., sitting with their back to a wall) that are beneficial for students who are experiencing PTS symptoms (Carello & Butler, 2015). Finally, results from our study and others (e.g., Chen et al., 2020) point to parental support (e.g., open, non-judgmental communication, responsiveness to disclosures) and increased parental education of bullying (e.g., letters about bullying or intervention sent home to parents/guardians) being a protective factor from their child being bullied and experiencing negative consequences of bullying (Gaffney et al., 2021).

Limitations

First, the sample size was small. Although the gender of the sample was split evenly between boys and girls, all participants identified as White and cisgender. Research suggests individuals in multiple marginalized groups, and/or members of the LGBTQ + community, are bullied more frequently and severely and have more internalizing and externalizing problems than members of the majority (Hinduja & Patchin, 2020). Due to these limitations, findings should not be generalized to more diverse groups. Additionally, the age range of participants was limited (range = 11–15). While bullying tends to peak around middle school (Kurniawan et al., 2022), older adolescents may experience bullying less frequently; therefore, these findings may not generalize to an older adolescent population. Further, it should be noted this study specifically focused on victims of bullying and did not assess bullies, bully-victims, or bystanders. Research also suggests peer, parent, and teacher nominations can be beneficial in identifying bullying (Olweus, 2013). Although parent report was collected, nominations from peers and teachers of victims would be beneficial in providing data on the youth’s experiences outside of the home context. Because parents had to endorse their adolescent being bullied to be eligible for the study, the adolescents in this sample may have higher perceived social support from parents than their peers who did not disclose their being bullied to their parent. As the current study found evidence for social support being beneficial in coping with bullying, our sample may endorse less severe symptoms than youth who have not disclosed their being bullied to a trusted adult. Furthermore, data was not collected on other traumatic events individuals could have experienced that may be contributing to PTS symptoms.

Future Directions

Future studies should consider using diagnostic interviews to understand the degree to which students meet criteria for PTSD, anxiety, and other depressive disorders. Although this study focused on victims of bullying specifically, future studies could also examine outcomes for students who are bullies or bully-victims, particularly as the latter group has a higher degree of impairment (Hellfeldt et al., 2020; Juvonen et al., 2003; Shetgiri, 2013). In addition, it would be beneficial for future studies to assess bystander outcomes as this participant role does not have as much data on the specific development of PTS symptoms after engaging in bystander behavior. Future studies would benefit from larger and more diverse samples. A longitudinal study would be beneficial to assess fluctuations of symptoms across the school year to determine stability and directionality of symptoms, and to assess whether consequences vary because of changing contextual factors, including social supports. In addition, researchers should continue to assess bullying and its symptoms qualitatively to provide context and increased understanding of the individual’s attribution of symptoms.

Conclusion

The current study provides detailed insight as to how adolescents perceive the effects of their being bullied. Adolescents in this study endorsed negative emotional, physical, relational, and academic outcomes after being bullied, which is consistent with previous research (Eyuboglu et al., 2021). Youth also expressed the benefits of friendship with peers and positive adult support on reducing the impacts of bullying. Previous retrospective and quantitative studies found support for bullying contributing to PTS symptoms (deLara, 2019; Ossa et al., 2019). This study adds to the existing literature by suggesting adolescents attribute PTS symptoms to their being bullied and directly describe the bullying as impacting their affect and thoughts about themselves, avoidance of school-related settings and individuals, arousal/reactivity to reminders of bullying, and potentially intrusive thoughts about being bullied. This study not only found evidence that adolescents endorse PTS symptoms while being bullied, but also found evidence of clinically significant PTS symptoms in several participants. The contextual factors investigated suggests the prevalence and severity of these symptoms may vary across youth, so bullying interventions should utilize a range of techniques such as emotion-regulation skills and trauma-focused adaptations of evidence-based bullying intervention programs. Parents and teachers should be educated on the common symptoms (e.g., somatic complaints) experienced by youth who are bullied to increase early identification and intervention. Future studies should continue investigating contextual factors associated with onset and severity of PTS symptoms, particularly using a longitudinal design with a larger and more diverse sample, to assess how symptoms change throughout the school year. Additionally, symptom profiles should continue to be assessed to inform bullying interventions. Overall, these findings suggest that researchers and practitioners should view bullying as a serious event that has consequences that parallel those of traumatic events.