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Committee on the Biological and Psychosocial Effects of Peer Victimization: Lessons for Bullying Prevention; Board on Children, Youth, and Families; Committee on Law and Justice; Division of Behavioral and Social Sciences and Education; Health and Medicine Division; National Academies of Sciences, Engineering, and Medicine; Rivara F, Le Menestrel S, editors. Preventing Bullying Through Science, Policy, and Practice. Washington (DC): National Academies Press (US); 2016 Sep 14.

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Preventing Bullying Through Science, Policy, and Practice.

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Bullying, long tolerated by many as a rite of passage into adulthood, is now recognized as a major and preventable public health problem, one that can have long-lasting consequences (McDougall and Vaillancourt, 2015; Wolke and Lereya, 2015). Those consequences—for those who are bullied, for the perpetrators of bullying, and for witnesses who are present during a bullying event—include poor school performance, anxiety, depression, and future delinquent and aggressive behavior. Federal, state, and local governments have responded by adopting laws and implementing programs to prevent bullying and deal with its consequences. However, many of these responses have been undertaken with little attention to what is known about bullying and its effects. Even the definition of bullying varies among both researchers and lawmakers, though it generally includes physical and verbal behavior, behavior leading to social isolation, and behavior that uses digital communications technology (cyberbullying). This report adopts the term “bullying behavior,” which is frequently used in the research field, to cover all of these behaviors.

Bullying behavior is evident as early as preschool, although it peaks during the middle school years (Currie et al., 2012; Vaillancourt et al., 2010). It can occur in diverse social settings, including classrooms, school gyms and cafeterias, on school buses, and online. Bullying behavior affects not only the children and youth who are bullied, who bully, and who are both bullied and bully others but also bystanders to bullying incidents. Given the myriad situations in which bullying can occur and the many people who may be involved, identifying effective prevention programs and policies is challenging, and it is unlikely that any one approach will be appropriate in all situations. Commonly used bullying prevention approaches include policies regarding acceptable behavior in schools and behavioral interventions to promote positive cultural norms.


Recognizing that bullying behavior is a major public health problem that demands the concerted and coordinated time and attention of parents, educators and school administrators, health care providers, policy makers, families, and others concerned with the care of children, a group of federal agencies and private foundations asked the National Academies of Sciences, Engineering, and Medicine to undertake a study of what is known and what needs to be known to further the field of preventing bullying behavior. The Committee on the Biological and Psychosocial Effects of Peer Victimization: Lessons for Bullying Prevention was created to carry out this task under the Academies' Board on Children, Youth, and Families and the Committee on Law and Justice. The study received financial support from the Centers for Disease Control and Prevention (CDC), the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Health Resources and Services Administration, the Highmark Foundation, the National Institute of Justice, the Robert Wood Johnson Foundation, Semi J. and Ruth W. Begun Foundation, and the Substance Abuse and Mental Health Services Administration. The full statement of task for the committee is presented in Box 1-1.

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BOX 1-1

Statement of Task.

Although the committee acknowledges the importance of this topic as it pertains to all children in the United States and in U.S. territories, this report focuses on the 50 states and the District of Columbia. Also, while the committee acknowledges that bullying behavior occurs in the school environment for youth in foster care, in juvenile justice facilities, and in other residential treatment facilities, this report does not address bullying behavior in those environments because it is beyond the study charge.


This section of the report highlights relevant work in the field and, later in the chapter under “The Committee's Approach,” presents the conceptual framework and corresponding definitions of terms that the committee has adopted.

Historical Context

Bullying behavior was first characterized in the scientific literature as part of the childhood experience more than 100 years ago in “Teasing and Bullying,” published in the Pedagogical Seminary (Burk, 1897). The author described bullying behavior, attempted to delineate causes and cures for the tormenting of others, and called for additional research (Koo, 2007). Nearly a century later, Dan Olweus, a Swedish research professor of psychology in Norway, conducted an intensive study on bullying (Olweus, 1978). The efforts of Olweus brought awareness to the issue and motivated other professionals to conduct their own research, thereby expanding and contributing to knowledge of bullying behavior. Since Olweus's early work, research on bullying has steadily increased (see Farrington and Ttofi, 2009; Hymel and Swearer, 2015).

Over the past few decades, venues where bullying behavior occurs have expanded with the advent of the Internet, chat rooms, instant messaging, social media, and other forms of digital electronic communication. These modes of communication have provided a new communal avenue for bullying. While the media reports linking bullying to suicide suggest a causal relationship, the available research suggests that there are often multiple factors that contribute to a youth's suicide-related ideology and behavior. Several studies, however, have demonstrated an association between bullying involvement and suicide-related ideology and behavior (see, e.g., Holt et al., 2015; Kim and Leventhal, 2008; Sourander, 2010; van Geel et al., 2014).

In 2013, the Health Resources and Services Administration of the U.S. Department of Health and Human Services requested that the Institute of Medicine1 and the National Research Council convene an ad hoc planning committee to plan and conduct a 2-day public workshop to highlight relevant information and knowledge that could inform a multidisciplinary road map on next steps for the field of bullying prevention. Content areas that were explored during the April 2014 workshop included the identification of conceptual models and interventions that have proven effective in decreasing bullying and the antecedents to bullying while increasing protective factors that mitigate the negative health impact of bullying. The discussions highlighted the need for a better understanding of the effectiveness of program interventions in realistic settings; the importance of understanding what works for whom and under what circumstances, as well as the influence of different mediators (i.e., what accounts for associations between variables) and moderators (i.e., what affects the direction or strength of associations between variables) in bullying prevention efforts; and the need for coordination among agencies to prevent and respond to bullying. The workshop summary (Institute of Medicine and National Research Council, 2014c) informs this committee's work.

Federal Efforts to Address Bullying and Related Topics

Currently, there is no comprehensive federal statute that explicitly prohibits bullying among children and adolescents, including cyberbullying. However, in the wake of the growing concerns surrounding the implications of bullying, several federal initiatives do address bullying among children and adolescents, and although some of them do not primarily focus on bullying, they permit some funds to be used for bullying prevention purposes.

The earliest federal initiative was in 1999, when three agencies collaborated to establish the Safe Schools/Healthy Students initiative in response to a series of deadly school shootings in the late 1990s. The program is administered by the U.S. Departments of Education, Health and Human Services, and Justice to prevent youth violence and promote the healthy development of youth. It is jointly funded by the Department of Education and by the Department of Health and Human Services' Substance Abuse and Mental Health Services Administration. The program has provided grantees with both the opportunity to benefit from collaboration and the tools to sustain it through deliberate planning, more cost-effective service delivery, and a broader funding base (Substance Abuse and Mental Health Services Administration, 2015).

The next major effort was in 2010, when the Department of Education awarded $38.8 million in grants under the Safe and Supportive Schools (S3) Program to 11 states to support statewide measurement of conditions for learning and targeted programmatic interventions to improve conditions for learning, in order to help schools improve safety and reduce substance use. The S3 Program was administered by the Safe and Supportive Schools Group, which also administered the Safe and Drug-Free Schools and Communities Act State and Local Grants Program, authorized by the 1994 Elementary and Secondary Education Act.2 It was one of several programs related to developing and maintaining safe, disciplined, and drug-free schools. In addition to the S3 grants program, the group administered a number of interagency agreements with a focus on (but not limited to) bullying, school recovery research, data collection, and drug and violence prevention activities (U.S. Department of Education, 2015).

A collaborative effort among the U.S. Departments of Agriculture, Defense, Education, Health and Human Services, Interior, and Justice; the Federal Trade Commission; and the White House Initiative on Asian Americans and Pacific Islanders created the Federal Partners in Bullying Prevention (FPBP) Steering Committee. Led by the U.S. Department of Education, the FPBP works to coordinate policy, research, and communications on bullying topics. The FPBP Website provides extensive resources on bullying behavior, including information on what bullying is, its risk factors, its warning signs, and its effects.3 The FPBP Steering Committee also plans to provide details on how to get help for those who have been bullied. It also was involved in creating the “Be More than a Bystander” Public Service Announcement campaign with the Ad Council to engage students in bullying prevention. To improve school climate and reduce rates of bullying nationwide, FPBP has sponsored four bullying prevention summits attended by education practitioners, policy makers, researchers, and federal officials.

In 2014, the National Institute of Justice—the scientific research arm of the U.S. Department of Justice—launched the Comprehensive School Safety Initiative with a congressional appropriation of $75 million. The funds are to be used for rigorous research to produce practical knowledge that can improve the safety of schools and students, including bullying prevention. The initiative is carried out through partnerships among researchers, educators, and other stakeholders, including law enforcement, behavioral and mental health professionals, courts, and other justice system professionals (National Institute of Justice, 2015).

In 2015, the Every Student Succeeds Act was signed by President Obama, reauthorizing the 50-year-old Elementary and Secondary Education Act, which is committed to providing equal opportunities for all students. Although bullying is neither defined nor prohibited in this act, it is explicitly mentioned in regard to applicability of safe school funding, which it had not been in previous iterations of the Elementary and Secondary Education Act.

The above are examples of federal initiatives aimed at promoting the healthy development of youth, improving the safety of schools and students, and reducing rates of bullying behavior. There are several other federal initiatives that address student bullying directly or allow funds to be used for bullying prevention activities.

Definitional Context

The terms “bullying,” “harassment,” and “peer victimization” have been used in the scientific literature to refer to behavior that is aggressive, is carried out repeatedly and over time, and occurs in an interpersonal relationship where a power imbalance exists (Eisenberg and Aalsma, 2005). Although some of these terms have been used interchangeably in the literature, peer victimization is targeted aggressive behavior of one child against another that causes physical, emotional, social, or psychological harm. While conflict and bullying among siblings are important in their own right (Tanrikulu and Campbell, 2015), this area falls outside of the scope of the committee's charge. Sibling conflict and aggression falls under the broader concept of interpersonal aggression, which includes dating violence, sexual assault, and sibling violence, in addition to bullying as defined for this report. Olweus (1993) noted that bullying, unlike other forms of peer victimization where the children involved are equally matched, involves a power imbalance between the perpetrator and the target, where the target has difficulty defending him or herself and feels helpless against the aggressor. This power imbalance is typically considered a defining feature of bullying, which distinguishes this particular form of aggression from other forms, and is typically repeated in multiple bullying incidents involving the same individuals over time (Olweus, 1993).

Bullying and violence are subcategories of aggressive behavior that overlap (Olweus, 1996). There are situations in which violence is used in the context of bullying. However, not all forms of bullying (e.g., rumor spreading) involve violent behavior. The committee also acknowledges that perspective about intentions can matter and that in many situations, there may be at least two plausible perceptions involved in the bullying behavior.

A number of factors may influence one's perception of the term “bullying” (Smith and Monks, 2008). Children and adolescents' understanding of the term “bullying” may be subject to cultural interpretations or translations of the term (Hopkins et al., 2013). Studies have also shown that influences on children's understanding of bullying include the child's experiences as he or she matures and whether the child witnesses the bullying behavior of others (Hellström et al., 2015; Monks and Smith, 2006; Smith and Monks, 2008).

In 2010, the FPBP Steering Committee convened its first summit, which brought together more than 150 nonprofit and corporate leaders, researchers, practitioners, parents, and youths to identify challenges in bullying prevention. Discussions at the summit revealed inconsistencies in the definition of bullying behavior and the need to create a uniform definition of bullying. Subsequently, a review of the 2011 CDC publication of assessment tools used to measure bullying among youth (Hamburger et al., 2011) revealed inconsistent definitions of bullying and diverse measurement strategies. Those inconsistencies and diverse measurements make it difficult to compare the prevalence of bullying across studies (Vivolo et al., 2011) and complicate the task of distinguishing bullying from other types of aggression between youths. A uniform definition can support the consistent tracking of bullying behavior over time, facilitate the comparison of bullying prevalence rates and associated risk and protective factors across different data collection systems, and enable the collection of comparable information on the performance of bullying intervention and prevention programs across contexts (Gladden et al., 2014). The CDC and U.S. Department of Education collaborated on the creation of the following uniform definition of bullying (quoted in Gladden et al., 2014, p. 7):

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.

This report noted that the definition includes school-age individuals ages 5-18 and explicitly excludes sibling violence and violence that occurs in the context of a dating or intimate relationship (Gladden et al., 2014). This definition also highlighted that there are direct and indirect modes of bullying, as well as different types of bullying. Direct bullying involves “aggressive behavior(s) that occur in the presence of the targeted youth”; indirect bullying includes “aggressive behavior(s) that are not directly communicated to the targeted youth” (Gladden et al., 2014, p. 7). The direct forms of violence (e.g., sibling violence, teen dating violence, intimate partner violence) can include aggression that is physical, sexual, or psychological, but the context and uniquely dynamic nature of the relationship between the target and the perpetrator in which these acts occur is different from that of peer bullying. Examples of direct bullying include pushing, hitting, verbal taunting, or direct written communication. A common form of indirect bullying is spreading rumors. Four different types of bullying are commonly identified—physical, verbal, relational, and damage to property. Some observational studies have shown that the different forms of bullying that youths commonly experience may overlap (Bradshaw et al., 2015; Godleski et al., 2015). The four types of bullying are defined as follows (Gladden et al., 2014):

  • Physical bullying involves the use of physical force (e.g., shoving, hitting, spitting, pushing, and tripping).
  • Verbal bullying involves oral or written communication that causes harm (e.g., taunting, name calling, offensive notes or hand gestures, verbal threats).
  • Relational bullying is behavior “designed to harm the reputation and relationships of the targeted youth (e.g., social isolation, rumor spreading, posting derogatory comments or pictures online).”
  • Damage to property is “theft, alteration, or damaging of the target youth's property by the perpetrator to cause harm.”

In recent years, a new form of aggression or bullying has emerged, labeled “cyberbullying,” in which the aggression occurs through modern technological devices, specifically mobile phones or the Internet (Slonje and Smith, 2008). Cyberbullying may take the form of mean or nasty messages or comments, rumor spreading through posts or creation of groups, and exclusion by groups of peers online.

While the CDC definition identifies bullying that occurs using technology as electronic bullying and views that as a context or location where bullying occurs, one of the major challenges in the field is how to conceptualize and define cyberbullying (Tokunaga, 2010). The extent to which the CDC definition can be applied to cyberbullying is unclear, particularly with respect to several key concepts within the CDC definition. First, whether determination of an interaction as “wanted” or “unwanted” or whether communication was intended to be harmful can be challenging to assess in the absence of important in-person socioemotional cues (e.g., vocal tone, facial expressions). Second, assessing “repetition” is challenging in that a single harmful act on the Internet has the potential to be shared or viewed multiple times (Sticca and Perren, 2013). Third, cyberbullying can involve a less powerful peer using technological tools to bully a peer who is perceived to have more power. In this manner, technology may provide the tools that create a power imbalance, in contrast to traditional bullying, which typically involves an existing power imbalance.

A study that used focus groups with college students to discuss whether the CDC definition applied to cyberbullying found that students were wary of applying the definition due to their perception that cyberbullying often involves less emphasis on aggression, intention, and repetition than other forms of bullying (Kota et al., 2014). Many researchers have responded to this lack of conceptual and definitional clarity by creating their own measures to assess cyberbullying. It is noteworthy that very few of these definitions and measures include the components of traditional bullying—i.e., repetition, power imbalance, and intent (Berne et al., 2013). A more recent study argues that the term “cyberbullying” should be reserved for incidents that involve key aspects of bullying such as repetition and differential power (Ybarra et al., 2014).

Although the formulation of a uniform definition of bullying appears to be a step in the right direction for the field of bullying prevention, there are some limitations of the CDC definition. For example, some researchers find the focus on school-age youth as well as the repeated nature of bullying to be rather limiting; similarly the exclusion of bullying in the context of sibling relationships or dating relationships may preclude full appreciation of the range of aggressive behaviors that may co-occur with or constitute bullying behavior. As noted above, other researchers have raised concerns about whether cyberbullying should be considered a particular form or mode under the broader heading of bullying as suggested in the CDC definition, or whether a separate defintion is needed. Furthermore, the measurement of bullying prevalence using such a definiton of bullying is rather complex and does not lend itself well to large-scale survey research. The CDC definition was intended to inform public health surveillance efforts, rather than to serve as a definition for policy. However, increased alignment between bullying definitions used by policy makers and researchers would greatly advance the field. Much of the extant research on bullying has not applied a consistent definition or one that aligns with the CDC definition. As a result of these and other challenges to the CDC definition, thus far there has been inconsistent adoption of this particular definition by researchers, practitioners, or policy makers; however, as the definition was created in 2014, less than 2 years is not a sufficient amount of time to assess whether it has been successfully adopted or will be in the future.


This report builds on the April 2014 workshop, summarized in Building Capacity to Reduce Bullying: Workshop Summary (Institute of Medicine and National Research Council, 2014c). The committee's work was accomplished over an 18-month period that began in October 2014, after the workshop was held and the formal summary of it had been released. The study committee members represented expertise in communication technology, criminology, developmental and clinical psychology, education, mental health, neurobiological development, pediatrics, public health, school administration, school district policy, and state law and policy. (See Appendix E for biographical sketches of the committee members and staff.) The committee met three times in person and conducted other meetings by teleconferences and electronic communication.

Information Gathering

The committee conducted an extensive review of the literature pertaining to peer victimization and bullying. In some instances, the committee drew upon the broader literature on aggression and violence. The review began with an English-language literature search of online databases, including ERIC, Google Scholar, Lexis Law Reviews Database, Medline, PubMed, Scopus, PsycInfo, and Web of Science, and was expanded as literature and resources from other countries were identified by committee members and project staff as relevant. The committee drew upon the early childhood literature since there is substantial evidence indicating that bullying involvement happens as early as preschool (see Vlachou et al., 2011). The committee also drew on the literature on late adolescence and looked at related areas of research such as maltreatment for insights into this emerging field.

The committee used a variety of sources to supplement its review of the literature. The committee held two public information-gathering sessions, one with the study sponsors and the second with experts on the neurobiology of bullying; bullying as a group phenomenon and the role of bystanders; the role of media in bullying prevention; and the intersection of social science, the law, and bullying and peer victimization. See Appendix A for the agendas for these two sessions. To explore different facets of bullying and give perspectives from the field, a subgroup of the committee and study staff also conducted a site visit to a northeastern city, where they convened four stakeholder groups comprised, respectively, of local practitioners, school personnel, private foundation representatives, and young adults. The site visit provided the committee with an opportunity for place-based learning about bullying prevention programs and best practices. Each focus group was transcribed and summarized thematically in accordance with this report's chapter considerations. Themes related to the chapters are displayed throughout the report in boxes titled “Perspectives from the Field”; these boxes reflect responses synthesized from all four focus groups. See Appendix B for the site visit's agenda and for summaries of the focus groups.

The committee also benefited from earlier reports by the National Academies of Sciences, Engineering, and Medicine through its Division of Behavioral and Social Sciences and Education and the Institute of Medicine, most notably:

Although these past reports and workshop summaries address various forms of violence and victimization, this report is the first consensus study by the National Academies of Sciences, Engineering, and Medicine on the state of the science on the biological and psychosocial consequences of bullying and the risk and protective factors that either increase or decrease bullying behavior and its consequences.


Given the variable use of the terms “bullying” and “peer victimization” in both the research-based and practice-based literature, the committee chose to use the current CDC definition quoted above (Gladden et al., 2014, p. 7). While the committee determined that this was the best definition to use, it acknowledges that this definition is not necessarily the most user-friendly definition for students and has the potential to cause problems for students reporting bullying. Not only does this definition provide detail on the common elements of bullying behavior but it also was developed with input from a panel of researchers and practitioners. The committee also followed the CDC in focusing primarily on individuals between the ages of 5 and 18. The committee recognizes that children's development occurs on a continuum, and so while it relied primarily on the CDC definition, its work and this report acknowledge the importance of addressing bullying in both early childhood and emerging adulthood. For purposes of this report, the committee used the terms “early childhood” to refer to ages 1-4, “middle childhood” for ages 5 to 10, “early adolescence” for ages 11-14, “middle adolescence” for ages 15-17, and “late adolescence” for ages 18-21. This terminology and the associated age ranges are consistent with the Bright Futures and American Academy of Pediatrics definition of the stages of development.4

A given instance of bullying behavior involves at least two unequal roles: one or more individuals who perpetrate the behavior (the perpetrator in this instance) and at least one individual who is bullied (the target in this instance). To avoid labeling and potentially further stigmatizing individuals with the terms “bully” and “victim,” which are sometimes viewed as traits of persons rather than role descriptions in a particular instance of behavior, the committee decided to use “individual who is bullied” to refer to the target of a bullying instance or pattern and “individual who bullies” to refer to the perpetrator of a bullying instance or pattern. Thus, “individual who is bullied and bullies others” can refer to one who is either perpetrating a bullying behavior or a target of bullying behavior, depending on the incident. This terminology is consistent with the approach used by the FPBP (see above). Also, bullying is a dynamic social interaction (Espelage and Swearer, 2003) where individuals can play different roles in bullying interactions based on both individual and contextual factors.

The committee used “cyberbullying” to refer to bullying that takes place using technology or digital electronic means. “Digital electronic forms of contact” comprise a broad category that may include e-mail, blogs, social networking Websites, online games, chat rooms, forums, instant messaging, Skype, text messaging, and mobile phone pictures. The committee uses the term “traditional bullying” to refer to bullying behavior that is not cyberbullying (to aid in comparisons), recognizing that the term has been used at times in slightly different senses in the literature.

Where accurate reporting of study findings requires use of the above terms but with senses different from those specified here, the committee has noted the sense in which the source used the term. Similarly, accurate reporting has at times required use of terms such as “victimization” or “victim” that the committee has chosen to avoid in its own statements.


This report is organized into seven chapters. After this introductory chapter, Chapter 2 provides a broad overview of the scope of the problem.

Chapter 3 focuses on the conceptual frameworks for the study and the developmental trajectory of the child who is bullied, the child who bullies, and the child who is bullied and also bullies. It explores processes that can explain heterogeneity in bullying outcomes by focusing on contextual processes that moderate the effect of individual characteristics on bullying behavior.

Chapter 4 discusses the cyclical nature of bullying and the consequences of bullying behavior. It summarizes what is known about the psychosocial, physical health, neurobiological, academic-performance, and population-level consequences of bullying.

Chapter 5 provides an overview of the landscape in bullying prevention programming. This chapter describes in detail the context for preventive interventions and the specific actions that various stakeholders can take to achieve a coordinated response to bullying behavior. The chapter uses the Institute of Medicine's multi-tiered framework (National Research Council and Institute of Medicine, 2009) to present the different levels of approaches to preventing bullying behavior.

Chapter 6 reviews what is known about federal, state, and local laws and policies and their impact on bullying.

After a critical review of the relevant research and practice-based literatures, Chapter 7 discusses the committee conclusions and recommendations and provides a path forward for bullying prevention.

The report includes a number of appendixes. Appendix A includes meeting agendas of the committee's public information-gathering meetings. Appendix B includes the agenda and summaries of the site visit. Appendix C includes summaries of bullying prevalence data from the national surveys discussed in Chapter 2. Appendix D provides a list of selected federal resources on bullying for parents and teachers. Appendix E provides biographical sketches of the committee members and project staff.


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Prior to 2015, the National Academy of Medicine was known as the Institute of Medicine.


The Safe and Drug-Free Schools and Communities Act was included as Title IV, Part A, of the 1994 Elementary and Secondary Education Act. See http://www​​/pubs/gun_violence/sect08-i.html [October 2015].


For details, see http://www​ [October 2015].

Copyright 2016 by the National Academy of Sciences. All rights reserved.
Bookshelf ID: NBK390418


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