A Centers for Disease Control and Prevention (CDC) report released in April has found that family violence is linked to bullying for both the bullied and the bullies. The CDC teamed with the Massachusetts Department of Public Health to analyze data from the 2009 Massachusetts Youth Health Survey. They assessed associations between family violence and other risk factors and involvement with bullying on either the giving or receiving end. The results were published in the April 22 Morbidity and Mortality Weekly Report.

The study broke bullying involvement into three categories: bully, victim, and bully-victim; bully-victims were both bullies and victims of bullying. A fourth category was made up of individuals who reported no involvement with bullying. The results "showed significant differences in risk factors for persons in all three bullying categories, compared with persons who reported being neither bullies nor victims."

The anonymous survey was conducted in 138 public middle and high schools. All surveys were completed during one class period; the sample sizes were 2,859 middle school students and 2,948 high school students. The response rate for middle school students was 55.8 percent and for high school students, 66.7 percent.

In the bullying section, students were asked two questions. The first was "During the past 12 months, how many times have you been bullied at school (being bullied included being repeatedly teased, threatened, hit, kicked, or excluded by another group of students)?" Those who responded one time or more were labeled victims. The second question was "Did you do any of the following in the past 12 months? (a) bully or push someone around, and (b) initiate or start a physical fight with someone." Students who responded positively to part "a" were categorized as bullies, while students who responded positively to part "b" were not categorized due to lack of knowledge about the nature of the fights. Students who responded positively to both questions were categorized as a "bully-victim," and students who responded negatively to both questions were categorized as "neither."

The most interesting finding of the study may be that when the researchers looked at the connection between the bullying-question responses and family violence, they found that "exposure to violent family encounters was more common among bully-victims than among bullies, and more common among bullies than victims of bullying. Those in the "neither" category experienced the lowest level of exposure to family violence.

The results for other risk factors—such as poor grades, suicidality, alcohol use, and drug use—mirrored those found for family violence. "Compared with students who were neither bullies nor bullying victims, both middle and high school bully-victims were more than three times as likely to report seriously considering suicide."

The report noted that previous studies have shown a link between family violence and bullying and between risk factors such as substance abuse and suicide and bullying. In speaking with Psychiatric News, Louis Kraus, M.D., chief of child and adolescent psychiatry at Rush University and a member of the APA Council on Children, Adolescents, and Their Families, agreed that while there have been studies indicating that bullies come from more violent homes, this study benefits from its large size.

The report authors and Kraus noted that the study is limited by the low student response rates. Also, the study is cross-sectional, so causality cannot be implied. The authors also acknowledge that it is problematic that the bullying question only focuses on physical violence, excluding the various forms of verbal and cyber-bullying. Kraus noted that these limitations, however, do not diminish the interconnection between kinds of exposure to violence and greatly increased later exposure to bullying and violence.

In an interview with Psychiatric News, David Finkelhor, Ph.D., the director of the University of New Hampshire Crimes Against Children Research Center, hypothesized about the higher levels of family violence for both bullies and the bullied. He said that "one obvious reason is that when one grows up in violence and aggression, the individual comes to see coercion in relationships as standard behavior." The individual internalizes the behavior and may not shy away from similar relationships. Finkelhor referred to this cycle as "polyvictimization," or the multiple victimizations of one person. For him the report points to the need for assessing different kinds of victimization and developing methods for treating and equipping victims with protective skills to avoid other victimization.

The study "Bullying Among Middle School and High School Students–Massachusetts, 2009" is posted at <www.cdc.gov/mmwr/preview/mmwrhtml/mm6015a1.htm?s_cid=mm6015a1_w>.