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Childhood bullying and the association with psychosis in non-clinical and clinical samples: a review and meta-analysis

  • D. S. van Dam (a1), E. van der Ven (a2) (a3), E. Velthorst (a1), J. P. Selten (a2) (a3), C. Morgan (a4) (a5) and L. de Haan (a1)...



Approximately 11% of schoolchildren are bullied on a regular basis. It has been argued that continuous exposure to stress is related to the development of psychotic symptoms. The current study sought to investigate whether being bullied in childhood is related to the development of psychotic symptoms.


A search of PubMed, PsycINFO and EMBASE was conducted. The reference lists of included papers were searched to identify other eligible papers. A meta-analysis was performed on a subgroup of studies.


We found four clinical and 10 general population studies that met inclusion criteria. The results of the clinical studies were mixed. However, the results of the non-clinical studies provided more consistent evidence that school bullying is related to the development of non-clinical psychotic symptoms. Stronger associations were found with increased frequency and severity and longer duration of being bullied. We performed a meta-analysis on seven population-based studies, yielding unadjusted and adjusted odds ratios (ORs) of 2.7 [95% confidence interval (CI) 2.1–3.6] and 2.3 (95% CI 1.5–3.4) respectively.


Although there is some evidence of an association between bullying and psychosis in clinical samples, the research is too sparse to draw any firm conclusions. However, population-based non-clinical studies support the role of bullying in the development of psychotic symptoms later in life. These findings are consistent with findings of an increased risk of psychotic symptoms among those exposed to other types of abuse.


Corresponding author

*Address for correspondence: D. S. van Dam, M.Sc., Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, Meibergdreef 5, Room PA3-133, 1105 AZ Amsterdam, The Netherlands. (Email:


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Allison, S, Roeger, L, Reinfeld-Kirkman, N (2009). Does school bullying affect adult health? Population survey of health-related quality of life and past victimization. Australian and New Zealand Journal of Psychiatry 43, 11631170.
Arsenault, L, Cannon, M, Fisher, HL, Polanczyk, G, Moffit, TE, Caspi, A (2011). Childhood trauma and children's emerging psychotic symptoms: a genetically sensitive longitudinal cohort study. American Journal of Psychiatry 168, 6572.
Bebbington, PE, Bhugra, D, Brugha, T, Singleton, N, Farrel, M, Jenkins, R, Lewis, G, Meltzer, H (2004). Psychosis, victimisation and childhood disadvantage: evidence from the second British National Survey of Psychiatric Morbidity. British Journal of Psychiatry 185, 220226.
Bechdolf, A, Thompson, A, Nelson, B, Cotton, S, Simmons, MB, Amminger, GP, Leicester, S, Francey, SM, McNab, C, Krstev, H, Sidis, A, McGorry, PD, Yung, AR (2010). Experience of trauma and conversion to psychosis in an ultra-high-risk (prodromal) group. Acta Psychiatrica Scandinavica 121, 377384.
Bendall, S, Jackson, HJ, Hulbert, CA, McGorry, PD (2008). Childhood trauma and psychotic disorders: a systematic, critical review of the evidence. Schizophrenia Bulletin 34, 568579.
Campbell, MLC, Morrison, AP (2007). The relationship between bullying, psychotic-like experiences and appraisals in 14-16 year olds. Behaviour Research and Therapy 45, 15791591.
Cannon, M, Jones, P, Huttunen, MO, Tanskanen, A, Huttunen, T, Rabe-Hesketh, S, Murray, RM (1999). School performance in Finish children and later development of schizophrenia. A population-based longitudinal study. Archives of General Psychiatry 56, 457463.
Carney, JLV (2008). Perceptions of bullying and associated trauma during adolescence. Professional School Counselling 11, 179188.
Cougnard, A, Marcelis, M, Myin-Germeys, I, de Graaf, R, Vollebergh, W, Krabbendam, L, Lieb, R, Wittchen, H, Henquet, C, Spauwen, J, van Os, J (2007). Does normal developmental expression of psychosis combine with environmental risk to cause persistence of psychosis? A psychosis proneness-persistence model. Psychological Medicine 37, 513527.
Craig, WM, Harel, Y (2004). Bullying, physical fighting, and victimization. In Young People's Health in Context: International Report from the HBSC 2001/02 Survey. WHO Policy Series: Health Policy for Children and Adolescents. No. 4 (ed. Currie, C., Roberts, C., Morgan, A., Smith, R., Settertobulte, W., Samdal, O. and Rasmussen, V. B.), pp. 133144. World Health Organization Regional Office for Europe: Copenhagen.
Crittendon, PM, Ainsworth, MDS (1989). Child maltreatment and attachment theory. In Childhood Maltreatment: Theory and Research on the Causes and Consequences of Child Abuse and Neglect (ed. Cicchetti, D. and Carlson, V.), pp. 432463. Cambridge University Press: Cambridge.
Crosby, JW, Oehler, J, Capaccioli, K (2010). Relationship between peer victimization and post-traumatic stress symptomatology in a rural sample. Psychology in the Schools 47, 297310.
De Loore, E, Drukker, M, Gunther, N, Feron, F, Deboutte, D, Sabbe, B, Mengelers, R, van Os, J, Myin-Germeys, I (2007). Childhood negative experiences and subclinical psychosis in adolescence: a longitudinal general population study. Early Intervention in Psychiatry 1, 201207.
Done, DJ, Crow, TJ, Johnstone, EC, Sacker, A (1994). Childhood antecedents of schizophrenia and affective illness: social adjustment at ages 7 and 11. British Medical Journal 309, 699703.
Fisher, H, Craig, T (2008). Childhood adversity and psychosis. In Society and Psychosis (ed. Morgan, C., McKenzie, K. and Fearon, P.), pp. 95–111. Cambridge University Press: Cambridge.
Frisén, A, Bjarnelind, S (2010). Health-related quality of life and bullying in adolescence. Acta Paediatrica 99, 597603.
Gracie, A, Freeman, D, Green, S, Garety, PA, Kuipers, E, Hardy, A, Ray, K, Dunn, G, Bebbington, P, Fowler, D (2007). The association between traumatic experience, paranoia and hallucinations: a test of the predictions of psychological models. Acta Psychiatrica Scandinavica 116, 280289.
Hawker, DSJ, Boulton, MJ (2000). Twenty years' research on peer victimization and psychosocial maladjustment: a meta-analytic review of cross-sectional studies. Journal of Child Psychology and Psychiatry, and Allied Disciplines 41, 441455.
Janssen, I, Krabbendam, L, Bak, M, Hanssen, M, Vollebergh, W, de Graaf, R, van Os, J (2004). Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatrica Scandinavica 109, 3845.
Kapur, S (2003). Psychosis as a state of aberrant salience: a framework linking biology, phenomenology, and pharmacology in schizophrenia. American Journal of Psychiatry 160, 1323.
Kelleher, I, Harley, M, Lynch, F, Arsenault, L, Fitzpatrick, C, Cannon, M (2008). Associations between childhood trauma, bullying and psychotic symptoms among a school based adolescent sample. British Journal of Psychiatry 193, 378382.
Lardinois, M, Lataster, T, Mengelers, R, van Os, J, Myin-Germeys, I (2011). Childhood trauma and increased stress sensitivity in psychosis. Acta Psychiatrica Scandinavica 123, 2835.
Larkin, W, Read, J (2008). Childhood trauma and psychosis: evidence, pathways, and implications. Journal of Postgraduate Medicine 54, 287293.
Lataster, T, van Os, J, Drukker, M, Henquest, C, Feron, F, Gunther, N, Myin-Germeys, I (2006). Childhood victimisation and developmental expression of non-clinical delusional ideation and hallucinatory experiences. Social Psychiatry and Psychiatric Epidemiology 41, 423428.
Luukkonen, AH, Riala, K, Hakko, H, Räsänen, P (2010). Bullying behaviour and substance abuse among underage psychiatric inpatient adolescents. European Psychiatry 25, 382389.
Mackie, CJ, Castellanos-Ryan, N, Conrod, PJ (2011). Developmental trajectories of psychotic-like experiences across adolescence: impact of victimization and substance use. Psychological Medicine 41, 4758.
Marshall, M, Lewis, S, Lockwood, A, Drake, R, Jones, P, Croudace, T (2005). Association between duration of untreated psychosis and outcome in cohorts of first-episode patients a systematic review. Archives of General Psychiatry 62, 975983.
Morgan, C, Fisher, H (2007). Environmental factors in schizophrenia: childhood trauma – a critical review. Schizophrenia Bulletin 33, 3–10.
Morrison, AP, Frame, L, Larkin, W (2003). Relationships between trauma and psychosis: a review and integration. British Journal of Clinical Psychiatry 42, 331353.
Morrison, AP, Petersen, T (2003). Trauma, metacognition and predisposition to hallucinations in non-patients. Behavioural and Cognitive Psychotherapy 31, 235246.
Murray, RM, Fearon, P (1999). The developmental ‘risk factor’ model of schizophrenia. Journal of Psychiatric Research 33, 497499.
Mynard, H, Joseph, S, Alexander, J (2000). Peer-victimisation and posttraumatic stress in adolescents. Personality and Individual Differences 29, 815821.
Newman, ML, Holden, GW, Delville, Y (2005). Isolation and the stress of being bullied. Journal of Adolescence 28, 343357.
Nishida, A, Tanii, H, Nishimura, Y, Kajiki, N, Inoue, K, Okada, M, Sasaki, T, Okazaki, Y (2008). Associations between psychotic-like experiences and mental health status and other psychopathologies among Japanese early teens. Schizophrenia Research 99, 125133.
Olweus, D (1996). Bullying at school: knowledge base and an effective intervention program. Annals of the New York Academy of Sciences 794, 265276.
Poulton, R, Caspi, A, Moffit, TE, Cannon, M, Murray, R, Harrington, H (2000). Children's self-reported psychotic symptoms and adult schizophreniform disorder: a 15-year longitudinal study. Archives of General Psychiatry 57, 10531058.
Read, J, van Os, J, Morrison, AP, Ross, CA (2005). Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica 112, 330350.
Rosenberg, MS, Adams, DC, Gurevitch, J (2000). MetaWin: Statistical Software for Meta-Analysis. Version 2. Sinauer Associates: Sunderland, MA.
Schreier, A, Wolke, D, Thomas, K, Horwood, J, Hollis, C, Gunnel, D, Lewis, G, Thompson, A, Zammit, S, Duffy, L, Salvi, G, Harrison, G (2009). Prospective study of peer victimization in childhood and psychotic symptoms in a nonclinical population at age 12 years. Archives of General Psychiatry 66, 527536.
Selten, JP, Cantor-Graae, E (2005). Social defeat: risk factor for schizophrenia? British Journal of Psychiatry 187, 101102.
Shevlin, M, Houston, JE, Dorahy, MJ, Adamson, G (2008). Cumulative traumas and psychosis: an analysis of the National Comorbidity Survey and the British Psychiatric Morbidity Survey. Schizophrenia Bulletin 34, 193199.
Sourander, A, Jensen, P, Rönning, J, Niemelä, S, Helenius, H, Sillanmäki, L, Kumpulainen, K, Piha, J, Tamminen, T, Moilanan, I, Almqvist, F (2007). What is the early adulthood outcome of boys who bully or are bullied in childhood? The Finnish ‘From a Boy to a Man’ Study. Pediatrics 120, 397404.
Sourander, A, Rönning, J, Brunstein-Klomek, A, Gyllenberg, D, Kumpulainen, K, Niemelä, S, Helenius, H, Sillanmäki, L, Ristkari, T, Tamminen, T, Moilanan, I, Piha, J, Almqvist, F (2009). Childhood bullying behavior and later psychiatric hospital and psychopharmacologic treatment: findings from the Finnish 1981 Birth Cohort Study. Archives of General Psychiatry 66, 10051012.
Spauwen, J, Krabbendam, L, Lieb, R, Wittchen, H, van Os, J (2006). Impact of psychological trauma on the development of psychotic symptoms: relationship with psychosis proneness. British Journal of Psychiatry 188, 527533.
Storch, EA, Esposito, LE (2003). Peer victimization and posttraumatic stress among children. Child Study Journal 33, 9198.
Thompson, JL, Kelly, M, Kimhy, D, Harkavy-Friedman, JM, Khan, S, Messinger, JW, Schobel, S, Goetz, R, Maalspina, D, Corcoran, C (2009). Childhood trauma and prodromal symptoms among individuals at clinical high risk for psychosis. Schizophrenia Research 108, 176181.
Vaillancourt, T, Duku, E, Decatanzaro, D, Macmillan, H, Muir, C, Schmidt, LA (2008). Variation in hypothalamic-pituitary-adrenal axis activity among bullied and non-bullied children. Aggressive Behavior 34, 294305.
van Nierop, M, van Os, J, Gunther, N, Myin-Germeys, I, de Graaf, R, ten Have, M, van Dorsselaer, S, Bak, M, van Winkel, R (2011). Phenotypically continuous with clinical psychosis, discontinuous in need for care: evidence for an extended psychosis phenotype. Schizophrenia Bulletin. Published online: 9 September 2011. doi:10.1093/schbul/sbr129.
Walker, EF, DiForio, D (1997). Schizophrenia: a neural diathesis-stress model. Psychological Review 104, 667685.
Wilkins-Shurmer, A, O'Callaghan, MJ, Najman, JM, Bor, W, Williams, GM, Anderson, MJ (2003). Association of bullying with adolescent health-related quality of life. Journal of Paediatrics and Child Health 39, 436441.



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