Experts agree that children who are bullied are more at risk for anxiety, depression and eating disorders. But researchers at Duke University have also found that those who taunt and tease their peers are twice as likely to binge and purge, symptoms related to bulimia.

The study’s author said this defeats the myth that bullies are tough. Instead, the evidence suggests bullies are likely suffering from low self-esteem, which leads them to provoke their classmates.

To conduct the study, interviews from 1,420 children were collected from the Great Smokey Mountains Study, a database containing more than 20 years of health records from participants who enrolled at age 9. The participants were divided into four groups: children who have never been involved with bullying; children who were always the victims; those who were sometimes victims and sometimes bullies; and those who were always the bullies. Bullying was defined as abusing others verbally and physically, excluding others socially and spreading rumors.

Those who were always a victim were almost twice as likely to display symptoms of anorexia and bulimia. Children who had been both the victim and instigator were the most likely to suffer from anorexia and binge eating compared with those never involved in bullying. Results also showed that almost 31 percent of those who were always bullies displayed symptoms of bulimia, compared with just under 18 percent of children not involved in bullying.

Researchers now plan to explore the financial and educational outcomes of those involved in bullying, and find if there are any genetic biomarkers related to being a bully or a victim.

They also suggest that more education about eating disorders needs to be given to anyone involved with bullying … not just the victims.