PETALING JAYA - For most of us, bullying is something we just grew up with or grew out of, something out of our school days and just "part of growing up."
Except it isn't. There is mounting evidence from increasing research that argues there are longer-term and wider effects, not just on the victims but also on the perpetrators and even those who watch such activities from the sidelines.
For example, victims often experience ongoing fear, anxiety and recurring nightmares, according to an expert, and there are warning signs.
KIN & KiDS Marriage, Family and Child Therapy Centre counsellor Tan Su Chen told The Star Online some victims may begin to suddenly do poorly in school and appear moody.
"Symptoms include anxiety of going to school, frequent headaches and stomach-aches, or other physical problems including loss of appetite and weight.
"They may also have difficulty sleeping or suffer recurring nightmares," she added.
Tan said victims may lose interest in school, suffer a loss of confidence, and begin acting withdrawn.
KIN & KiDS is a group of mental health practitioners who provide counselling and therapy in Kuala Lumpur.
The effects of bullying do not necessarily surface immediately either, nor do they disappear after victims grow up and leave school.
"The after-effects of bullying such as school anxiety or school refusal, loss of self-esteem, and traumatic stress will surface immediately in most children.
"These may persist into adulthood if not resolved or attended to earlier," said Tan.
She added that it was not uncommon to see adults struggle with the effects of bullying from their childhood or teenage years.
"They may appear to struggle with feelings of insecurities or anger, and may face difficulties in family or romantic relationship, or even at work.
"For these adults, their childhood bullying experiences were repressed and were not disclosed or addressed at the time," she added.
Two overseas studies in 2015 - the UK-based Avon Longitudinal Study of Parents and Children which covered more than 4,000 participants, and the US-based Great Smoky Mountain Study which covered more than 1,200 participants - found that the effects of bullying were even more damaging than previously thought.
The results in both showed that children who were bullied but not maltreated by adults, suffered worse outcomes later in life than those maltreated by adults but not bullied, according to a report in Forbes.
As for the bullies, Tan said poorly managed anger and their own personal experience of being bullied can result in an individual becoming a bully.
She said some children turn to bullying because they are unaware of the impact of their actions.
"It varies from child to child. Sometimes, it is not uncommon for younger children to be unaware that their actions may oppress or harm others.
"Some children may have been bullied at home or in school, and inadvertently channel their hurt and anger towards hurting others.
"Some other children who bully have a lot of anger and have not learned how to manage this, which often results in aggression towards others," she said.
A study in the Journal of the American Medical Association that covered more than 1,400 participants found that "the effects of being bullied are direct, pleiotropic (producing more than one effect), and long-lasting, with the worst effects for those who are both victims and bullies."
"Victims of bullying in childhood were at increased risk of anxiety disorders in adulthood, and those who were both victims and perpetrators were at increased risk of adult depression and panic disorder," the researchers found.
Tan said that the best way to address the situation in both victims and bullies was to have people who are compassionate and caring around them.
"These are people who take bullying seriously and are willing to listen empathetically to how they feel.
"It is not helpful to shame the child for being a victim of bullying because it will further degrade his or her self-esteem for not being able to stand up for himself or herself.
"School and teachers, in addition to parents, have a role in teaching children how to treat one another, how to stand up for each other when they notice bullying in school, and how to get help when needed," she said.