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The effects of bullying at an early age are felt as the child grows into adulthood, a new study shows.

“Bullying is not just a harmless rite of passage or an inevitable part of growing up,” the report, published in the journal JAMA Psychiatry on Wednesday, reads. According to the study, researchers have been able to conclude that bullied children have a higher risk of developing psychological troubles when they become adults.

The study was conducted in Western North Carolina and followed 1,420 subjects who were divided into four groups: bullies, victims, bullies who were also victims, and children who were not exposed to bullying at all.

Over the years, participants were assessed between four to six times between the ages of 9 and 16. They were also studied in young adulthood — at 19, 21 and between 24 and 26 years of age.

The study found those who had been childhood victims of bullying were four times more likely to have an anxiety disorder as adults.

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Bullies and victims were particularly troubled, being 14 times more likely to develop panic disorder as adults.

“The experience of bullying in childhood can have profound effects on mental health in adulthood, particularly among youths involved in bullying as both a perpetuator and a victim,” Catherine Bradshaw, an expert on bullying and a deputy director of the Center for the Prevention of Youth Violence at Johns Hopkins University, told the New York Times.

While the study only addressed bullying at school, it is the first of its kind to follow children affected by the issue over time.

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