Bullying and taunts that may have once stayed in the schoolyard increasingly spill over into text messages and social media. A new study shows that the combined effect of both face-to-face and cyber-bullying may have a powerful effect on adolescents, more than doubling the odds that victims show aggressive behaviors themselves such as verbal hostility, physical fighting and damaging property.

An abstract of the study, "Increased Risk of Aggressive Behavior among Victims of Multiple Forms of Bullying," will be presented at the Pediatric Academic Societies 2016 Meeting on Saturday, April 30 in Baltimore. Noting that previous studies showed victims of peer aggression are at greater risk for victimizing others, the researchers compared how likely a national sample of adolescents between ages 10 and 17 were to display based on whether they themselves experienced face-to-face , cyber-bullying, or both.

Overall, 43 percent of the teens in the study reported having been the victim of face-to-face bullying, while 7 percent reported that they experienced some form of cyber-bullying. Teens who were bulled either in person or online were more likely to engage in aggressive behaviors such as physical fighting, damaging property, verbal hostility and coercing peers. But teens who were victims of both face-to-face and cyber-bullying, representing 3 percent of the youth, were more than twice as likely as those experiencing just one form of bullying to engage in aggressive behaviors. Of the teens who experienced both forms of victimization, 38 percent showed , compared with 15 percent of those who were cyber-bullied and 4 percent of those were victims of face-to-face bullying.

Senior investigator Andrew Adesman, MD, FAAP, chief of developmental and behavioral pediatrics at the Cohen Children's Medical Center of New York, said it was concerning, though not surprising, that who had been subjected to multiple forms of peer aggression were at increasingly greater risk of showing aggressive behaviors themselves. "These behaviors may involve retaliatory measures against their aggressors, acting aggressive in order to fend off future bullying attempts, or worse, learning by example and engaging in bullying of previously uninvolved peers," he said.

Principal investigator Alexandra Hua said that with the growing use of cell phones and the Internet among youth, there should be a greater focus on cyber-bullying and these negative "downstream" effects, especially when combined with face-to-face bullying. "Students who are victimized are more likely to exhibit aggressive behaviors towards others," she said. "This phenomenon may lead to a vicious cycle whereby bullies create bullies out of those they victimize."