Frequent exposure to bullying is independently associated with high levels of distress.2 But why do a small proportion of bullied children choose to use self harm rather than other coping strategies (such as exercise or talking) to deal with these emotions? One possibility is that 12 year old children lack opportunities for reducing distress that are available to adults, such as self medication with alcohol or cigarettes, working out at the gym, or excessive food consumption. Children may use self harm after their attempts to talk to others about their distress have not been successful and more drastic attention seeking behaviours are thus needed. The last explanation is probably more likely in abusive or neglectful family environments where the child’s voice is seldom heard owing to their own fear of being “punished” if they speak out or to the unavailability of empathetic caregivers.38 39 This hypothesis is partially supported by the greater prevalence of self harm among bullied children in our sample who were also physically maltreated. Repeated exposure to such victimisation by adults as well as bullying by peers
