Although bullying is often commonly seen as a children’s issue—big kids shoving small kids against lockers, spiteful girls and boys slinging gossip, or teens systematically assassinating each other’s character online—the fact is that people of all age groups can suffer physical and psychological damage from this type of behavior. Indeed, according to health experts, bullying is linked to a wide range of health problems.

Studies show that bullying behavior affects victims and perpetrators alike. Those bullied, and those who bully, complain of headaches and stomachaches, have difficulty falling asleep and fall victim to psychological symptoms, most notably depression, eating disorders, alcohol and drug abuse and self-inflicted or accidental injuries and suicidal behavior, says Jorge C. Srabstein, MD, medical director of the Clinic for Health Problems Related to Bullying at the Children’s National Medical Center.

What’s more, symptoms associated with bullying often appear in a cluster. For example, people affected by bullying often get headaches accompanied by anxiety, stomachaches and depression, Srabstein explains. Meanwhile, adults bullied at work tend to suffer from many of these same problems and other serious physical and mental disorders.

When symptoms like these appear together, they’re labeled a medical syndrome. But, Srabstein says, at this point, there’s not enough evidence for doctors to declare these types of symptoms a “bullying syndrome.” So, is this a public health issue or what?

Well, public health officials warn that these groups of symptoms affect the health and development of bullying victims and perpetrators, and that they poison the quality of life for everyone in our communities.

A big challenge is that many people view bullying as a normal part of childhood development. “This is a dangerous and erroneous assumption,” Srabstein stresses.

For one thing, bullying is not restricted to children in school. This behavior can also affect children in the home, adolescents in relationships and even adults in the workplace. What’s more, “the consequences of bullying extend into adulthood,” Srabstein says, noting that “there is evidence of a significant association between childhood bullying behavior and later psychiatric illness.”

But realistically, even the most vigilant public health campaigns can’t be expected to end bullying. That’s why health officials must treat the symptoms of bullying, Srabstein advises. This means using a public health approach to the problem and creating interventions that promote sensitivity, mutual respect and a tolerance of diversity.

Those interventions should also document and monitor bullying behavior on all levels, identify effective programs and policies and include continued research to assess the problem.

Plain and simple, Srabstein says, bullying can lead to death.