HomeRecoletos Multidisciplinary Research Journalvol. 11 no. 2 (2023)

Bullying, Eating Disorders and Coping Strategies among Adolescents in Malaysia

Naveena A P Arokiasamy Rajkumar | Latha Ravindran | Pei Boon Ooi | Qi Rui Goh | Kay Hooi Keoy | Meng Chuan Ho | Jessica Avenido

Discipline: Psychology and Health



Understanding how bullying leads to eating disorders can help develop effective intervention strategies. This phenomenological study examines the relationship between bullying and coping strategies Malaysian adolescents diagnosed with eating disorders use. Using the snowball sampling technique, 12 Kuala Lumpur participants, six females and six males aged 10 to 19, responded to interview questions based on the literature reviews, theories, and a published questionnaire. By using thematic analysis, the researcher found out that all 12 participants with EDs were bullied about their weight or size. Most of the bullying and teasing were verbal or via online platforms. The findings suggest that bullying can be a significant cause of the development of eating disorders among adolescents in Malaysia. Proper coping strategies can be essential in overcoming the trauma of being bullied and treating eating disorders.


  1. Adeline, B. I., Kay, H. N. N., Tan, G. W. H., Lo, P. S., Chaw, L. Y., & Ooi, K. B. (2023). A relook at the mobile advertising landscape: What are the new consumer expectations in the retailing industry? Telematics and Informatics, 79, 101953. https://doi.org/10.1016/j.tele.2023.101953
  2. Balciuniene, V., Jankauskiene, R., & Baceviciene, M. (2022). Effect of an education and mind-fulness-based physical activity intervention for the promotion of positive body image in Lithuanian female students. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 27, 563–577. https://doi.org/10.1007/s40519-021-01195-4
  3. Ben-Zur, H., & Yagil, D. (2005). The relationship between empowerment, aggressive behaviours of customers, coping, and burnout. European Journal of Work and Organizational Psychology, 14(1), 81-99. https://doi.org/10.1080/13594320444000281
  4. Blodgett Salafia, E. H., & Gondoli, D. M. (2011). A 4-year longitudinal investigation of the processes by which parents and peers influence the development of early adolescent girls’ bulimic symptoms. The Journal of Early Adolescence, 31(3), 390–414. https://doi.org/10.1177/0272431610366248
  5. Brown, J. D., & Bobkowski, P. S. (2011). Older and newer media: Patterns of use and effects on adolescents’ health and well-being. Journal of Research on Adolescence, 21(1), 95–113. https://doi.org/10.1111/j.1532-7795.2010.00717.x
  6. Burton, A. L., & Abbott, M. J. (2019). Processes and pathways to binge eating: Development of an integrated cognitive and behavioural model of binge eating. Journal of Eating Disorders, 7(1), 1-9. https://doi.org/10.1186/s40337-019-0248-0
  7. Calvete, E., las Hayas, C., & Gómez del Barrio, A. (2018). Longitudinal associations between resilience and quality of life in eating disorders. Psychiatry Research, 259, 470-475. https://doi.org/10.1016/j.psychres.2017.11.031
  8. Camodeca, M., & Goossens, F. A. (2005). Children’s opinions on effective strategies to cope with bullying: The importance of bullying role and perspective. Educational Research, 47(1), 93-105. https://doi.org/10.1080/0013188042000337587
  9. Castleberry, A., & Nolen, A. (2018). Thematic analysis of qualitative research data: Is it as easy as it sounds? Currents in Pharmacy Teaching and Learning, 10(6), 807–815. Sciencedirect. https://doi.org/10.1016/j.cptl.2018.03.019
  10. Causey, D. L., & Dubow, E. F. (1992). Development of a self-report coping measure for elementary school children. Journal of Clinical Child Psychology, 21(1), 47–59. https://doi.org/10.1207/s15374424jccp2101_8
  11. Chamberlain, C., Gee, G., Brown, S. J., Atkinson, J., Herrman, H., Gartland, D., Glover, K., Clark, Y., Campbell, S., Mensah, F. K., Atkinson, C., Brennan, S. E., McLachlan, H., Hirvonen, T., Dyall, D., Ralph, N., Hokke, S., & Nicholson, J. (2019). Healing the past by nurturing the future—co-designing perinatal strategies for aboriginal and torres strait islander parents experiencing complex trauma: Framework and protocol for a community-based participatory action research study. BMJ Open, 9(6), e028397. https://doi.org/10.1136/bmjopen-2018-028397
  12. Chaw, L. Y., & Tang, C. M. (2023). Exploring the role of learner characteristics in learners' learning environment preferences. International Journal of Educational Management, 37(1), 37-54. https://doi.org/10.1108/IJEM-05-2022-0205
  13. Cho, Y., & DioGuardi, S. (2020). Strain, negative emotion, and cyber violence among South Korean juveniles: A mediation analysis. Children and Youth Services Review, 108, 104601. https://doi.org/10.1016/j.childyouth.2019.104601
  14. Chua, S. N., Fitzsimmons‐Craft, E. E., Austin, S. B., Wilfley, D. E., & Taylor, C. B. (2022). Estimated prevalence of eating disorders in Malaysia based on a diagnostic screen. International Journal of Eating Disorders, 55(6). https://doi.org/10.1002/eat.23711
  15. Compas, B. E., Connor-Smith, J. K., Saltzman, H., Thomsen, A. H., & Wadsworth, M. E. (2001). Coping with stress during childhood and adolescence: Problems, progress, and potential in theory and research. Psychological Bulletin, 127(1), 87–127. https://doi.org/10.1037/0033-2909.127.1.87
  16. Cook-Cottone, C., Serwacki, M., Guyker, W., Sodano, S., Nickerson, A., Keddie-Olka, E., & Anderson, L. (2016). The role of anxiety on the experience of peer victimization and eating disorder risk. School Mental Health, 8, 354–367. https://doi.org/10.1007/s12310-016-9178-z
  17. Corbin, J., & Strauss, A. (2008). Basics of qualitative research: Techniques and procedures for developing grounded theory (3rd ed.). Sage Publications.
  18. Currin, L., Schmidt, U., Treasure, J., & Jick, H. (2005). Time trends in eating disorder incidence. The British Journal of Psychiatry, 186(2), 132–135. https://doi.org/10.1192/bjp.186.2.132
  19. Day, S., Bussey, K., Trompeter, N., Hay, P., Lonergan, A., & Mitchison, D. (2021). Associations of weight- or shape-related bullying with diverse disordered eating behaviors in adoles-cents. International Journal of Eating Disorders, 54(9), 1641–1651. https://doi.org/10.1002/eat.23573
  20. Elliott, R. K., & Timulak, L. (2021). Essentials of descriptive-interpretive qualitative research: A generic approach. American Psychological Association.
  21. Erriu, M., Cimino, S., Cerniglia, L. (2020). The role of family relationships in eating disorders in adolescents: A narrative review. Behavioral Sciences, 10(4), 71. https://doi.org/10.3390/bs10040071
  22. Fairburn, C. G., & Bohn, K. (2005). Eating disorder NOS (EDNOS): an example of the trouble-some “not otherwise specified” (NOS) category in DSM-IV. Behaviour Research and Therapy, 43(6), 691–701. https://doi.org/10.1016/j.brat.2004.06.011
  23. Farrow, C. V., & Fox, C. L. (2011). Gender differences in the relationships between bullying at school and unhealthy eating and shape-related attitudes and behaviours. British Journal of Educational Psychology, 81(3), 409–420. https://doi.org/10.1348/000709910X525804
  24. Fernández-Felipe, I., Marco, J. H., & Quero, S. (2021). Cyberbullying and bullying in spanish participants with eating disorders. In L. R. Salazar (Ed.), Handbook of Research on Cyberbullying and Online Harassment in the Workplace (pp. 360–378). IGI Global.
  25. Flaskerud, J. H. (2012). Coping and health status: John Henryism. Issues in Mental Health Nursing, 33(10), 712–715. https://doi.org/10.3109/01612840.2012.673695
  26. Folkman, S., Lazarus, R. S., Dunkel-Schetter, C., DeLongis, A., & Gruen, R. J. (1986). Dynamics of a stressful encounter: Cognitive appraisal, coping, and encounter outcomes. Journal of Personality and Social Psychology, 50(5), 992–1003. https://doi.org/10.1037/0022-3514.50.5.992
  27. Gini, G., Pozzoli, T., & Hymel, S. (2013). Moral disengagement among children and youth: A meta-analytic review of links to aggressive behavior. Aggressive Behavior, 40(1), 56–68. https://doi.org/10.1002/ab.21502
  28. Haines, J., Kleinman, K. P., Rifas-Shiman, S. L., Field, A. E., & Austin, S. B. (2010). Examina-tion of shared risk and protective factors for overweight and disordered eating among adolescents. Archives of Pediatrics & Adolescent Medicine, 164(4). https://doi.org/10.1001/archpediatrics.2010.19
  29. Hooper, L., Puhl, R., Eisenberg, M. E., Crow, S., & Neumark‐Sztainer, D. (2021). Weight teas-ing experienced during adolescence and young adulthood: Cross‐sectional and longitu-dinal associations with disordered eating behaviors in an ethnically/racially and socio-economically diverse sample. International Journal of Eating Disorders, 54(8), 1449–1462. https://doi.org/10.1002/eat.23534
  30. Hunter, S. C., & Boyle, J. M. E. (2004). Appraisal and coping strategy use in victims of school bullying. British Journal of Educational Psychology, 74(1), 83–107. https://doi.org/10.1348/000709904322848833
  31. Izydorczyk, B., & Sitnik-Warchulska, K. (2018). Sociocultural appearance standards and risk factors for eating disorders in adolescents and women of various ages. Frontiers in Psy-chology, 9(429). https://doi.org/10.3389/fpsyg.2018.00429
  32. Jackson, T. D., Grilo, C. M., & Masheb, R. M. (2000). Teasing history, onset of obesity, current eating disorder psychopathology, body dissatisfaction, and psychological functioning in binge eating disorder. Obesity Research, 8(6), 451–458. https://doi.org/10.1038/oby.2000.56
  33. Kanetsuna, T., Smith, P. K., & Morita, Y. (2006). Coping with bullying at school: Children’s recommended strategies and attitudes to school-based interventions in England and Japan. Aggressive Behavior, 32(6), 570–580. https://doi.org/10.1002/ab.20156
  34. Keski-Rahkonen, A., & Mustelin, L. (2016). Epidemiology of eating disorders in Europe: Prevalence, incidence, comorbidity, course, consequences, and risk factors. Current Opinion in Psychiatry, 29(6), 340–345. https://doi.org/10.1097/YCO.0000000000000278
  35. Kwan, M. Y., Gordon, K. H., Minnich, A. M., Carter, D. L., & Troop-Gordon, W. (2017). Peer victimization and eating disorder symptoms in college students. Journal of Social and Clinical Psychology, 36(5), 419–436. https://doi.org/10.1521/jscp.2017.36.5.419
  36. Kwek, C. L., Yeow, K. S., Zhang, L., Keoy, K. H., & Japos, G. (2022). The Determinants of Fake News Adaptation during COVID-19 Pandemic: A Social Psychology Approach. Recoletos Multidisciplinary Research Journal, 10(2), 19–39. https://doi.org/10.32871/rmrj2210.02.05
  37. Levine, M. P., & Smolak, L. (1992). Toward a model of the developmental psychopathology of eating disorders: The example of early adolescence. In J. H. Crowther, D. L. Tennen-baum, S. E. Hobfoll, & M. A. P. Stephens (Eds.), The Etiology of Bulimia nervosa: the Individual and Familial Context. Hemisphere Publishing Corp.
  38. Lie, S. Ø., Rø, Ø., & Bang, L. (2019). Is bullying and teasing associated with eating disorders? A systematic review and meta‐analysis. International Journal of Eating Disorders, 52(5), 497–514. https://doi.org/10.1002/eat.23035
  39. Macpherson-Sánchez, A. E. (2015). Integrating fundamental concepts of obesity and eating dis-orders: Implications for the obesity epidemic. American Journal of Public Health, 105(4), e71–e85. https://doi.org/10.2105/ajph.2014.302507
  40. Masten, A., & Barnes, A. (2018). Resilience in children: Developmental perspectives. Children, 5(7), 98. https://doi.org/10.3390/children5070098
  41. Maunder, R. E., & Crafter, S. (2018). School bullying from a sociocultural perspective. Aggression and Violent Behavior, 38, 13–20. https://doi.org/10.1016/j.avb.2017.10.010
  42. Murphy, H., Tubritt, J., & Norman, J. O. (2018). The role of empathy in preparing teachers to tackle bullying. Journal of New Approaches in Educational Research (NAER Journal), 7(1), 17–23. https://www.learntechlib.org/p/182221/
  43. Olweus, D. (1994). Bullying at school. In L. R. Huesmann (Ed.), Aggressive Behavior. the Plenum Series in Social/Clinical Psychology. Springer. https://doi.org/10.1007/978-1-4757-9116-7_5
  44. Pettman, J. J. (2003). Gendering globalization in Asia through miracle and crisis. Gender, Technology and Development, 7(2), 171–187. https://doi.org/10.1177/097185240300700202
  45. Pike, K. M., & Dunne, P. E. (2015). The rise of eating disorders in Asia: a review. Journal of Eating Disorders, 3, 33. https://doi.org/10.1186/s40337-015-0070-2
  46. Potard, C., Kubiszewski, V., Combes, C., Henry, A., Pochon, R., & Roy, A. (2022). How adolescents cope with bullying at school: Exploring differences between pure victim and bully-victim roles. International Journal of Bullying Prevention, 4, 144–159. https://doi.org/10.1007/s42380-021-00095-6
  47. Puhl, R. M., Himmelstein, M. S., & Watson, R. J. (2019). Weight-based victimization among sexual and gender minority adolescents: Findings from a diverse national sample. Pediatric Obesity, 14(7), e12514.
  48. Puhl, R. M., Neumark-Sztainer, D., Bryn Austin, S., Suh, Y., & Wakefield, D. B. (2016). Policy actions to address weight-based bullying and eating disorders in schools: Views of teachers and school administrators. Journal of School Health, 86(7), 507–515. https://doi.org/10.1111/josh.12401
  49. Puhl, R., & Suh, Y. (2015). Health consequences of weight stigma: Implications for obesity prevention and treatment. Current Obesity Reports, 4(2), 182–190. https://doi.org/10.1007/s13679-015-0153-z
  50. Quintero-Jurado, J., Moratto-Vásquez, N., Caicedo-Velasquez, B., Cárdenas-Zuluaga, N., & Espelage, D. L. (2021). Association between school bullying, suicidal ideation, and eating disorders among school-aged children from antioquia, colombia. Trends in Psychology, 30, 58–72. https://doi.org/10.1007/s43076-021-00101-2
  51. Rai, T., Mainali, P., Raza, A., Rashid, J., & Rutkofsky, I. (2019). Exploring the link between emotional child abuse and anorexia nervosa: A psychopathological correlation. Cureus, 11(8), e5318. https://doi.org/10.7759/cureus.5318
  52. Sabramani, V., Idris, I. B., Ismail, H., Nadarajaw, T., Zakaria, E., & Kamaluddin, M. R. (2021). Bullying and its associated individual, peer, family and school factors: Evidence from Malaysian national secondary school students. International Journal of Environmental Research and Public Health, 18(13), 7208. https://doi.org/10.3390/ijerph18137208
  53. Sapouna, M. (2008). Bullying in Greek primary and secondary schools. School Psychology International, 29(2), 199–213. https://doi.org/10.1177/0143034308090060
  54. Sarantakos, S. (1998). Varieties of social research. In Social Research (pp. 31–71). https://doi.org/10.1007/978-1-349-14884-4_2
  55. Schaumberg, K., Welch, E., Breithaupt, L., Hübel, C., Baker, J. H., Munn-Chernoff, M. A., Yilmaz, Z., Ehrlich, S., Mustelin, L., Ghaderi, A., Hardaway, A. J., Bulik-Sullivan, E. C., Hedman, A. M., Jangmo, A., Nilsson, I. A. K., Wiklund, C., Yao, S., Seidel, M., & Bulik, C. M. (2017). The science behind the academy for eating disorders’ nine truths about eating disorders. European Eating Disorders Review, 25(6), 432–450. https://doi.org/10.1002/erv.2553
  56. Schensul, S. L., Schensul, J. J., & LeCompte, M. D. (1999). Essential ethnographic methods: Observations, interviews, and questionnaires. AltaMira Press.
  57. Schlegl, S., Maier, J., Meule, A., & Voderholzer, U. (2020). Eating disorders in times of the COVID‐19 pandemic—Results from an online survey of patients with anorexia nervosa. International Journal of Eating Disorders, 53(11). https://doi.org/10.1002/eat.23374
  58. Side, J., & Johnson, K. (2014). Bullying in schools: Why it happens, how it makes young people feel and what we can do about it. Educational Psychology in Practice, 30(3), 217–231. https://doi.org/10.1080/02667363.2014.915209
  59. Smink, F. R. E., van Hoeken, D., & Hoek, H. W. (2012). Epidemiology of eating disorders: Incidence, prevalence and mortality rates. Current Psychiatry Reports, 14(4), 406–414. https://doi.org/10.1007/s11920-012-0282-y
  60. Smokowski, P. R., & Kopasz, K. H. (2005). Bullying in school: An overview of types, effects, family characteristics, and intervention strategies. Children & Schools, 27(2), 101–110. https://doi.org/10.1093/cs/27.2.101
  61. Stanisławski, K. (2019). The coping circumplex model: An integrative model of the structure of coping with stress. Frontiers in Psychology, 10(694). https://doi.org/10.3389/fpsyg.2019.00694
  62. Sweetingham, R., & Waller, G. (2008). Childhood experiences of being bullied and teased in the eating disorders. European Eating Disorders Review, 16(5), 401–407. https://doi.org/10.1002/erv.839
  63. Thomas, H. J., Chan, G. C. K., Scott, J. G., Connor, J. P., Kelly, A. B., & Williams, J. (2016). Association of different forms of bullying victimisation with adolescents’ psychological distress and reduced emotional wellbeing. Australian & New Zealand Journal of Psychiatry, 50(4), 371–379. https://doi.org/10.1177/0004867415600076
  64. Ttofi, M. M., & Farrington, D. P. (2011). Effectiveness of school-based programs to reduce bullying: A systematic and meta-analytic review. Journal of Experimental Criminology, 7, 27–56. https://doi.org/10.1002/cl2.1143
  65. Vanderlinden, J., Kamphuis, J. H., Slagmolen, C., Wigboldus, D., Pieters, G., & Probst, M. (2009). Be kind to your eating disorder patients: The impact of positive and negative feedback on the explicit and implicit self-esteem of female patients with eating disorders. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 14(4), e237–e242. https://doi.org/10.1007/bf03325124
  66. Varjas, K., Henrich, C. C., & Meyers, J. (2009). Urban middle school students’ perceptions of bullying, cyberbullying, and school safety. Journal of School Violence, 8(2), 159–176. https://doi.org/10.1080/15388220802074165
  67. Vartanian, L. R., & Porter, A. M. (2016). Weight stigma and eating behavior: A review of the literature. Appetite, 102, 3–14. https://doi.org/10.1016/j.appet.2016.01.034
  68. Voelker, D. K., Reel, J. J., & Greenleaf, C. (2015). Weight status and body image perceptions in adolescents: Current perspectives. Adolescent Health, Medicine and Therapeutics, 6, 149–158. https://doi.org/10.2147/AHMT.S68344
  69. Vuillier, L., May, L., Greville-Harris, M., Surman, R., & Moseley, R. L. (2021). The impact of the COVID-19 pandemic on individuals with eating disorders: The role of emotion regulation and exploration of online treatment experiences. Journal of Eating Disorders, 9(10), 1–18. https://doi.org/10.1186/s40337-020-00362-9
  70. Webb, H. J., & Zimmer-Gembeck, M. J. (2014). The role of friends and peers in adolescent body dissatisfaction: A review and critique of 15 years of research. Journal of Research on Adolescence, 24(4), 564–590. https://doi.org/10.1111/jora.12084
  71. World Health Organization. (n.d.). Adolescent health. World Health Organization. https://www.who.int/health-topics/adolescent-health#tab=tab_1
  72. Yap, W. X., (2020, July 27). Malaysia ranks 2nd in Asia for cyberbullying among youth. SAYS. https://says.com/my/news/malaysia-ranks-2nd-in-asia-for-cyberbullying-among-children
  73. Yilmaz, K. (2013). Comparison of quantitative and qualitative research traditions: Epistemological, theoretical, and methodological differences. European Journal of Education, 48(2), 311–325. https://doi.org/10.1111/ejed.12014
  74. Zerwas, S., Larsen, J. T., Petersen, L., Thornton, L. M., Mortensen, P. B., & Bulik, C. M. (2015). The incidence of eating disorders in a Danish register study: Associations with suicide risk and mortality. Journal of Psychiatric Research, 65, 16–22. https://doi.org/10.1016/j.jpsychires.2015.03.003