Bullying often is seen as the first step on a continuum of escalating mental health concerns, including violence to self or others, according to child and adolescent psychiatrists. Depression, anxiety, insomnia, digestive problems, low self-esteem, and other symptoms consistent with Post Traumatic Stress Disorder are common after-effects of bullying in children, teens, and adults.

Girls are more likely to engage in verbal or relational bullying, in which the victim is denigrated and ostracized by a social group or clique. Boys are more likely to engage in verbal and physical bullying. In some cases, bullying and harassment turn into physical or sexual assault.

While many bullying victims don’t commit suicide, thoughts of suicide are common, according to researchers and child psychiatrists. Victims often carry permanent scars from the emotional, relational, verbal, physical, and online abuse they endure from bullies, experts say.

Although Prince’s abuse occurred primarily at school, the young teen did experience electronic harassment as well. Cyber bullying and cyber stalking can be particularly painful for teens.

The 24-7, constantly connected nature of their lives makes it difficult to escape or find a safe haven. Hateful text messages, humiliating Facebook comments, and online threats don’t stop just because the bullies and victims aren’t in close proximity to each other anymore.

The anonymity afforded by many social media sites and other digital communications only makes matters worse, as bullies feel free to say and do things online they’d never do in person or at school.

A 2007 Pew Research Center study shows that 32 percent of online teens have experienced some form of electronic bullying. Tactics range from posting embarrassing photos without permission (6 percent) to having private material forwarded without permission (15 percent).

About 13 percent of online teens also report receiving threats or have been the victims of digital rumor-mongering, the same study showed. Similar to bullying that occurs at school or in the community, perpetrators of online bullying tend to be the same age as their victims.

For Phoebe Prince and other victims of abuse by bullies, where and how the bullying occurs matters little. They just want it to stop.

As educators charged with helping keep students safe from emotional and physical harm, we can and should do more.

As community leaders charged with creating a more just society by forming future citizens, we can’t dismiss cruelty as “normal” teenage behavior. It’s not.

Award-winning eSchool News columnist Nora Carr is the chief of staff for North Carolina’s Guilford County Schools.