A/HRC/43/39 49. Research has demonstrated that the most commonly reported problems fall into three categories: behavioural and emotional, cognitive and attitudinal, and long-term problems.28 50. In terms of behavioural and emotional disorders, research has found that those who are exposed to violence during their lifetime, including violence at home, violence in the community and war trauma exposure, are more likely to develop mental health problems including post-traumatic stress disorder, depression, psychological distress, aggression and significantly harmful effects on the development process.29 51. Children tend to either externalize (exhibiting greater levels of aggression, ruleviolation and acting out) or they internalize (suffering from increased anxiety, depression and moodiness). For example, in various studies it has been reported that neglected children are more likely to suffer from behavioural, cognitive and internalizing problems, as well as physical and mental health problems.30 52. In terms of externalizing disorders, one consequence of experiencing trauma and violence during childhood can be the adoption of behaviour that poses health risks. Drug and alcohol use by children has risen globally and in the context of children should be viewed as a means of coping and managing negative emotions.31 Children who experience violence and maltreatment in one setting are at risk of also experiencing violence in other settings. 32 The external expression of mental health symptoms, such as aggressive or antisocial behaviour, is more likely to result in increased peer victimization. 53. As regards internalizing disorders, in a study carried out in Norway, all combinations of childhood violence were significantly associated with anxiety or depression. Among participants exposed to one childhood violence category, those exposed to neglect and/or psychological violence reported more anxiety or depression than those exposed to sexual abuse alone or to family violence alone. Of those who were exposed to two childhood violence categories, those exposed to neglect or psychological violence in combination with sexual abuse and/or family violence reported more anxiety or depression than individuals reporting a combination of sexual abuse and family physical violence. Individuals experiencing three childhood violence categories had the highest anxiety or depression scores.33 54. There is also now convincing evidence of a causative association between peer bullying and depression, anxiety and self-harm.34 Peer bully victims are at increased risk of internalizing disorders, whereas peer bullies are at increased risk of externalizing disorders, 28 29 30 31 32 33 34 10 See Jane G. Stapleton and others, “The mental health needs of children exposed to violence in their homes”, New Hampshire Coalition against Domestic and Sexual Violence. See, for example, Kevin Fiscella and Harriet Kitzman H. “Disparities in academic achievement and health: the intersection of child education and health policy”, Pediatrics, vol. 123, No. 3 (March 2009); and Steven A. Haas and Nathan Edward Fosse, “Health and the educational attainment of adolescents: evidence from the NLSY97”, Journal of Health and Social Behavior, vol. 49, No. 2 (June 2008). See Dexter R. Voisin, Torsten B. Neilands and Shannon Hunnicutt, “Mechanisms linking violence exposure and school engagement among African American adolescents: examining the roles of psychological problem behaviors and gender”, American Journal of Orthopsychiatry, vol. 81, No. 1 (January 2011); and Vangie Ann Foshee and others, “A longitudinal examination of psychological, behavioral, academic, and relationship consequences of dating abuse victimization among a primarily rural sample of adolescents”, Journal of Adolescent Health, vol. 53, No. 6 (December 2013). See Kevin D. Murphy and others, “‘You don’t feel’: the experience of youth benzodiazepine misuse in Ireland”, Journal of Psychoactive Drugs, vol. 50, No. 2 (2018). See David Finkelhor, Richard K. Ormrod and Heather A. Turner, “Poly-victimization: a neglected component in child victimization”, Child Abuse & Neglect, vol. 31 (2007). See Siri Thoresen and others, “Violence against children, later victimisation, and mental health: a cross-sectional study of the general Norwegian population”, European Journal of Psychotraumatology, vol. 6, No. 1 (January 2015). See William E. Copeland and others, “Adult psychiatric outcomes of bullying and being bullied by peers in childhood and adolescence”, JAMA Psychiatry, vol. 70, No. 4 (April 2013).