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Much research probing the link between bullying and mental health has focused on how being bullied contributes to the development of issues like anxiety and depression. But a new study suggests the relationship goes both ways, finding that boys and girls with mental health disorders are three times more likely to be the bully.

The study, presented at the American Academy of Pediatrics’ national conference in New Orleans on Monday, found that kids with Oppositional Defiant Disorder (ODD) — which is characterized by frequent tantrums and revenge seeking — were six times more likely to be identified as bullies than children with no mental health disorders, while children with depression were three times more likely. Children with anxiety and attention deficit hyperactivity disorder (ADHD) were also around three times more likely to be bullies, according to parental reports.

“There is a larger story behind why children bully,” said study author Dr. Frances Turcotte-Benedict, a Brown University masters of public health student and a fellow at Hasbro Children’s Hospital in Providence. “And part of that story may include the diagnosis of a mental health disorder.”

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