It doesn’t need to get physical.

Nonphysical forms of sexual harassment — i.e., unwanted sexual attention; rumors; offensive sexual remarks about looks, orientation and behavior; and sexual images being shown — inflict psychological damage on high school students, a recent Norwegian study suggests. They take the hardest toll on girls.

“Being exposed to non-physical sexual harassment can negatively affect symptoms of anxiety, depression, negative body image and low self-esteem,” study co-authors Mons Bendixen and Leif Edward Ottesen Kennair, professors at the Norwegian University of Science and Technology, said in a statement.

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The report, analyzing a 2007 study of 1,384 high schoolers and a 2013-2014 study of 1,485 high schoolers, differentiated nonphysical harassment transpiring in the previous year from “physically coercive” acts like sexual intercourse, groping, intimate touching and unwanted kissing. It also allowed kids to decide whether they deemed the various nonphysical actions offensive or not.

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The results suggest that “though sticks and stones may break bones, it does seem that derogatory words and other forms of non-physical sexual harassment definitely harm high school students,” the authors concluded.

Though girls and boys were exposed to nonphysical harassment equally, girls were more negatively affected by it — regardless of the degree to which they were harassed. Sexual minorities and immigrants, meanwhile, did not appear to be at greater risk for depressive symptoms.

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The researchers, who want to develop practices to curtail sexual harassment, offered little in the way of solutions.

“This has been studied for years and in numerous countries, but no studies have yet revealed any lasting effects of measures aimed at combating sexual harassment,” Bendixen said. “We know that attitude campaigns can change people’s attitudes to harassment, but it doesn’t result in any reduction in harassment behaviour.”