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To better understand adolescents experiencing peer victimization, ostracism, and emotional health problems, this study aimed to describe a cohort of middle school students identified as having school peer-related social difficulties as 2 groups: those with mental health diagnoses (MHDs; n = 17) and those without diagnoses (n = 8). Participants were administered a test battery to examine communication ability, social responsiveness, social activity, ostracism, victimization, and emotional health. Results showed that adolescents with MHDs, relative to those without, scored significantly lower on measures of communication ability, social responsiveness, and social activity but similarly on measures of victimization, ostracism, and internalizing/externalizing factors. Results suggest that adolescents with and without MHDs can endure ostracism and peer victimization to a similar extent. Because ostracism and victimization have serious morbidity in adolescents, physicians and caregivers must look for signs in all adolescents, irrespective of MHD. Recommendations for appropriate primary care management are discussed.