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Psychiatric distress and symptoms of PTSD among victims of bullying at work

Psychiatric distress and symptoms of PTSD among victims of bullying at work

Distress and symptoms of Post-Traumatic Stress Disorder (PTSD) were investigated

among targets of experienced bullying at work, that is, the exposure to persistent or recurrent

oppressive, offensive, abusive behaviour where the aggressor may be a superior or a colleague. The

participants in the present study were all recruited from two associations of bullied victims (n�/102, response rate�/57%). A high level of distress and symptoms of PTSD was revealed in the sample, both according to recommended cut point scores for HSCL-25, PTSS-10 and IES-R, and when

comparing the sample with traumatised samples. Three out of four victims reported an HSCL-25 level

higher than the recommended threshold for psychiatric disease. Sixty and 63% of the sample reported

a high level of IES intrusion and IES avoidance, correspondingly. The level of bullying,

operationalised as the frequency of negative acts the individual had been exposed to at work, showed

a stronger interconnection with distress and PTSD than a more unspecified, subjective measure of

bullying, as well as the time since the bullying took place and the duration of the bullying episode.

Those still being pestered reported a higher level of distress and PTSD than victims in which the

bullying episodes were terminated more than 1 year ago, but the findings were somewhat mixed.

Positive affectivity (PA) and especially negative affectivity (NA) contributed significantly to the

explained variance of distress and PTSD in various regression analysis models, but did not interact

with measures of bullying. Nor were mediator effects found between bullying, PA/NA and traumatic

stress reactions. Implications of the findings are discussed.

During the last decade there has been a growing awareness of the detrimental effects

on employee health and well-being caused by exposure to bullying and non-sexual

harassment in the workplace (Einarsen, 1999; Einarsen et al ., 2003; Hoel et al .,

1999). Although studied by the use of many different concepts, such as ‘emotional

abuse at work’ (Keasly, 1998), ‘harassment at work’ (Brodsky, 1976; Einarsen &

Raknes, 1997), ‘bullying at work’ (Vartia, 1996), ‘mistreatment’ (Spratlen, 1995),

‘mobbing’ (Leymann, 1996; Zapf et al ., 1996), ‘workplace aggression’ (Baron &

Neuman, 1996) or as ‘workplace incivility’ (Andersson & Pearson, 1999), compar-

able conclusions seem to be reached. Exposure to systematic and long-lasting

British Journal of Guidance & Counselling, Vol. 32, No. 3, August 2004

ISSN 0306-9885/print/ISSN 1469-3534/online/04/030335-22 # 2004 Careers Research and Advisory Centre

DOI: 10.1080/03069880410001723558

verbal, non-physical, and non-sexual, abusive and aggressive behaviour at the

workplace may cause a host of negative health effects in the target. Although single

acts of aggression and harassment do occur fairly often in everyday interaction, they

seem to be associated with severe health problems when occurring on a regular basis

(Einarsen & Raknes, 1997; Leymann, 1987). Bullying at work is claimed to be an

extreme form of social stress at work (Zapf et al ., 1996). It is referred to as a more

crippling and devastating problem for employees than all other work-related stressors

put together (Wilson, 1991).

Bullying can be described as a certain subset of conflicts (Zapf & Gross, 2001),

and may be defined as the exposure to persistent or recurrent oppressive, offensive,

abusive, intimidating, malicious, or insulting behaviour by a superior or a colleague.

Feelings of being victimised from bullying at work seem to be associated with the

experience of (a) bullying behaviours being intentional, (b) a lack of opportunities to

evade it, and (c) these behaviours or sanctions as unfair or over-dimensioned

(Matthiesen et al ., 2003). To be a victim of intentional and systematic psychological

harm by another person, real or perceived, seems to produce severe emotional

reactions such as fear, anxiety, helplessness, depression and shock (Mikkelsen &

Einarsen, 2002a,b). These reactions seem to be especially pronounced if the

perpetrator is in a position of power or the situation is an unavoidable or inescapable

one (Einarsen, 1999; Niedl, 1996). The workplace seems to be a setting where

people are especially vulnerable when facing aggression, abuse, or harassment

(Einarsen & Raknes, 1997). Victimisation, such as exposure to intense bullying at

work, may change the individual’s perceptions of their work-environment and life in

general to one of threat, danger, insecurity and self-questioning (cf. Janoff-Bulman,

1992), which may result in pervasive emotional, psychosomatic and psychiatric

problems (Leymann, 1990a).

In an interview study among 30 Irish victims, O’Moore and associates found

that all subjects reported anxiety, irritability, feelings of depression and paranoia as a

consequence of experiences of bullying at work (O’Moore et al ., 1998). Also very

common were symptoms like mood swings, feelings of helplessness, a lowered self-

esteem, and a range of physical symptoms. Clinical observations of victims of

harassment at work have also shown other grave effects such as social isolation, social

maladjustment, psychosomatic illnesses, depressions, helplessness, anger, anxiety,

and despair (Leymann, 1990a). A study among a representative sample of

Norwegian assistant nurses showed a significant relationship between exposure to

on-going workplace harassment and an elevated level of burn-out, as well as a

lowered job satisfaction and a lowered psychological well-being (Einarsen et al .,


On the basis of clinical observations and interviews with American victims of

work harassment, Brodsky (1976) identified three patterns of effects on the victims.

Some expressed their reaction by developing vague physical symptoms such as

weakness, loss of strength, chronic fatigue, pains and various aches. Others reacted

with depression and related symptoms such as impotence, lack of self-esteem, and

sleeplessness. A third group reacted with psychological symptoms such as hostility,

336 Stig Berge Matthiesen & Ståle Einarsen

hypersensitivity, memory problems, feelings of victimisation, nervousness, and the

avoidance of social contact.

In view of the particular symptom constellation presented above, it has been

argued that many victims of long term bullying at work may in fact suffer from Post-

Traumatic Stress Disorder (PTSD) (Björkqvist et al ., 1994; Einarsen & Hellesøy,

1998; Leymann, 1992). In a Finnish study of 350 university employees, 19 persons

subjected to victimisation by harassment were interviewed as a follow-up study

(Björkqvist et al ., 1994). The victims experienced high levels of insomnia, various

nervous symptoms such as anxiety, depression and aggression, melancholy, apathy,

lack of concentration and socio-phobia, leading the authors to conclude that these

victims portrayed symptoms reminiscent of PTSD. In his 1992 report, the Swedish

psychiatrist Heinz Leymann argued that PTSD probably was the correct diagnosis

for approximately 95% of a representative sample of 350 victims of bullying at work

(Leymann, 1992).

A host of studies (see e.g. Creamer, 2000) have suggested that victimisation

caused by the aggressive and violent behaviour of other fellow human beings

may produce high levels of distress and symptoms of post-traumatic stress even

long after the event actually happened. Studies also suggest that psychological or

physical abuse seems to be at least as traumatising as for example physical and

criminal forms of violence. Experiencing sexual assault made a larger impact on

PTSD symptomatology than combat exposure, according to a study of 160 army

women after returning from the Persian Gulf (Wolfe et al ., 1998). In another

investigation, 100 victims of harassment by stalking were interviewed to assess

the impact of the experience on their psychological, social, and interpersonal

functioning (Pathe & Mullen, 1997). The majority of the victims were subjected

to multiple forms of harassment such as being followed, repeatedly approached,

and bombarded with letters and telephone calls for periods varying from 1 month

to 20 years. Threats were perceived by 58%, whereas 34% were physically or

sexually assaulted. Increased levels of anxiety were reported by 83%. Intrusive

recollections and flashbacks were reported by 55%, while nightmares, appetite

disturbances, and depressed mood were commonly experienced. The criteria for a

diagnosis of Post-Traumatic Stress Disorder (PTSD) were fulfilled in 37% of the


Fontana and Rosenheck (1998) studied the relative impact of stress

from military duty and exposure to sexual harassment on the development of

PTSD among 327 female veterans. Sexual abuse and harassment were almost

four times as influential in the development of PTSD compared to other kinds

of duty-related stress. Using a liberal cutoff score, Vitanza et al . (1995) diagnosed

73% of a group of psychological abused women as having severe symptoms of PTSD.

A Swedish study of PTSD in a group of 64 victims attending a rehabilitation

programme for victims of bullying at work revealed that most of these victims

were troubled with intrusive thoughts and avoidance reactions (Leymann &

Gustavson, 1996). A Danish study of 118 bullied victims found that 76% portrayed

symptoms indicating post-traumatic disorder (Mikkelsen & Einarsen, 2002a).

Interpersonal conflicts in general may also be linked to PTSD symptoms. In a

Bullying and PTSD 337

Canadian study of 51 emergency personnel, a significant relationship was found

between the level of interpersonal conflicts, and symptoms of PTSD (Laposa et al .,


Only a few studies (Leymann & Gustavson, 1996; Mikkelsen & Einarsen,

2002a) have been published on the relationship between exposure to bullying and

symptoms of PTSD using a community sample. The aim of community studies is to

assess specific disorders, in this case symptoms of post-traumatic stress, among a

specified population, regardless of whether they have sought treatment or not

(Schlenger et al ., 1997). The aim of the present study is therefore to examine the

level of psychiatric symptoms and symptoms of PTSD among former and current

victims of bullying at work, who has not necessarily sought medical or psychological


The literature on post-traumatic stress focus primarily on factors such as

life-threatening menaces, object loss, physical harm and how hideous the critical

incident turned out to be, as the main risk elements in development of PTSD

(Davidson & Foa, 1993). This notion is however somewhat different from Dahl and

his colleagues (Dahl et al ., 1994), who claim that Post-Traumatic Stress Disorder

evolves if an event is perceived as threatening, scaring or awful, beyond a certain

level. The risk of PTSD is claimed to increase if the incident(s) are prolonged,

especially if adequate leadership is non-existent or social connections are lacking.

Traumatic episodes connected to man-made aggressive acts (injustice, assaults,

harassment) are argued to pose a greater risk than to incidents caused by accidents or

disasters (Dahl et al ., 1994). A study of post-traumatic stress among women abused

by their husbands concluded that psychological abuse even in rather subtle forms

seems to produce clear cut symptoms of PTSD (Vitanza et al ., 1995). On the basis of

case studies, Scott and Stradling (1994) argue that enduring psychosocial stress in

the absence of one single acute and dramatic trauma may produce full symptoma-

tology of PTSD.

In a theoretical framework of trauma at work, Williams (1993) argues that

individual variables in personality and coping styles may have some overlap with

PTSD as in regard to emotional distress. Although the causal relationship between

individual differences and victimisation from bullying is a debatable one (Einarsen,

1999, 2000; Leymann, 1990a, 1996), victims of bullying at work do differ from non-

bullied workers on a range of factors. For instance, Vartia (1996) found a high level

of negative affectivity among a group of Finnish victims of bullying at work, while

Zapf (1999) found German victims of bullying to be high on negative and low on

positive affectivity compared to a control group. Experiences of negative social

interactions in general seems to be associated with an increase in negative affectivity

as well as low self-esteem and many dysfunctional attitudes (Lakey et al ., 1994).

While Zapf (1999) argues that these characteristic may have caused bullying in the

first place, other researchers (Mikkelsen & Einarsen, 2002b) claim that negative

affectivity acts as a mediator and thus accounts for the relation between the

victimisation and symptomatology by explaining how bullying takes on a psycholo-

gical meaning. In a study of battered women the relationship between exposure to

abuse and PTSD to a certain degree depended on vulnerability factors of

338 Stig Berge Matthiesen & Ståle Einarsen

psychological dysfunctions such as cognitive failure and private self-consciousness

(Saunders, 1994). The former is defined as the tendency to have perception and

memory failures as well as engaging in misdirected action, while the latter refers to

people who tend toward a self-analysis manner, focusing on their own perceptions,

feelings and thoughts. Both concepts are considered to result from the excessive

worry and anxiety caused by a highly threatening situation, hence they may be seen

as partial mediators of the relationship between the experience of abuse and the

evolving post-traumatic stress symptoms.

In the present study we will include the concepts of negative and positive

affectivity as such possible mediating factors. Research has demonstrated those two

independent dispositional variables to comprise the dominant factors of emotional

experience (Watson, 1988). Negative affectivity (NA) is seen as a general factor of

subjective distress and comprises a broad range of aversive mood states, including

distress, nervousness, fear, anger and guilt. Individuals high in negative affectivity

often focus on the negative sides of life and tend to have negative views of themselves,

other people and the world in general. Positive affectivity (PA) reflects one’s level of

pleasurable engagement with the environment. High PA is composed of terms

reflecting enthusiasm, energy, mental alertness and determination (e.g. excited,

active, attentive, determined). Low PA is best defined by descriptors reflecting

fatigue and depression (e.g. sluggish, sad). Positive and negative affectivity

correspond roughly with the dominant factors extraversion and anxiety/neuroticism

(Watson et al ., 1988).

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