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Current Psychiatry April 200946

Workplacemobbing

get of workplace mobbing, and that hisinsomnia and paranoia developed because

of a deliberate campaign by coworkers. This article discusses how to recognizesymptoms of workplace mobbing, usingMr. Gs experience to illustrate the dynam-ics of this group behavior. An informedmental health professional can be of enor-mous help to a mobbing victim, but anuninformed professional can unwittinglymake the situation much worse.

What is mobbing?Initiated most often by a person in a po-sition of power or in uence, mobbinghas been described as a desperate urgeto crush and eliminate the target. Asthe campaign proceeds, a steadily largerrange of hostile ploys and communica-tions comes to be seen as legitimate. 1 This behavior pattern has been recognized inEurope since the 1980s but is not well rec-ognized in the United States.

Davenport et al 2 brought the phenom-enon and its consequences to the U.S. pub-lics attention in 1999 with the publicationof Mobbing: emotional abuse in the Americanworkplace. Otherwise, little professional lit-erature on workplace mobbing has beenproduced in the United States.

A PubMed search on the term mobbing limited to 1982 through October 2008returned 95 listings, excluding those deal-ing purely with ethology, but only 1 report

from the United States. Studies from out-side the United States indicate that mobbing is relatively common ( Box ).

Mobbing, bullying, and harassment. Theterm workplace mobbing was coined by Leymann, 3 an occupational psycholo-gist who investigated the psychology ofworkers who had suffered severe trauma.

He observed that some of the most severereactions were among workers who had been the target of an impassioned collec-tive campaign by coworkers to exclude,punish, or humiliate them.

Many researchers use the term mobbingto describe a negative work environmentcreated by several individuals working to-gether. 1-3 However, some researchers suchas Namie et al 4 use the term workplace bullying to describe the creation of a hos-

tile work environment by either a singleindividualusually a bossor a numberof individuals.

CASE CONTINUED

Why I rst thought paranoiaDuring our rst interview, Mr. G said that 6months before he sought treatment he hadreported misuse of government property byhis supervisors boss. The case was investi-gated and dismissed. Mr. Gs supervisor never

confronted him about the complaint, butshortly afterwards Mr. G started to notice dis-turbing changes in the workplace.

His supervisor avoided Mr. Gs phone callsand e-mails and stopped meeting with him.Instead, she met with Mr. Gs subordinates.The subordinates started to ignore Mr. Gs in-structions and would roll their eyes or be in-attentive when he spoke. Coworkers stoppedtalking when Mr. G approached, and he start-ed receiving anonymous e-mails questioning

his ability and sanity. He was reprimanded inwriting for having made a $9 mathematicalerror in an expense reimbursement request.

Mr. G said when he approached his supe-rior about the work environment, she statedthat he was just paranoid and needed tosee a psychiatrist.

When Mr. Gs wife accompanies him tothe second interview, she conrms his im-pressions of ostracism and gossip at work.She also relates her experiences with people

from Mr. Gs offi ce who previously had beenfriendly but now were distant or hostile. Mr.G shows me copies of harassing work e-mails

Box

Workplace mobbing: Howoften does it occur?

In 1990 Leymann3 estimated that 3.5% of

the Swedish workforce had been victimsof signi cant mobbing. Studies from variousother European countries have estimatedprevalence of mobbing at 4% to 15% of thetotal workforce. 10

Studies from Europe have shown thatall age groups can be affected, but thatposttraumatic stress disorder among mobbingvictims is more common in patients age >40.Both genders are equally at risk. 6

Clinical Point

n uninformedAn uninformedmental healthmental healthprofessional canprofessional canunwittingly makeunwittingly makea mobbing victimsa mobbing victimssituation muchsituation muchworseworse

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Current Psychiatry Vol. 8, No. 4 47

and memos. I tell Mr. G I believe his story anddiagnose him as suffering from posttraumaticstress disorder (PTSD). He begins supportive/cognitive therapy and continues urazepam.

Mobbing syndromeAs it turns out, Mr. G was not paranoid; hiscoworkers really were trying to get him.Leymann 5 divided 45 types of mobbing

behaviors into 5 categories. These were or-ganized as attacks on:

self-expression and ability to commu-nicate (victim is silenced, given no oppor-tunity to communicate, subject to verbalattacks)

social relationships (colleagues do not

talk to the victim, victim is physically iso-lated from others)

reputation (victim is the target of gos-sip and ridicule)

occupational situation (victim is givenmeaningless tasks or no work at all)

physical health (victim is assigneddangerous tasks, threatened with bodilyharm, or physically attacked).

Davenport et al 2 distilled this list into10 key factors of the mobbing syndrome

(Table 1 ); identi ed 5 phases in the mobbing process ( Table 2, page 48 ); and de-ned 3 degrees of mobbing analogousto rst-, second-, and third-degree burns(Table 3, page 48 ).

Mobbing risk factors. According to Ley-mann, 5 no speci c personality factorspredispose workers to being mobbed.Westhues 1 and others, however, identify avariety of social risk factors. These include

any factors that make an individual differ-ent from other members of his or her workenvironment, such as:

different ethnicity an odd personality high achievement.

Whistleblowers or union organizersalso run a risk of stigmatization and mob-

bing. Organizations with unclear goals orextensive recent turnover in senior leader-ship can be conducive to mobbing. Three

industries identi ed as at special risk formobbing are academia, government, andreligious organizations. 5

Secondary morbidity. Victims of work-place mobbing frequently suffer from:

adjustment disorders somatic symptoms (eg, headaches or

irritable bowel syndrome) PTSD 6,7

major depression. 8

In mobbing targets with PTSD, Ley-mann notes that the mental effects were

fully comparable with PTSD from war orprison camp experiences. 3 Some patientsmay develop alcoholism or other substanceabuse disorders. Family relationships rou-tinely suffer. 9 Some targets may even de-velop brief psychotic episodes, generallywith paranoid symptoms.

Leymann 3 estimated that 15% of sui-cides in Sweden could be directly attrib-uted to workplace mobbing. Although noother researcher has reported such a dra-

matic proportion, others have reportedincreased risk of suicidal behavior amongmobbing victims. 10

Clinical Point

Factors that mightFactors that mightincrease ones riskincrease ones riskof being mobbedof being mobbedinclude having ainclude having adi erent ethnicity,different ethnicity,an odd personality,an odd personality,or high achievementor high achievement

continued

Table 1

Assaults on dignity, integrity, credibility, andcompetence

Negative, humiliating, intimidating, abusive,

malevolent, and controlling communicationCommitted directly or indirectly in subtle orobvious ways

Perpetrated by 1 staff members*

Occurring in a continual, multiple, andsystematic fashion over time

Portraying the victim as being at fault

Engineered to discredit, confuse, intimidate,isolate, and force the person into submission

Committed with the intent to force the

person out

Representing the removal as the victimschoice

Unrecognized, misinterpreted, ignored,tolerated, encouraged, or even instigated bymanagement

*Some researchers limit their de nition of mobbing toacts committed by >1 personSource: Adapted with permission from Davenport N,Schwartz RD, Elliott GP. Mobbing: emotional abusein the American workplace. Ames, IA: Civil SocietyPublishing; 1999:41

Mobbing syndrome: 10 factors

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Workplacemobbing

CASE CONTINUED

Redirecting energy into a job searchAs I met with Mr. G over the next 3 months,the pattern of malicious communication andactions continued at his offi ce. For example,he received a written reprimand for being10 minutes late after having overslept when

starting urazepam, which he continued totake for about 6 weeks without further tardi-ness. I encouraged Mr. G to withdraw energyfrom work by keeping a low prole and tryingnot to react to provocations. Instead, I coun-seled him to put energy into family activitiesand try to nd a new job. Within 3 months, Mr. G found a new posi-tion in the private sector at a similar salary, al-though with lower benets. Six months later,he was still with his wife, had been promoted

at his new job, lost the 10 pounds he gained,discontinued psychotherapy, and was sleep-ing well without medication. He reported that

he still thinks almost every day about whathappened in his previous job but keeps tellinghimself everything did work out OK after all.

Mr. G experienced relatively mild, rst-degree workplace mobbing, but it had a

substantial effect on his quality of life andthat of his wife for almost 1 year. If I hadfollowed my rst impulse and had Mr. Ginvoluntarily hospitalized after our rstinterview, it would have con rmed rumorsat his of ce and probably would have es-calated the mobbing behavior.

Diagnostic recommendationsConsider the possibility that seemingly

paranoid individuals could be the target ofmobbing at work, and dont underestimatethe psychological stress of being mobbed.Other forms of workplace harassment can be extremely stressful but do not have theparanoidogenic potential of mobbing.Patients may be so distressed that it is dif-cult to gure out what is going on in theirwork environment.

Ask patients to present physical evi-dence of conspiracy or harassment. Mob-

bing patients usually are willing to bringin large quantities of material. Keep inmind that when subjected to mobbing be-havior over time, a person who is not ini-tially paranoid is likely to develop somesecondary suspiciousness and even frankparanoia. Also consider the possibility of pseudo-mobbing, in which an individual falsely be-lieves he or she is a mobbing victim. Casesof pseudomobbing have been reported in

European literature 11 and may represent anegative side effect of greater public aware-ness of the mobbing phenomenon (and oflegal remedies to mobbing available in var-ious European countries).

Mobbing is a serious stressor that canlead to psychiatric and medical morbidityand even suicide. Major depressive disor-deroften with suicidal ideationis fre-quently associated with being mobbed. 12

A diagnosis of PTSD can be missed if

the mobbing victim does not seem to have been subjected to a severe enough stress tomeet PTSD criteria.

Table 2

Phases of mobbing

Con ict, often characterized by a criticalincident

Aggressive acts, such as those in Table 1,

page 47 Management involvement

Branding as dif cult or mentally ill

Expulsion or resignation from the workplace

Source: Adapted with permission from Davenport N,Schwartz RD, Elliott GP. Mobbing: emotional abusein the American workplace. Ames, IA: Civil SocietyPublishing; 1999:38

Table 3

Degrees of mobbing

First degree: Victim manages to resist, escapesat an early stage, or is fully rehabilitated in theoriginal workplace or elsewhere

Second degree: Victim cannot resist orescape immediately and suffers temporary orprolonged mental and/or physical disability andhas dif culty reentering the workforce

Third degree: Victim is unable to reenter theworkforce and suffers serious, long-lastingmental or physical disability

Source: Adapted with permission from Davenport N,Schwartz RD, Elliott GP. Mobbing: emotional abusein the American workplace. Ames, IA: Civil SocietyPublishing; 1999:39

Clinical Point

Major depressiveMajor depressivedisorder often withdisorder (often withsuicide ideation) issuicide ideation) isfrequently associatedfrequently associatedwith being mobbedwith being mobbed

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Current Psychiatry Vol. 8, No. 4 51

Treatment recommendationsFirst, do no harm: Do not allow yourself to

be used by the mob. This process can be di-rectas in the Mr. Gs case, where the pa-tient was almost involuntarily committedor subtle. For example, a person you know

may describe the behavior of someone atwork, and you may be tempted to respond,Well, I have not examined this person, butfrom what you say, it sounds like maybeYou could then be quoted as a psychiatristwho agrees that the person is paranoid. Giving your patient a name for what ishappening to him or her may be the mosttherapeutic intervention. Generally, pa-tients have not heard of mobbing. Theytypically are confused about what is hap-

pening and may blame themselves. Treat the patients family. Giving a pa-tients spouse or partner a name for what ishappening is almost always helpful. One-third of mobbing victims suffer breakup oftheir marriages or relationships during thecourse of a mobbing, which can create a vi-cious cycle of stress, leading to isolation,leading to more stress. 3 Encourage the pa-tient not to subject the spouse to repeatedruminations about insults at work.

Treat secondary symptoms of depres-sion, anxiety, PTSD, or other sequelae withpharmacotherapy, psychotherapy, or acombination as appropriate. Refer patientswith somatic symptoms to primary care ifyou feel that they need further evaluation.

Encourage your patient to visualizechoices and ways to escape the situation.Frequently, patients will be locked into ghting for justice or putting up withthe situation because they see no options.

Encourage your patient to withdraw en-ergy from work and invest it in family, so-cial life, or anything else. At the appropriate

time, encourage him or her to grieve lossesexperienced as a result of the mobbing.

References

1. Westhues K. At the mercy of the mob: a summary of researchon workplace mobbing. Canadas Occupational Health andSafety Magazine. 2002;18:30-36.

2. Davenport N, Schwartz RD, Elliott GP. Mobbing: emotionalabuse in the American workplace. Ames, IA: Civil SocietyPublishing; 1999.

3. Leymann H. Mobbing and psychological terror at workplaces.Violence Vict. 1990;5:119-125.

4. Namie G, Namie R. The bully at work: what you can do tostop the hurt and reclaim your dignity on the job. Naperville,IL: Sourcebooks, Inc; 2003.

5. Leymann H. The content and development of mobbingat work. European Journal of Work and OrganizationalPsychology. 1996;5:165-184.

6. Leymann H, Gustafsson A. Mobbing at work and the

development of post-traumatic stress disorders. European Journal of Work and Organizational Psychology. 1996;5:251-275.

7. Bonafons C, Jehel L, Coroller-Bequet A. Speci city of the links between workplace harassment and PTSD: primary resultsusing court decisions, a pilot study in France. Int Arch OccupEnviron Health. 2008 Oct 25 (Epub ahead of print).

8. Girardi P, Monaco C, Prestigiacomo C, et al. Personalityand psychopathological pro les in individuals exposed tomobbing. Violence Vict. 2007;22:172-188.

9. Duffy M. Workplace mobbing: individual and family healthconsequences. The Family Journal. 2007;15:398-404.

10. Pompili M, Lester D, Innamorati M, et al. Suicide risk andexposure to mobbing. Work. 2008;31:237-243.

11. Jarreta BM. Medico-legal implications of mobbing. A falseaccusation of psychological harassment at the workplace.

Forensic Sci Int. 2004;146(suppl):S17-S18. 12. Girardi P, Monaco E, Prestigiacomo C, et al. Personality

and psychopathological pro les in individuals exposed tomobbing. Violence Vict. 2007;22(2):172-188.

Related Resources Leymann H. The Mobbing Encyclopaedia. www.leymann.se.

Westhues K. Workplace mobbing in academe. http://arts.uwaterloo.ca/~kwesthue/mobbing.htm.

Namie R, Namie G. The Workplace Bullying Institute.www.bullyinginstitute.org.

Drug Brand NameFlurazepam Dalmane

Disclosure

Dr. Hillard reports no nancial relationship with any companywhose products are mentioned in this article or withmanufacturers of competing products.

Consider the possibility that a seemingly paranoid patient is a victim of workplacemobbing. Mobbing victims are subject to severe stress and may develop adjustment

disorders, depression, or posttraumatic stress disorder. Treat these disorderssymptomatically, and encourage patients to withdraw energy from the workplaceand invest it in family, job searching, or other activities.

Bottom Line

Clinical Point

iving patientsGiving patientsa name for whata name for whatis happening tois happening tothem may be thethem may be themost therapeuticmost therapeuticinterventionintervention

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