Workplace mobbing: Are they really out to get your patient? Consider that coworkers’ hostile behavior could be causing paranoid symptoms r. G, age 46, works for a large federal® Dowden govern- Health Media ment agency in a middle-management position. MHe presents seeking treatment for insomnia. He says, “I just need a sleepingCopyright pill. I haven’tFor been personal able to use only sleep for the last 3 months because everybody at work is talking behind my back and spreading rumors about how I’m crazy. My boss is in on it, too. She is always trying to undermine me and makes a big deal out of every little mistake I make.” Mr. G is suspicious, asking questions about the confi - dentiality of medical records. His speech is rapid, and he is anxious but exhibits a full range of aff ect and no pressured speech or fl ight of ideas. Mr. G describes early, middle, and late insomnia, decreased energy and interest, and gaining 10 pounds over the past 3 months. ALEX NABAUM FOR CURRENT PSYCHIATRY He admits owning a gun and having frequent thoughts of suicide and fantasies of killing his boss, although Mr. G James Randolph Hillard, MD repeatedly affi rms he would never act on these thoughts. A Professor Department of psychiatry week ago, his wife moved in with her parents because, he Associate provost for human health aff airs says, “she just couldn’t stand to be around me any longer.” Michigan State University East Lansing, MI I consider involuntary hospitalization for Mr. G. Ultimately I contact his wife, who agrees to pick him up, stay with him overnight, and return with him the next morning. Because the only medication Mr. G is willing to consider is sleeping pills, I prescribe fl urazepam, 30 mg qhs. Mr. G was apparently paranoid, thinking of killing his boss, and had a gun. If his wife had not answered the phone and been willing to stay with him, he might have been involuntarily committed. As it was, further Current Psychiatry interviews with him revealed that Mr. G had been a tar- Vol. 8, No. 4 45 For mass reproduction, content licensing and permissions contact Dowden Health Media. 45_CPSY0409 45 3/16/09 11:35:47 AM Box Workplace mobbing: How Mobbing, bullying, and harassment. The often does it occur? term “workplace mobbing” was coined by Leymann,3 an occupational psycholo- n 1990 Leymann3 estimated that 3.5% of gist who investigated the psychology of Ithe Swedish workforce had been victims workers who had suffered severe trauma. of signifi cant mobbing. Studies from various He observed that some of the most severe Workplace other European countries have estimated reactions were among workers who had prevalence of mobbing at 4% to 15% of the mobbing been the target of “an impassioned collec- total workforce.10 Studies from Europe have shown that tive campaign by coworkers to exclude, all age groups can be affected, but that punish, or humiliate” them. posttraumatic stress disorder among mobbing Many researchers use the term mobbing victims is more common in patients age >40. to describe a negative work environment 6 Both genders are equally at risk. created by several individuals working to- gether.1-3 However, some researchers such get of workplace “mobbing,” and that his as Namie et al4 use the term workplace Clinical Point insomnia and paranoia developed because bullying to describe the creation of a hos- An uninformed of a deliberate campaign by coworkers. tile work environment by either a single mental health This article discusses how to recognize individual—usually a boss—or a number symptoms of workplace mobbing, using of individuals. professional can Mr. G’s experience to illustrate the dynam- unwittingly make ics of this group behavior. An informed CASE CONTINUED a mobbing victim’s mental health professional can be of enor- Why I fi rst thought ‘paranoia’ situation much mous help to a mobbing victim, but an During our fi rst interview, Mr. G said that 6 uninformed professional can unwittingly months before he sought treatment he had worse make the situation much worse. reported misuse of government property by his supervisor’s boss. The case was investi- gated and dismissed. Mr. G’s supervisor never What is ‘mobbing’? confronted him about the complaint, but Initiated most often by a person in a po- shortly afterwards Mr. G started to notice dis- sition of power or infl uence, mobbing turbing changes in the workplace. has been described as “a desperate urge His supervisor avoided Mr. G’s phone calls to crush and eliminate the target…. As and e-mails and stopped meeting with him. the campaign proceeds, a steadily larger Instead, she met with Mr. G’s subordinates. range of hostile ploys and communica- The subordinates started to ignore Mr. G’s in- tions comes to be seen as legitimate.”1 This structions and would roll their eyes or be in- behavior pattern has been recognized in attentive when he spoke. Coworkers stopped Europe since the 1980s but is not well rec- talking when Mr. G approached, and he start- ognized in the United States. ed receiving anonymous e-mails questioning Davenport et al2 brought the phenom- his ability and sanity. He was reprimanded in enon and its consequences to the U.S. pub- writing for having made a $9 mathematical lic’s attention in 1999 with the publication error in an expense reimbursement request. of Mobbing: emotional abuse in the American Mr. G said when he approached his supe- workplace. Otherwise, little professional lit- rior about the work environment, she stated erature on workplace mobbing has been that he was “just paranoid” and needed to produced in the United States. see a psychiatrist. A PubMed search on the term “mob- When Mr. G’s wife accompanies him to bing” limited to 1982 through October 2008 the second interview, she confi rms his im- returned 95 listings, excluding those deal- pressions of ostracism and gossip at work. ing purely with ethology, but only 1 report She also relates her experiences with people from the United States. Studies from out- from Mr. G’s offi ce who previously had been side the United States indicate that mob- friendly but now were distant or hostile. Mr. Current Psychiatry 46 April 2009 bing is relatively common (Box). G shows me copies of harassing work e-mails 46_CPSY0409 46 3/17/09 11:09:37 AM and memos. I tell Mr. G I believe his story and Table 1 diagnose him as suff ering from posttraumatic Mobbing syndrome: 10 factors stress disorder (PTSD). He begins supportive/ cognitive therapy and continues fl urazepam. Assaults on dignity, integrity, credibility, and competence Negative, humiliating, intimidating, abusive, Mobbing syndrome malevolent, and controlling communication As it turns out, Mr. G was not paranoid; his Committed directly or indirectly in subtle or coworkers really were trying to get him. obvious ways Leymann5 divided 45 types of mobbing Perpetrated by ≥1 staff members* behaviors into 5 categories. These were or- ganized as attacks on: Occurring in a continual, multiple, and • self-expression and ability to commu- systematic fashion over time nicate (victim is silenced, given no oppor- Portraying the victim as being at fault tunity to communicate, subject to verbal Engineered to discredit, confuse, intimidate, attacks) isolate, and force the person into submission • social relationships (colleagues do not Clinical Point Committed with the intent to force the talk to the victim, victim is physically iso- person out Factors that might lated from others) Representing the removal as the victim’s increase one’s risk • reputation (victim is the target of gos- choice sip and ridicule) of being mobbed • occupational situation (victim is given Unrecognized, misinterpreted, ignored, include having a tolerated, encouraged, or even instigated by meaningless tasks or no work at all) management diff erent ethnicity, • physical health (victim is assigned *Some researchers limit their defi nition of mobbing to an ‘odd’ personality, dangerous tasks, threatened with bodily acts committed by >1 person or high achievement harm, or physically attacked). Source: Adapted with permission from Davenport N, Davenport et al2 distilled this list into Schwartz RD, Elliott GP. Mobbing: emotional abuse in the American workplace. Ames, IA: Civil Society 10 key factors of the mobbing syndrome Publishing; 1999:41 (Table 1); identifi ed 5 phases in the mob- bing process (Table 2, page 48); and de- fi ned 3 “degrees” of mobbing analogous Secondary morbidity. Victims of work- to fi rst-, second-, and third-degree burns place mobbing frequently suffer from: (Table 3, page 48). • adjustment disorders • somatic symptoms (eg, headaches or Mobbing risk factors. According to Ley- irritable bowel syndrome) mann,5 no specifi c personality factors • PTSD6,7 predispose workers to being mobbed. • major depression.8 Westhues1 and others, however, identify a In mobbing targets with PTSD, Ley- variety of social risk factors. These include mann notes that the “mental effects were any factors that make an individual differ- fully comparable with PTSD from war or ent from other members of his or her work prison camp experiences.”3 Some patients environment, such as: may develop alcoholism or other substance • different ethnicity abuse disorders. Family relationships rou- • an “odd” personality tinely suffer.9 Some targets may even de- • high achievement. velop brief psychotic episodes, generally Whistleblowers or union organizers with paranoid symptoms. also run a risk of stigmatization and mob- Leymann3 estimated that 15% of sui- bing. Organizations with unclear goals or cides in Sweden could be directly attrib- extensive recent turnover in senior leader- uted to workplace mobbing. Although no ship can be conducive to mobbing. Three other researcher has reported such a dra- industries identifi ed as at special risk for matic proportion, others have reported mobbing are academia, government, and increased risk of suicidal behavior among Current Psychiatry religious organizations.5 mobbing victims.10 Vol.