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Psychopathological Dimensions of Harassment in the

Workplace (Mobbing)

Article  in  International Journal of Mental Health · December 2007

DOI: 10.2753/IMH0020-7411360406

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International Journal of Mental Health, vol. 36, no. 4, Winter 2007–08, pp. 70–88.
© 2008 M.E. Sharpe, Inc. All rights reserved.
ISSN 0020–7411/2008 $9.50 + 0.00.
DOI 10.2753/IMH0020-7411360406

Giovanni Nolfe, Claudio Petrella, Francesco

Blasi, Gemma Zontini, and Giuseppe Nolfe

Psychopathological Dimensions
of Harassment in the Workplace
(Mobbing)

ABSTRACT: Aims: This study (a) evaluates the subjective perception and the
psychopathological effects on workers subjected to harassment at the workplace,
(b) examines the pathogenic relation between workplace harassment and psy-
chiatric aspects, and (c) assesses the correlation between socio-demographic
variables and the pathogenic extent of this phenomenon. Methods: The study
was carried out with the participation of 733 workers who approached the Work
Psychopathology Medical Centre of the Department of Mental Health of Naples
(Italy); 533 (73 percent) completed the diagnostic trial. Diagnoses were made in
accord to the Diagnostic and Statistical Manual of Mental Disorders (4th edi-
tion, text revision) criteria. Each individual was graded on an empirical scale to
quantify the correlation between diagnosis and harassment at the workplace. Two
groups, with the highest and the lowest degrees of working pathogenesis, were
compared. Statistical analysis was carried out to study the correlation between
diagnoses and working pathogenesis. Results: The greatest subjective perception
of mobbing is found among workers of high (managers, officials, etc.) and medium
(employees, white-collars workers, etc.) work level and the highest care demand is
experienced by workers in the fields of public administration, health-care, social

Giovanni Nolfe, xxx, is xxx at the Mobbing Regional Observatory of Campania (Italy).
Claudio Petrella, xxx, is xxx at the Mobbing Regional Observatory of Campania (Italy).
Francesco Blasi, xxx, is xxx at the Work Psychopathology Medical Center, Department of
Mental Health, Naples. Gemma Zontini, xxx, is xxx at the Italian Psychoanalytical Society,
Naples. Guiseppe Nolfe, xxx, is xxx at the National Research Council of Italy, Institute of
Cybernetics. <<AU: Please amend brief author biographical statements (e.g., include
academic degree if appropriate, position, etc.).>>

70
 WINTER 2007–08  71

work, commerce, and industry. Adjustment disorders, mood disorders (mainly

major depression), anxiety disorders (mainly posttraumatic stress disorder; PTSD)
are the more frequent diagnoses. We also found a limited sample of individuals
suffering from schizophrenic- and psychotic-spectrum disorders. The correlation
between diagnosis and working pathogenesis degree shows that the more significant
correlation is found with mood and anxious disorders. Conclusion: Depression
and PTSD are the more frequent psychiatric diseases related to harassment at the
workplace, mainly when the pathogenic effect of mobbing is highly relevant. The
greatest incidence of pathogenic work conflicts is observed in men, and the risk
increases with aging, high work, and high education levels.

The relation between work and mental health has been emphasized by a number of
studies--both cross-sectional [1–3] and longitudinal [4–13]--based on the assump-
tion that work demands and conflicts are considered important variables of mental
illness [14]. These studies confirmed previous findings within social psychiatry as
to the relevance of job-related stressful life events (both in terms of interpersonal
relations and organizational systems) and created rating scales in which these events
were emphasized [15–16].
Over the last 20 years, starting with the empirical data of Leymann [17–18]
who drew attention to several studies from the 1970s [19], the phenomenon of
harassment at the workplace has been studied in a systematic fashion, and it has
been more accurately defined as an interaction comprised of acts of harassments,
discriminations, unwanted conducts with an adverse effect on dignity, social isola-
tion or exclusion, public and professional humiliations, criticism, intimidations, and
psychological and sometimes physical abuses. This process must occur repeatedly
and over a period of time (almost six months). In fact “a conflict cannot be called
bullying if the incident is an isolated event or if two parties of approximately equal
‘strength’ are in conflict” [20, p. xxx] <<AU: Please provide page number or
reword to avoid direct quote.>> Several other terms have been introduced to
describe this subject including scapegoating [21], mobbing-psychological terror
[22–23], workplace trauma [24]. work harassment [25], bullying [26–28], and
abusive behaviour and emotional abuse [29–30]. In this study, in accordance with
other authors [20, 23, 31], we use the term harassment (bullying) at the workplace
to identify persistent and repeated negative acts operated by one or more work
colleagues (generally coworkers or superiors) toward one or more victims who
are usually unable to defend themselves.
The frequency of psychiatric illness related to workplace harassment has be-
come of increasing interest within the international literature both because of its
high health-care demands and its social and economic costs [32–34]. These topics

The authors thank Sara Rundle-Smith and Rosanna Scalabrini for their helpful insight
and suggestions.
72 international journal of mental health

were initially examined within work and organizational psychology and, due to
their frequent legal aspects, within forensic psychiatry. Subsequently, a number
of researchers have considered the clinical, psychogenetic, and therapeutic impli-
cations [14, 35] and have also suggested the need for further investigations, with
larger samples of participants [36] to delineate the phenomenon more accurately.
However, to date, few systematic studies have been carried out. An increased risk
of poor mental health, suggested by a follow-up study carried out on individuals
reporting interpersonal conflicts at work [37] was found by Ferrie et al. [13]<<AU:
Please confirm that this is correctly cited as Ferrie et al. (the original was Fer-
rie, 2006)>> who used the General Health Questionnaire [38]. Another study [39]
observed a high incidence of sickness absence ascribable to work characteristics
but did not focus on specific diagnoses and symptoms. Quine [40] found clinical
anxiety (30 percent) and depression (8 percent) among people who had experienced
workplace harassment, and Kivimäki, Ferrie, Head, Shipley, Vahtera, and Marmot
[11] examined the exposure to workplace harassment by a postal questionnaire
sent to more than 10,000 employees and observed an increase in cardiovascular
disease and depression in respondents exposed to a prolonged period of bullying
when compared with those who had not been exposed to workplace harassment.
Furthermore, Paterniti, Niedhammer, Lang, and Consoli [41] emphasized the
relation, independent of personality traits, between psychosocial factors at work
and depression (measured by self-administered questionnaires as well as by the
subjective assessment of depressive symptoms).
The aim of this study is to appraise and characterize, within a large sample,
both the clinical features of individuals and the socio-demographic variables of
workplace harassment (mobbing) by means of diagnostic and nosographic tools
of psychiatric research. Most previous information is based on data from ques-
tionnaires administered to more or less large workers cohorts, and such methods,
although able to evaluate subjective perception of the phenomenon, may only
provide indirect and not standardized measurements insofar as they only provide
information about the association between subjectively self-reported work char-
acteristics and subjectively self-reported mental health outcomes. In contrast, our
study considers the association between subjectively self-reported harassment at
the workplace and objectively evaluated mental disease according to standardized
clinical and diagnostic criteria, as well as proposing a simple methodology to assess
the “weight” of work as a pathogenic factor. This course of action appears even
more pertinent in the Italian population, which shows a high reticence to answer,
as deduced from the observation that the Italian cohort gave one of the smallest
response rates to questionnaires used by the European Community in a large epi-
demiological study [42, pp. 2–3].

Method

The study was carried out on 733 participants ( 297 women and 436 men) who ap-
 WINTER 2007–08  73

proached the Work Psychopathology Medical Centre of the Department of Mental

Health of Naples (Italy) between 2001 and 2005.
The individuals who arrive at our center are referred either by other health-care
structures in the Campania region of Southern Italy (general medicine, occupational
or forensic medicine, departments of mental health, etc.), trade unions, and legal
organizations or workers who directly request our intervention. Each individual is
included in a clinical trial, with a minimum six-month observation period (during
which the individuals are seen at least once a month) to make a diagnosis meeting
the Diagnostic and Statistical Manual of Mental Disorders (4th edition, text revi-
sion; DSM-IV-TR) [43] criteria and quantify the pathogenic weight of workplace
harassment (see the following discussion). These individuals are treated by a mul-
tidisciplinary team (i.e., psychiatrists, psychologists, and sociologists) to make a
diagnosis and decide pharmacological and psycho-therapeutical (i.e., individual,
familial, or group) strategies.
Among the total sample of 733 individuals, 533 (73 percent) completed the
diagnostic trial; drop-outs represented 27 percent. Several socio-demographic
variables such as age, sex, education, work level, and work sector were evaluated.
The diagnoses were collected in the four more frequent classes: mood disorders,
anxiety disorders, adjustment disorders, schizophrenic and schizophrenic spectrum
disorders (schizotypal, schizoid, paranoid and borderline personality).
The variables employed to evaluate the work-induced pathogenesis were (a) prior
case history and temporal relation between illness onset (or warning symptoms) and
the bullying process; (b) social and family adjustment premorbid level; (c) other
psychosocial stress factors, and, of course, (d) the nature, intensity, and duration
of life events accountable as workplace harassment (mobbing) using Leymann’s
[22, 44] definition. According to Leymann, harassment at the workplace consists of
hostile acts, oppressions, psychological or physical harassments, and repeated and
persistent attacks on work and personal identity carried out against the individual
to exclude him or her from the working group. Each variable was estimated from
a minimum of 5 points to a maximum of 25 points in percentage terms. For ex-
ample, a individual (a) without a previous history of mental disturbance and with a
co-occurrence of illness onset and workplace harassment, (b) with a good level of
social functioning, (c) not exposed to other stressful life-events, and (d) exposed to
acts explainable as workplace harassment (e.g., psychological abuses, hostile and
unethical communications, negative behaviours, sexual harassments, humiliations,
intimidations, high job demands, low social supports at work, manipulations of
the victim’s reputation and social life, etc.) will receive high scores (in each single
areas and in the total score).
This scale is divided into five levels based on the percentage allocated to each
participant: Cases in the first level have the highest degree of correlation (76 percent
and above, of percentage probability); in the second level, a high degree (51–75
percent); in the third level, with a medium degree (25–50 percent); in the fourth
level, with a lower degree (1–25 percent); and, finally, in the fifth level, with little
74 international journal of mental health

180
160
140
No. of Participants

120
Men
100
Women
80
60
40
20
0
18-30 31-40 41-50 51-60 61 & over
Age (years)

Figure 1. Distribution of Partipicants by Number and Age

to no link between psychopathology and workplace harassment (0–10 percent).

The individuals framed in the first and second level were included in the highest
degree (Group H) of working pathogenesis, and, those in the fourth and fifth levels
represented the lowest pathogenic group (Group L). The individuals in the third
level were not allocated to any group because they constituted a borderline zone
between these two categories.
Statistical correlations between high or low pathogenic significance of workplace
harassment and various socio-demographic variables (age, sex, education, sector
and work level) were estimated. Likewise, a statistical analysis was performed to
verify which of the four diagnostic areas might significantly discriminate the two
groups. The statistical analysis was carried out using descriptive statistics, the t-test
to compare mean values, and the χ2 test and the z-test to compare percentages.

Results

We first investigate the comprehensive number of people arrived at the Work Psy-
chopathology Medical Centre to analyze their demographic characteristics. The
assignment of 733 individuals through five classes of age has shown the highest
prevalence in the ranges from 41 to 50 years of age (37.0 percent) and 51–60
years of age (33.4 percent). This percentage decreases to 21.1 percent in the range
31–40 and declines to slighter values in the extreme intervals of 18–30 and 61 and
 WINTER 2007–08  75

Mail &
Telecommunications
Industry & Building
10% Others
Energy Industry
2% 12% Farming, Fishing,
2% & Handicraft
Armed & Police 1%
Forces
3% Commerce &
Tourism
15%

Public
Adminstration
23% Health & Social
Work
Bank & Insurance Transport 17%
10% 5%
Figure 2. Work Sectors

over, which constituted, respectively, 4.1 percent and 4.3 percent of the sample.
The distribution of men and women in these five classes is shown in Figure 1.
Although the allotment of women in the five categories reproduces a symmetric
curve, with the highest level in the medium range (from 41–50), in the categorical
allotment of men by age, we observe a progressive increase with aging with the
widest score between 51–60.
The distribution of workers in the various sectors is shown in Figure 2. The
highest care demand is operated by workers of the public administration, health-
care and social work, and commerce and industry. The private sector accounted
for 57.8 percent of cases, the public sector accounted for 38.7 percent of cases, and
3.5 percent of cases were mixed (public and private) sector.
The workforce is subdivided into three categories: low level (e.g., blue collars,
laborers, tradesmen, etc.), medium level (e.g., employees, white collars, etc.) and
high level (e.g., managers, 5officials, professionals, etc ). The first level was found
in 16 percent of the population, 50 percent were categorized in the medium level,
and 34 percent of individuals were allocated into the third level.
The diagnostic trial was completed on 533 workers and diagnoses were made
based on DSM-IV-TR criteria [43]. The results are summarized in Table 1.
Adjustment disorders appear as the most frequent diagnosis (51.05 percent),
followed by anxiety disorders (24.24 percent) and mood disorders (23.05 percent).
The diagnoses of schizophrenic spectrum are relatively rare (1.66 percent), with an
increase up to 2.56 percent when considering all individuals suffering from psy-
chotic spectrum disorder. Within mood disorders, depression (as a single episode
without psychotic symptoms) emerged as the more frequent nosographic entity
(92 percent). The diagnosis of post traumatic stress disorder (PTSD) concerned
85 percent of all anxiety disorders.
76 international journal of mental health

Table 1. Diagnoses and Diagnostic Groups, Number of Patients

Diagnostic Group/Diagnosis n
A Mood disorders 153
Depressive 142
Disthymia 8
Bipolar 3
Depressive with psychotic incongruent symptoms 3
B Anxiety disorders 161
Posttraumatic stress syndrome 138
Generalized anxiety disorder 10
Panic attacks with or without agoraphobia 7
NAS <<AU: Please spell out NAS.>> 2
C Adjustment disorders 339
Anxious mood 56
Depressed mood 60
Mixed 222
Behavior disease 1
D Schizophrenic spectrum and personalitya disorders 11
Brief psychotic 3
Delusional 1
Borderline personality 3
Schizoid personality 2
Paranoid personality 1
Other diagnosis 4
Eating disorder 3
Dependent personality 1
Cluster A.
a

We observed that comorbidity was a very frequent circumstance with a highly

frequent link between anxiety and mood disorders (25.27 percent), whereas single
diagnoses were only 6.13 percent (mood disorder) and 3.90 percent (anxiety dis-
order). The observation that these individuals receive two or more diagnoses can
be related to the heterogeneous nature of psychopathology in these individuals as
well as to a “by-product of recent diagnostic systems” [45, p. xxx]. <<AU: Please
include page number or reword to avoid direct quote.>>
Each individual is allocated into one of the five pathogenic categories, and the
five categories are then subdivided into two groups: Group H (n = 323), which
includes individuals from the first and second levels, with the highest pathogenic
rank; and Group L (n = 113), which includes individuals from the fourth and fifth
levels, with the lowest pathogenic degree of harassment. The individuals in the
third category are not assigned to any group.
We conducted a statistical analysis to determine whether any socio-demographic
variable could discriminate significantly between the two groups. We find that the
number of years of education constitutes a significant difference (p < 0.001), with
 WINTER 2007–08  77

Table 2. Age and Sex Distribution of Participants and Scores of High/Low

(H/L) Ratio
Men (%) Women (%) H/L Ratio
Group H
18–30 years 1.91 3.17 1.33
31–40 years 15.79 29.37 4.74
41–50 years 32.09 34.92 2.79
51–60 years 44.50 29.37 5.16
61 years and over 5.74 3.17 2.40
Group L
18–30 years 5.26 7.55 1.00
31–40 years 12.28 18.87 3.70
41–50 years 42.11 47.17 1.76
51–60 years 31.58 24.52 2.84
61 years and over 8.77 1.89 4.00
Notes. Group H: Men (n = 179); women (n = 126). Group L: Men (n = 57); women (n =
53).

averaged values of 14.1±3.2 for Group H versus 12.9±2.9 for Group L.

Among the total sample of 439 individuals, 58.7 percent were men and 41.3
percent were women. Group H consisted of 78.6 (70.4) percent of men (women),
and Group L was comprised of 21.4 (29.6) percent of men (women). The male/fe-
male ratio is 1.65/1 in Group H and 1.07/1 in Group L .
The mean (SD) age was 48.8(± 8.6) years in Group H and 48.8(±8.8) years in
Group L. These data, although relevant, have no statistical significance. The differ-
ences become more clear when the five age intervals are linked to sex (see Table
2). In the male population, moreover, the high versus low pathogenic degree of
workplace harassment shows noteworthy differences in a large interval from 31– 60
(with the peak of GroupH/GroupL ratio=5.16/1 between 51–60). Among women,
the peak (H/L ratio 3.7/1) is found between 31 and 40 (the subgroup of 61 years
of age and over is excluded because the sample size is too small; see Table 2).
We also compare high versus low pathogenic work groups with regards to job
duration (Group H: mean =18.3 ± 9.9 years; Group L: 16.3 ± 10.0 years). These
differences--due to the high level of the standard deviation--are not statistically
significance.
We examine the distribution of the individuals (n= 433) in the three different
work levels in Groups H and L. The individuals of the lowest level (n = 66) were
more numerous in Group H (66.7 percent) than in Group L (33.3 percent). This
trend increases among the individuals (n = 248) of medium work level (Group H
= 72.1 percent; Group L = 27.9 percent), and it further increases on the third level
(Group H = 83.6 percent; Group L = 16.4 percent).
Finally, we note the correlation between diagnoses and the degree of the patho-
genic effect of harassment at the workplace. These data are reported in Figure 3,
78 international journal of mental health

90

80
Group H
70 Group L
Participants (%)

60
Group L
50
Group H
40

30 Group H

Group L
20

10

0
Mood Mood/Anxiety Adjustment Others
Diagnoses
Figure 3. Correlation Between Diagnosis and Working Pathogenic Level

which shows that significant differences are found in two diagnostic classes: A
(mood disorders) and, most significant, AB (mood and anxious disorders). Of in-
dividuals suffering from mood pathology, 80 percent (20 percent) were in Group H
(Group L). The data for individuals with combined anxiety and mood disorders are
even more marked (Group H = 84 percent; Group L = 16 percent). In contrast, the
differences were lower among individuals with adjustment disorders (Group H =
65 percent; Group L = 35 percent) and not relevant among diagnoses of psychotic
spectrum (both Groups H and L = 50 percent).

Discussion

This study examines both clinical features and socio-demographic variables in

a large sample of individuals exposed to workplace harassment and attempts to
assess their pathogenic relation. The evaluation of the cohort of individuals who
requested assistance from the Work Psychopathology Medical Centre shows a
higher prevalence of men, with a male/female ratio of 3:2.
The age group between 41 and 60 shows the highest subjective perception of
workplace harassment processes and, consequently, is the sector with the highest
demand for health treatment. This datum is in accordance with the research by
Varhama & Björkqvist [46].
 WINTER 2007–08  79

When sex/age-related data are cross-examined, we are able to verify important

differences: Within the female group, the distribution of individuals asking for treat-
ment runs the course of a perfect Gaussian curve (with peak of demands between
41–50 years), whereas within the male group, requests progressively increased with
age, until the maximum level is reached in the age range between 51 and 60. This
result appears to be of great interest because according to data from the Organisation
for Economic Cooperation and Development [47], only a moderate proportion of
this age segment is employed (about 27 percent from 54–64 years).
From our results, it appears clear that the differences between men and women
from 21 to 30 and from 31 to 40 are minimal (especially when considering the
different employment rate between the two sexes). These differences tend to in-
crease slowly between 41 and 50 and rise significantly between 51 and 60 and over.
Finally, we might claim that the subjective perception of job harassment increases
with aging among men, whereas it is more relevant among women during earlier
phases of working life. This observation may be related to the high frequency of
a particular kind of harassment at the workplace, known as “predatory bullying”
or “bossing” [48–50], which affects male workers within company reorganization
strategies of workforce reduction. Conversely, women could suffer damages dur-
ing working periods in which discriminations are more significantly focused on
career, harmonization between work and family life, and other forms of vexation
or sexual harassment already underlined in the literature [51–53] mainly in the
work organizations with low levels of professionalism [54].
Moreover, we notice a trend that, although not statistically significance, shows
within the male population a higher correlation between working stressors and
clinical diagnoses. In fact, the male/female ratio is 1.5/1 within the group with the
highest level of working pathogenesis, whereas the same ratio declines to nearly
equality (1.1/1) among individuals with the lowest working aetiology. The greater
incidence of job pathogenic conflicts within men is in agreement with the results
obtained by means of questionnaires administration in some studies [46]. On the
contrary, various authors have singled out female workers as the group with the
highest risk degree [55–56]. Other researches found no gender difference [26, 40,
51, 57]. In the light of our observations, we conclude that psychiatric illness in
women is, most probably, linked to other life-events stressors rather than only to
work-related causes. This datum is likely to be related to the complex social role of
women who are involved in multiple and demanding tasks (e.g., work, family, child
care, etc.), especially within the geographic area we studied (Southern Italy).
Although Marchand, Demers, and Durand [58] suggest that the job sector
does not modify the effects of harassment on mental health, other studies have
shown mobbing to be more frequent among civil servants than in the private sec-
tor [59–60]. Concerning this issue, Einarsen and Skogstad [26] obtained no clear
results but observed a higher prevalence of such phenomenon in industry, as have
other researchers [61]. Paoli and Merllié [42] found the main risk sector in Europe
in transportation, communication, education, and health-care. Hoel and Cooper
80 international journal of mental health

[60] emphasized this prevalence in prison, postal, and communication services as

well as transport, education, and health workers. Several studies have stressed the
prominent risk in the tertiary economy [26, 42, 60]. In our sample, the work sec-
tors mainly implicated are public administration, health-care and social services,
industry, and commerce. Demands for health-care from both farmimg, fishing, and
handicraft and armed and police forces was very rare.
We also verify the correlation between work level and mobbing, which has been
previously denied by several researches [62]. Conversely, Salin [28] found a higher
mobbing rate in lower positions among a sample of business workers. Our results
show that the highest percentage of demands for treatment comes from medium
(50 percent) and high (34 percent) work levels. This data could be related to the
higher perception of work rights and one’s own self-reported health among people
of the middle and upper classes who represent the individuals characterized by a
greater degree of working pathogenesis. Still, with regards to the socio-demographic
factors that can influence the mobbing phenomenon in our sample, we verify that
education level is linked to working pathogenesis with a highly significant statisti-
cal correlation (p < 0.001).
The significance of work and its importance on the epidemiology of mental
illness have been emphasized by recent studies [63]. In our research. adjustment
disorders are the main clinical and psychopathological dimensions of mobbing
as they appeared in over 50 percent of individuals. Anxiety and mood disorders
(mainly major depression and PTSD) were highly recurrent. Schizophrenic spec-
trum disorders--or more generally, diagnoses within the psychotic spectrum--are
found more rarely.
The considerations relating to depressive disease are quite interesting. Tokuyama,
Nakao, Seto, Watanabe, and Takeda [64] in a previous research stated that the
analysis of the relation between work stress and major depression provide only
controversial proof. Nevertheless, the high prevalence of depressive illness and its
high correlation with the pathogenic effect of workplace harassment (mobbing),
observed in our study are both along the lines of other groups [65–69] and of other
studies that have emphasized the frequent association between depressive symptoms
and cardiovascular illness in these individuals [11]. Also, Niedhammer, David, and
Degioanni [70], using a large sample of the French general working population,
found a highly significant correlation between mobbing and depressive symptoms.
Moreover, the high relation between depression and working pathogenesis further
increases in the comorbid conditions of both depressive and anxiety disorders .
Some previous studies have reported that adverse work conditions increase
the risk of depression irrespective of personality traits [41]. On the contrary, we
think that further studies are needed to quantify better the significance of other
factors (e.g., stressful life events, long-term difficulties, neuroticism) considered
within the international literature as predictors of major depression [71–72] and
 WINTER 2007–08  81

to evaluate better the actual effect of harassment at the workplace as a risk factor
for depression.
The high incidence of anxious disorders in our patients is in agreement with
other epidemiological studies that evaluate the link between work strain and mental
illness [73]. Many authors have already underlined the weight of life-events, such
as humiliation and entrapment (highly prominent features among people subjected
to workplace harassment) in the pathogenesis of anxious diseases, mainly when
linked to depression [74]
Within anxiety disorders, the cases of PTSD were very frequent. This diagno-
sis is often found to be linked to depressive illness, thus confirming the clinical
relation already suggested by other researches [75], who have underlined how
the same traumatic mechanisms act autonomously in these two psychopathologic
dimensions.
The high PTSD incidence is connected with the current diagnostic criteria, in
place from the DSM-IV [76] onward, which rules out the quantitative (and in-
definite) dimension “outside the range of normal human experience” of traumatic
events as previously required by the DSM-III [77, p. xxx]. <<Please provide page
number or reword to avoid direct quote.>> Such historical modification of PTSD
diagnostic criteria [78] amplifies its conceptualization as far as to encompass, prob-
ably, the Freudian concept of traumatische neurose [79–80].
The bidimensional theory of PTSD [81], the evaluation of this illness in a di-
mensional perspective [82], and the late investigations that have connected PTSD
to affect arousal dysregulation and to numbing [83–84] make the high relevance
of PTSD (and its recurrent link with depression) in our cohort not at all surpris-
ing. Quantitatively less relevant, but significant in relation to the development of
theoretical models [85], appears to be the link between PTSD and psychosis.
We observe, in agreement with previous studies [86–87], that adjustment disor-
ders are the most frequent pathology. To date, this diagnosis has not been studied in
detail, although it represents a psychopathological dimension, whose nosographical
relevance [88–89] and correlation to significant disability levels, including the non-
negligible suicidal risk [90], has often been underlined. Its frequent confirmation,
criticized by other authors [91] as a psychiatric complication of many somatic
pathologies with chronic evolution and a relevant emotional impact [92–96], sug-
gests that traumatic phenomena, characterized by a higher degree of chronicity but
a lower dramatic power (i.e., catastrophic stressor), can engender the disorder both
in the case of workplace harassment and of organic illness.
Regarding the psychotic spectrum disorders, our findings, for the first time,
provide data in this area, although the relation between trauma and psychotic
process has already been reported [97]. The prevalence of these severe illnesses
is limited, although it shows an increase of risk when compared with the general
population. We suppose, however, that harassment at the workplace might cause
82 international journal of mental health

psychotic spectrum disorders and that the incidence observed in our sample might
be underestimated. Indeed, the appearance of psychotic spectrum symptoms could
direct these individuals (both outpatients and inpatients) to other general psychiatric
services rather than to our Center, which is more specifically dedicated to work
psychopathology.
We hypothesize two main categories of pathogenic mechanisms: First, trau-
matic stressors can produce (in relation to the violence and harassment degree of
the bullying process, as well as to the specific traits of the victim’s personality) a
severe symptomatic frame that might even reach PTSD (with intense hyperarousal,
flashbacks, and dissociation phenomena) and psychotic spectrum disorders; and sec-
ond, the traumatic event with a prolonged but lower intensity mechanism produces
the polymorphic pattern of adjustment disorders. Within this limit, depression--
considered a specific disorder as well as a symptom (within adjustment disorder
with depressed and mixed mood, PTSD, personality disorders, etc.)--crosses these
pathogenic mechanisms and grounds, and is, therefore, the main psychopathologi-
cal dimension of workplace harassment.
These data and the significance of the phenomenon have strong therapeutic im-
plications. In fact, the early identification of stressful working conditions is (particu-
larly in depression) a fundamental approach to the care of these pathologies because
their treatment can frequently be grounded (beyond individual pharmacological and
psychotherapeutics strategies) in the therapeutic involvement of relational, familial.
and social backgrounds to amplify the defenses, resources, and coping strategies
of the individuals. On the other hand, in the cases in which working pathogenesis
is found, the evaluation and the treatment of the working organization patterns
appears to be essential above all to achieve preventive intervention forms that can
be planned only on the basis of suitable health-care government strategies, and.
to this end, the sensitization in the scientific and psychiatric community to these
topics is a fundamental necessity.
Further findings are needed concerning the personality characteristics of the
individuals exposed to workplace harassment and to develop, as also suggested by
other authors [98], more standardized criteria to measure the cause–effect relation,
which are the main limitations of this study. We have not carried out an objective
measurement of workplace harassment and need to exclude more clearly any
modification of the perception of the psychosocial and interpersonal factors within
the working environment as a consequence of personality traits.

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