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International Journal of Mental Health, vol. 36, no. 4, Winter 20078, pp. 6785.
2008 M.E. Sharpe, Inc. All rights reserved.
ISSN 00207411/2008 $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 psychiatric
aspects, and (c) assesses the correlation between socio-demographic variables and
the pathogenic extent of this phenomenon. Method: 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 edition, revised) 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, ofcials, etc.) and medium (employees, white-collar workers, etc.)
Giovanni Nolfe, M.D., is Medical Director of the Psycho-diagnostic and Epidemiological
Research Unit at the Mobbing Regional Observatory of Campania (Italy). Claudio Petrella,
M.D., is Chairperson of the Mobbing Regional Observatory of Campania (Italy). Francesco
Blasi, M.D., is Medical Director at the Work Psychopathology Medical Centre, Department
of Mental Health, Naples. Gemma Zontini, M.D., is Medical Director of the Psychiatric Hospital Service, V. Monaldi, in Naples, and a full member of the International Psychoanalytical
Association. Giuseppe Nolfe, Ph.D., is Senior Research Scientist at the National Research
Council of Italy, Institute of Cybernetics, E. Caianiello, in Pozzuoli, Italy.
The authors thank Sara Rundle-Smith and Rosanna Scalabrini for their helpful insight
and suggestions.
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work level and the highest care demand is experienced by workers in the elds of
public administration, health-care, social 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 psychoticspectrum disorders. The correlation between diagnosis and working pathogenesis
degree shows that the more signicant 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
conicts 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
studiesboth cross-sectional [13] and longitudinal [413]based on the assumption that work demands and conicts are considered important variables of mental
illness [14]. These studies conrmed previous ndings 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 [1516].
Over the last 20 years, starting with the empirical data of Leymann [1718]
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 dened as an interaction consisting of acts of harassment,
discrimination, unwanted conduct with an adverse effect on dignity, social isolation or exclusion, public and professional humiliation, criticism, intimidation, and
psychological and sometimes physical abuse. This process must occur repeatedly
and over a period of time (almost six months). In fact, a conict cannot be called
bullying if the incident is an isolated event or if two parties of approximately equal
strength are in conict [20, p. 378]. Several other terms have been introduced
to describe this subject including scapegoating [21], mobbingpsychological terror [2223], workplace trauma [24], work harassment [25], bullying [2628], and
abusive behavior and emotional abuse [2930]. 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 become of increasing interest within the international literature both because of its
high health-care demands and its social and economic costs [3234]. These topics
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 implica-

WINTER 20078 69

tions [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 conicts at work [37] was found by Ferrie et al. [13] 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 specic diagnoses and symptoms. Quine [40] found clinical anxiety (30 percent)
and depression (8 percent) among people who had experienced workplace harassment, and Kivimki, Virtanen, Vartia, Elovainio, Vahtera, and Keltikangas-Jrvinen
[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 relationindependent of personality traitsbetween 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 questionnaires
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 characteristics 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 epidemiological study
[42, pp. 23].
Method
The study was carried out on 733 participants (297 women and 436 men) who approached the Work Psychopathology Medical Center 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

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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 ed., revised; DSMIV-TR) [43] criteria and quantify the pathogenic weight of workplace harassment
(see the following discussion). These individuals are treated by a multidisciplinary
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 Leymanns
[22, 44] denition. According to Leymann, harassment at the workplace consists of
hostile acts, oppression, 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 example, 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 abuse, hostile
and unethical communication, negative behaviors, sexual harassment, humiliation,
intimidation, high job demands, low social support at work, manipulations of the
victims reputation and social life, etc.) will receive high scores (in each single
areas and in the total score).
This scale is divided into ve levels based on the percentage allocated to each
participant: Cases in the rst level have the highest degree of correlation (76 percent
and above, of percentage probability); in the second level, a high degree (5175
percent); in the third level, with a medium degree (2550 percent); in the fourth
level, with a lower degree (125 percent); and, nally, in the fth level, with little
to no link between psychopathology and workplace harassment (010 percent).
The individuals framed in the rst and second level were included in the highest
degree (Group H) of working pathogenesis, and, those in the fourth and fth levels
represented the lowest pathogenic group (Group L). The individuals in the third

WINTER 20078 71

Figure 1. Distribution of partipicants by number and age

180
160
140

No. of Participants

120

Males

Females

100
80
60
40
20
0

18-30

31-40

41-50
Age (years)

51-60

61 & over

level were not allocated to any group because they constituted a borderline zone
between these two categories.
Statistical correlations between high or low pathogenic signicance 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 signicantly discriminate the two
groups. The statistical analysis was carried out using descriptive statistics, the
t-test to compare mean values, and the chi-square test and the z-test to compare
percentages.
Results
We rst investigate the comprehensive number of people who arrived at the Work
Psychopathology Medical Center to analyze their demographic characteristics.
The assignment of 733 individuals through ve age groups has shown the highest
prevalence in the ranges from 4150 age groups (37.0 percent) and 5160 age
groups (33.4 percent). This percentage decreases to 21.1 percent in the range
3140 and declines to slighter values in the extreme intervals of 1830 and 61 and
over, which constituted, respectively, 4.1 percent and 4.3 percent of the sample.
The distribution of men and women in these ve classes is shown in Figure 1.
Although the allotment of women in the ve categories reproduces a symmetric
curve, with the highest level in the medium range (from 4150), in the categorical

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Figure 2. Work sectors

Mail &
Telecommunication
10%
Energy
2%

Others
2%

Industry & Building

Industry
13%

Farming, Fishing,
Handicraft
1%

Armed & Police Forces

3%
Commerce & Tourism
15%

Public Administration
22%

Bank & Insurance

10%

Transport
5%

Health & Social Work

17%

allotment of men by age, we observe a progressive increase with aging with the
widest score between 5160.
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, healthcare 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 collar
laborers, tradesmen), medium level (e.g., employees, white collar) and high level
(e.g., managers, ofcials, professionals). The rst 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 psychotic 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 posttraumatic stress disorder (PTSD) concerned 85
percent of all anxiety disorders.
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 disorder). The observation that these individuals receive two or more diagnoses can

WINTER 20078 73

Table 1
Diagnoses and Diagnostic Groups (Number of patients)
Diagnostic Group/Diagnosis
A. Mood disorders
Depressive
Disthymia
Bipolar
Depressive with psychotic incongruent symptoms
B. Anxiety disorders
Posttraumatic stress disorder
Generalized anxiety disorder
Panic attacks with or without agoraphobia
Not otherwise specied
C. Adjustment disorders
Anxious mood
Depressed mood
Mixed
Behavior disease
D. Schizophrenic spectrum and personalitya disorders
Brief psychotic
Delusional
Borderline personality
Schizoid personality
Paranoid personality
Other diagnosis
Eating disorder
Dependent personality

n
153
142
8
3
3
161
138
10
7
2
339
56
60
222
1
11
3
1
3
2
1
4
3
1

Cluster A.

be related to the heterogeneous nature of psychopathology in these individuals as

well as to a by-product of recent diagnostic systems [45, p. 182].
Each individual is allocated into one of the ve pathogenic categories, and the
ve categories are then subdivided into two groups: Group H (n = 323), which
includes individuals from the rst and second levels, with the highest pathogenic
rank; and Group L (n = 113), which includes individuals from the fourth and fth
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 signicantly between the two groups. We nd that the
number of years of education constitutes a signicant difference (p < 0.001), with
averaged values of 14.13.2 for Group H versus 12.92.9 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),

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Table 2
Age and Sex Distribution of Participants and Scores of High/Low (H/L)
Ratio
Men (%)

Women (%)

H/L Ratio

Group H
1830
3140
4150
5160
61 and over

1.91
15.79
32.09
44.50
5.74

3.17
29.37
34.92
29.37
3.17

1.33
4.74
2.79
5.16
2.40

Group L
1830
3140
4150
5160
61 and over

5.26
12.28
42.11
31.58
8.77

7.55
18.87
47.17
24.52
1.89

1.00
3.70
1.76
2.84
4.00

Notes: Group H: Men (n = 179); women (n = 126). Group L: Men (n = 57); women (n =
53).

and Group L consisted of 21.4 (29.6) percent of men (women). The male/female
ratio is 1.65/1 in Group H and 1.07/1 in Group L .
The mean (SD) age was 48.8 (8.6) in Group H and 48.8 (8.8) in Group L.
These data, although relevant, have no statistical signicance. The differences become more clear when the ve 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 Group H/Group L ratio = 5.16/1 between 51 and 60). Among women, the
peak (H/L ratio 3.7/1) is found between 31 and 40 (the subgroup of 61 and over
is excluded because the sample size is too small; see Table 2).
We also compare high versus low pathogenic work groups with regard to job
duration (Group H: mean = 18.39.9 years; Group L: 16.310.0 years). These
differencesdue to the high level of the standard deviationare not statistically
signicant.
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 pathogenic effect of harassment at the workplace. These data are reported in Figure 3,
which shows that signicant differences are found in two diagnostic classes: A

WINTER 20078 75

Figure 3. Correlation between diagnosis and working pathogenic level

90
80
70

Pa rticipants (%)

60
50

Group H
Group L

40
30
20
10
0
Mood

Mood/Anxiety
Diagnoses

Adjustment

Others

(mood disorders) and, most signicant, AB (mood and anxious disorders). Of individuals 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 and Bjrkqvist [46].
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 treatment runs the course of a perfect Gaussian curve (with peak of demands between

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4150 years), whereas within the male group, requests progressively increased with
age, until the maximum level is reached in the age range between 5160. This result
appears to be of great interest because according to data from the Organization for
Economic Cooperation and Development [47], only a moderate proportion of this
age segment is employed (about 27 percent from 54 to 64).
From our results, it appears clear that the differences between men and women
2130 and 3140 are minimal (especially when considering the different employment rate between the two sexes). These differences tend to increase slowly 4150
and rise signicantly among those 5160 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 [4850],
which affects male workers within company reorganization strategies of workforce
reduction. Conversely, women could suffer damage during working periods in
which discriminations are more signicantly focused on career, harmonization
between work and family life, and other forms of vexation or sexual harassment
already underlined in the literature [5153] mainly in the work organizations with
low levels of professionalism [54].
Moreover, we notice a trend that, although not statistically signicant, 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 conicts 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 [5556]. Other research 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-event 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 sector [5960]. 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 Merlli [42] found the main risk sector in Europe
in transportation, communication, education, and health care. Hoel and Cooper
[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 service sector [26, 42, 60]. In our sample, the work sectors

WINTER 20078 77

mainly implicated are public administration, health care, social services, industry, and commerce. Demands for health care among workers in farming, shing,
handicrafts, and armed police forces were very rare.
We also verify the correlation between work level and mobbing, which has
been previously denied by prior studies [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 ones 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 regard to the socio-demographic
factors that can inuence the mobbing phenomenon in our sample, we verify that
education level is linked to working pathogenesis with a highly signicant statistical correlation (p < 0.001).
The signicance 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 spectrum disordersor more generally, diagnoses within the psychotic spectrumare
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 [6569] 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 signicant 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 signicance of other
factors (e.g., stressful life events, long-term difculties, neuroticism) considered
within the international literature as predictors of major depression [7172] and
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

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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 diagnosis
is often found to be linked to depressive illness, thus conrming 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 indenite) dimension outside the range of normal human experience of traumatic events
as previously required by the DSM-III [77, p. 237]. Such historical modication of
PTSD diagnostic criteria [78] amplies its conceptualization as far as to encompass,
probably, the Freudian concept of traumatische neurose [7980].
The bidimensional theory of PTSD [81], the evaluation of this illness in a dimensional perspective [82], and the late investigations that have connected PTSD
to affect arousal dysregulation and to numbing [8384] make the high relevance
of PTSD (and its recurrent link with depression) in our cohort not at all surprising. Quantitatively less relevant, but signicant 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 [8687], that adjustment disorders are the most frequent pathology. To date, this diagnosis has not been studied in
detail, although it represents a psychopathological dimension, whose nosographical
relevance [8889] and correlation to signicant disability levels, including the nonnegligible suicidal risk [90], has often been underlined. Its frequent conrmation,
criticized by other authors [91] as a psychiatric complication of many somatic
pathologies with chronic evolution and a relevant emotional impact [9296], suggests 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 ndings, for the rst 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
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 specically dedicated to work
psychopathology.
We hypothesize two main categories of pathogenic mechanisms: First, traumatic
stressors can produce (in relation to the violence and harassment degree of the bullying process, as well as to the specic traits of the victims personality) a severe
symptomatic frame that might even reach PTSD (with intense hyperarousal, ash-

WINTER 20078 79

backs, and dissociation phenomena) and psychotic spectrum disorders; and second,
the traumatic event with a prolonged but lower intensity mechanism produces the
polymorphic pattern of adjustment disorders. Within this limit, depressionconsidered a specic 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 psychopathological dimension of workplace harassment.
These data and the signicance of the phenomenon have strong therapeutic
implications. In fact, the early identication of stressful working conditions is
(particularly in depression) a fundamental approach to the care of these pathologies because their treatment can frequently be grounded (beyond individual pharmacological and psychotherapeutic strategies) in the therapeutic involvement of
relational, familial, and social backgrounds to amplify the defenses, resources, and
coping strategies of the individual. 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 scientic and psychiatric community to these
topics is a fundamental necessity.
Further ndings 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 causeeffect 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
modication of the perception of the psychosocial and interpersonal factors within
the working environment as a consequence of personality traits.
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