Mobbing is a serious problem, which attracts increasing attention. Mobbing is long-term and repetitive negative attitudes and behaviors towards an individual by peers, subordinates or superiors (1). According to Matthiesen (2), some of the features of mobbing include; perception of mobbing as an intentional and direct behavior to self, not being possible to avoid this behavior, not having enough social support to buffer, experiencing the behavior as unjust and groundless, being vulnerable and thus feeling degraded or embarrassed. 

Mobbing can be direct, like verbal assault or indirect, such as withdrawing necessary information or denigration. Based on theoretical and experimental evidence, Matthiesen (3), groups mobbing into five. 1- Related to work (changing assignments or making them harder), 2- Social isolation (isolation from daily communication or events), 3- Personal assault (humiliation, being subject to a whispering campaign), 4- Verbal intimidation (criticized by others, denigration, to be scolded), 5- Defamation (hurting social reputation). 

Typically, mobbing victims are unable to protect themselves from these negative behaviors and try to ignore them (4). Hostile attitudes in work environment, continuous criticizing and personal abuse lead to psychosomatic problems (5). In this article, psychiatric aspects of mobbing will be reviewed in the context of two cases that had psychiatric disorders due to mobbing. 

CASE 1

33 years old, married, college graduate women who was working in a university as an instructor applied to our outpatient clinic because of complaints which were getting worse in the last 6 months, such as anhedonia, crying attacks without an apparent cause, sleep and appetite problems, headache, irritability, inattentiveness, pessimism, difficulty in working, lack of tolerance to her children and family, touchiness and anxiety of future. Psychiatric examination did not reveal any positive findings other than depressive affect. When the factors which could be associated with the disorder were investigated, she stated that while she had been working in the same workplace for two years without any problems, but in the last year she had been living a different period, which she had difficulty to understand, involving behaviors and attitudes in an increasing manner such as being forced to work on nonsense assignments lower than her status and being ignored. She had felt she was guilty at the beginning of this process, but it had evolved into something repetitive and chronic, independent of her work. She told that, because of these events, she was anxious at home, she was unable to take care of her family and therefore she had problems at home. In this period, she had small accidents due to attention problems, she had frequent upper respiratory infections and she could not go to work. The patient did not have a positive history of other psychiatric or medical disorders. She did not have a familial history of psychiatric disorders. Treatment was initiated with depression diagnosis and followed-up on a regular basis. After approximately 3 months applying our outpatient clinic, she told that she was not wanted anymore in her workplace and that she was told to find another job; she resigned and moved to another city. 

CASE 2

Forty-one year old, college graduate, widower with one child woman who was working as a civil servant applied to our outpatient clinic for inability to breath, choking sensation, palpitation, cold sweating, tremor and fear of dying and having a heart attack, for no apparent reason, in the last 2 months. She told that she was afraid of staying alone in her house and she did not let her daughter go outside for this reason. She stated that cardiologist and internal medicine specialists could not find any reason to explain these complaints and she was referred to our clinic. Psychiatric examination did not reveal anything besides anxious affect. She moved to another city and started her new work after her daughter managed to enter a college program. After three months, she had been exposed to increasingly negative behaviors and attitudes, beginning with transfer offers for the institution was not suitable to her, and after she stated that she will stay in the institution, going on with insults, negative criticizing of her work, isolation, being left alone, and being forced to work under people who had lower positions than her. She told that she did not respond to these behaviors and after it was evident that she would not move to another institution, she was moved to another room to work alone and that she had inappropriate proposals from her supervisor and that he touched her without her consent. She stated that, since her co-workers ignored the situation, she felt hopeless and she recorded these behaviors in a voice recorder and resorted to a court. She did not have a positive history of other psychiatric or medical disorders. She did not have a familial history of psychiatric disorders. Treatment was initiated for panic disorder. Legal process is still going on. 

Interpersonal problems in the workplace lead to more negative consequences when compared with problems out of work (6). Employment is not only an obligation to the individual and his/her family, but it is also quite important for self-perception and identity (7).

Mobbing is a common condition in Turkey and the world (1.2-86.0%) (8-10). 

“Mobbing syndrome” has not yet been described clearly and precisely (11). In ICD-10 and DSM-IV, two conditions which are not particularly associated with work but related to stress are pointed out: the first one is post traumatic stress disorder (PTSD) and the other one is adjustment disorder. Severity and intensity of stress described in these disorders are different. 

Mobbing leads to health problems, which in turn lead to sick leaves (9,12). It has been suggested that immune system becomes weaker and neuroendocrine mechanisms are impaired because of stress (12,13). Studies based on interviews to identify effects of psychological abuse process on victims showed that victims experience serious health problems during the psychological abuse process (2). A study reported sleep problems, apathy, impaired attention and concentration and social phobia in mobbing victims (14); another study found depression, anxiety, shortened attention span, repetitive intrusive thoughts, irritability, suicidal tendency, choking sensation, nausea and problems associated with muscles and skeletal system (15). A study conducted in Spain reported stress signs such as headaches, anhedonia, and fatigue among victims (9). Several other studies showed that mobbing causes PTSD (11,15). Mobbing is one of the major causes of suicide (16). Most common disorders seen with mobbing are depression and anxiety (17). A study conducted in Britain with 1137 participants reported that 36% of the mobbing victims quit their jobs (18). While depression and leaving her job in our first case was consistent with the literature, panic disorder in our second case is not common among mobbing victims. However, anxiety disorders in general are common in these victims. While PTSD is known to be particularly common in this group, however, “the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others” criteria of PTSD causes a diagnostic controversy in mobbing victims.

Mobbing has a negative effect on both the individual and the family (13). Changes in relationship pattern, affect and increased irritability have an unavoidable negative impact on even the best relationship (13). If the person has to quit his/her job, financial problems will come into play and economic hardship will lead to embarrassment and guilt. Family issues were more prominent particularly in our first case and she had financial concerns regarding leaving her job. 

Mobbing victims commonly have physical and psychiatric problems such as PTSD, adjustment disorder, depression, lower self-esteem, guilty feelings, sleep problems, anxiety problems, gastrointestinal problems, and skeletal system problems (11,19). These conditions lead to significant impairments in functioning and interpersonal relations. Therefore, taking mobbing into consideration among working people may help to increase solutions to these problems. 

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