It's widely accepted that PTSD can result from a single, major,
life-threatening event, as defined in DSM-IV. Now there is growing awareness that PTSD can also result from an
accumulation of many small, individually non-life-threatening incidents. To differentiate
the cause, the term "Complex PTSD" is used. The reason that Complex PTSD is not in
DSM-IV is that the definition of PTSD in DSM-IV was derived using only people who had suffered a
single major life-threatening incident such as Vietnam veterans and survivors of disasters.
Note: there has recently been a trend amongst some psychiatric
professionals to label people suffering Complex PTSD as a exhibiting a
personality disorder, especially Borderline Personality Disorder. This is not the case - PTSD, Complex or otherwise, is apsychiatric injury and nothing to do with personality
disorders. If there is an overlap, then Borderline
Personality Disorder should be regarded as a psychiatric injury, not a
personality disorder. If you encounter a psychiatrist, psychologist or other mental
health professional who wants to label your Complex PTSD as a personality
disorder, change to another, more competent professional.

It seems that Complex PTSD can potentially arise from any prolonged period of
negative stress in which certain factors are present, which may include any of
captivity, lack of means of escape, entrapment, repeated violation of
boundaries, betrayal, rejection, bewilderment, confusion, and - crucially - lack
of control, loss of control and disempowerment. It is the overwhelming nature of
the events and the inability (helplessness, lack of knowledge, lack of support
etc) of the person trying to deal with those events that leads to the
development of Complex PTSD. Situations which might give rise to Complex PTSD
include bullying, harassment, abuse, domestic violence, stalking, long-term
caring for a disabled relative, unresolved grief, exam stress over a period of
years, mounting debt, contact experience, etc. Those working in regular traumatic situations, eg the
emergency services, are also prone to developing Complex PTSD.

A key feature of Complex PTSD is the aspect of captivity. The individual experiencing
trauma by degree is unable to escape the situation. Despite some people's assertions to
the contrary, situations of domestic abuse and workplace abuse can be extremely difficult
to get out of. In the latter case there are several reasons, including financial
vulnerability (especially if you're a single parent or main breadwinner - the rate of
marital breakdown is approaching 50% in the UK), unavailability of jobs, ageism (many
people who are bullied are over 40), partner unable to move, and kids settled in school
and you are unable or unwilling to move them. The real killer, though, is being unable to get a job
reference - the bully will go to great lengths to blacken the person's name, often for
years, and it is this lack of reference more than anything else which prevents people escaping.

Until recently, little (or no) attention was paid to the psychological harm caused by
bullying and harassment. Misperceptions (usually as a result of the observer's lack of
knowledge or lack of empathy) still abound: "It's something you have to put up
with" (like rape or repeated sexual abuse?) and "Bullying toughens you
up" (ditto). Armed forces personnel faced threats of being labelled with
"cowardice" and "lack of moral fibre" (LMF) if they gave in to the
symptoms of PTSD. In World War I, 306 British and Commonwealth soldiers were shot as "cowards"
and "deserters" on the orders of General Haig in an act which today would be treated as a war crime - seeseparate page on this injustice.

In the UK at least 16 children kill themselves each year because they are being bullied
at school. This figure is established in the book Bullycide: death at
playtime. Each of these deaths is unnecessary, foreseeable,
and preventable. The UK has one of the highest adult suicide rates in
Europe: around 5000 a year. The number of adults in the UK committing suicide because of
bullying is unknown. Each year 19,000 children attempt suicide in the UK - one every half
hour. in the UK, suicide is the number one cause of death for 18-24-year-old males.
Females also attempt suicide in large numbers but tend to use less successful means.

Since Andrea Adams first identified workplace bullying and gave it its name in 1988,
recognition of adult bullying has grown steadily. Tim Field's UK National Workplace
Bullying Advice Line has logged over 8000 cases in seven years; in
the majority of cases (over 80%), the caller is a white-collar worker
who has become
the prey of a serial bully whose behaviour profile
suggests a disordered personality. Callers refer to predecessors who have had stress breakdowns, taken early
or ill-health retirement, or been dismissed on grounds of ill-health - all caused by the same individual.
Sometimes callers refer to suicides of fellow employees.
Mapping the health effects of bullying onto PTSD and Complex PTSD

Repeated bullying, often over a period of years, results in symptoms of Complex Post Traumatic Stress Disorder.
How do the PTSD symptoms resulting from bullying meet the criteria in DSM-IV?

A. The prolonged (chronic) negative stress resulting from bullying has lead to threat
of loss of job, career, health, livelihood, often also resulting in threat to marriage and family life.
The family are the unseen victims of bullying.

A.1.One of the key symptoms of prolonged negative stress is reactive depression; this
causes the balance of the mind to be disturbed, leading first to thoughts of, then
attempts at, and ultimately, suicide.

A.2.The target of bullying may be unaware that they are being bullied, and even when they do
realise (there's usually a moment of enlightenment as the person realises that the
criticisms and tactics of control etc are invalid), they often cannot bring themselves to believe they are
dealing with a disordered personality who lacks a conscience and does not share the same moral values
as themselves. Naivety is the great enemy. The target of bullying is bewildered, confused,
frightened, angry - and after enlightenment, very angry. For an answer to the question Why
me? click here.

B.1. The target of bullying experiences regular intrusive violent visualisations and
replays of events and conversations; often, the endings of these replays are altered in favour of the target.

B.2. Sleeplessness, nightmares and replays are a common feature of being bullied.

B.3. The events are constantly relived; night-time and sleep do not bring relief as it
becomes impossible to switch the brain off. Such sleep as is achieved is
non-restorative and people wake up as tired, and often more tired, than when they went to bed.

B.4. Fear, horror, chronic anxiety, and panic attacks are triggered by any reminder of the
experience, eg receiving threatening letters from the bully, the employer, or personnel
about disciplinary hearings etc.

B.5. Panic attacks, palpitations, sweating, trembling, ditto.

Criteria B4 and B5 manifest themselves as immediate physical and mental paralysis in
response to any reminder of the bullying or prospect of having to take action against the bully.

C. Physical numbness (toes, fingertips, lips) is common, as is emotional numbness
(especially inability to feel joy). Sufferers report that their spark has gone
out and, even years later, find they just cannot get motivated about anything.

C.1. The target of bullying tries harder and harder to avoid saying or doing anything
which reminds them of the horror of the bullying.

C.2. Work, especially in the person's chosen field becomes difficult, often impossible, to
undertake; the place of work holds such horrific memories that it becomes impossible to
set foot on the premises; many targets of bullying avoid the street where the workplace is located.

C.3. Almost all callers to the UK National Workplace Bullying Advice Line report impaired
memory; this may be partly due to suppressing horrific memories, and partly due to damage
to the hippocampus, an area of the brain linked to learning and memory (see John O'Brien's paper below)

C.4. the person becomes obsessed with resolving the bullying experience which takes over their life,
eclipsing and excluding almost every other interest.

C.5. Feelings of withdrawal and isolation are common; the person just wants to be on their
own and solitude is sought.

C.6. Emotional numbness, including inability to feel joy (anhedonia) and deadening of
loving feelings towards others are commonly reported. One fears never being able to feel love again.

C.7. The target of bullying becomes very gloomy and senses a foreshortened career -
usually with justification. Many targets of bullying ultimately give up their career; in
the professions, severe psychiatric injury, severely impaired health, refusal by the bully
and the employer to give a satisfactory reference, and many other reasons, conspire to bar
the person from continuance in their chosen career.

D.1. Sleep becomes almost impossible, despite the constant fatigue; such sleep as is
obtained tends to be unsatisfying, unrefreshing and non-restorative. On waking, the person often feels more tired than when
they went to bed. Depressive feelings are worst early in the morning. Feelings
of vulnerability may be heightened overnight.

D.2. The person has an extremely short fuse and is often permanently irritated, especially
by small insignificant events. The person frequently visualises a violent solution, eg
arranging an accident for, or murdering the bully; the resultant feelings of
guilt tend to hinder progress in recovery.

D.3. Concentration is impaired to the point of precluding preparation for legal action,
study, work, or search for work.

D.4. The person is on constant alert because their fight or flight mechanism has become
permanently activated.

D.5. The person has become hypersensitized and now unwittingly and inappropriately perceives almost any
remark as critical.

E. Recovery from a bullying experience is measured in years. Some people never fully recover.

F. For many, social life ceases and work becomes impossible; the overwhelming need to
earn a living combined with the inability to work deepens the trauma.
Common symptoms of PTSD and Complex PTSD that
sufferers report experiencing

hypervigilance (feels like but is not paranoia)

exaggerated startle response


sudden angry or violent outbursts

flashbacks, nightmares, intrusive recollections, replays, violent visualisations


sleep disturbance

exhaustion and chronic fatigue

reactive depression


feelings of detachment

avoidance behaviours

nervousness, anxiety

phobias about specific daily routines, events or objects

irrational or impulsive behaviour

loss of interest

loss of ambition

anhedonia (inability to feel joy and pleasure)

poor concentration

impaired memory

joint pains, muscle pains

emotional numbness

physical numbness

low self-esteem

an overwhelming sense of injustice and a strong desire to do something about it

Associated symptoms of Complex PTSD
Survivor guilt: survivors of disasters often experience abnormally high levels
of guilt for having survived, especially when others - including family, friends or fellow
passengers - have died. Survivor guilt manifests itself in a feeling of "I should
have died too". In bullying, levels of guilt are also abnormally
raised. The survivor of workplace bullying may have develop an intense albeit
unrealistic desire to work with their employer (or, by now, their former
employer) to eliminate bullying from their workplace. Many
survivors of bullying cannot gain further employment and are thus forced into
self-employment; excessive guilt may then preclude the individual from negotiating fair
rates of remuneration, or asking for money for services rendered. The person may also find
themselves being abnormally and inappropriately generous and giving in business and other situations.
Shame, embarrassment, guilt, and fear are encouraged by the bully, for this is
how all abusers - including child sex abusers - control and silence their victims.
Marital disharmony: the target of bullying becomes obsessed with understanding and resolving
what is happening and the experience takes over their life; partners become confused, irritated,
bewildered, frightened and angry; separation and divorce are common outcomes.

The word "breakdown" is often used to describe the mental collapse of someone
who has been under intolerable strain. There is usually an (inappropriate) inference of "mental
illness". All these are lay terms and mean different things to different people. I
define two types of breakdown:

Nervous breakdown or mental breakdown is a
consequence of mental illness
Stress breakdown is a psychiatric injury, which is a normal
reaction to an abnormal situation

The two types of breakdown are distinct and should not be confused. A stress
breakdown is a natural and normal conclusion to a period of prolonged negative stress; the
body is saying "I'm not designed to operate under these conditions of prolonged
negative stress so I am going to do something dramatic to ensure that you reduce
or eliminate the stress otherwise your body may suffer irreparable damage; you must take
action now". A stress breakdown is often predictable days - sometimes weeks - in
advance as the person's fear, fragility, obsessiveness, hypervigilance and hypersensitivity
combine to evolve into paranoia (as evidenced by increasingly bizarre talk of conspiracy
or MI6). If this happens, a stress breakdown is only days or even hours away and the
person needs urgent medical help. The risk of suicide at this point is heightened.

Often the cause of negative stress in an organisation can be traced to the behaviour of
one individual. The profile of this individual is on the serial bully page. I believe
bullying is the main - but least recognised - cause of negative stress in the workplace
today. To see the effects of prolonged negative stress on the body click here.

The person who suffers a stress breakdown is often treated as
if they have had a mental breakdown; they are sent to a psychiatrist, prescribed
drugs used to treat mental illness, and may be encouraged - sometimes coerced or sectioned - into
becoming a patient in a psychiatric hospital. The sudden transition from professional
working environment to a ward containing schizophrenics, drug addicts and other people
with genuine long-term mental health problems adds to rather than alleviates the
trauma. Words like "psychiatrist", "psychiatric unit" etc are often
translated by work colleagues, friends, and sometimes family into "nutcase",
"shrink", "funny farm", "loony" and other inappropriate
epithets. The bully encourages this, often ensuring that the employee's personnel record
contains a reference to the person's "mental health problems". Sometimes, the
bully produces their own amateur diagnosis of mental illness - but this is more likely to
be a projection of the bully's own state of mind and should be regarded as such.

During the First World War, British soldiers suffering PTSD and stress breakdown were
labelled as "cowards" and "deserters". During the Second World War,
soldiers suffering PTSD and stress breakdowns were again vilified with these labels; Royal
Air Force personnel were labelled as "lacking moral fibre" and their papers
stamped "LMF". For further commentary on this issue, click here. It's noticeable that
those administrators and top brass enforcing this labelling were themselves always
situated a safe distance from the fighting; see the section on projection.

The person who is being bullied often thinks they are going mad, and may be
encouraged in this belief by those who do not have that person's best interests
at heart. They are not going mad; PTSD is an injury, not an illness.

Sometimes, the term "psychosis" is applied to mental illness, and the term
"neurosis" to psychiatric injury. The main difference is that a psychotic person
is unaware they have a mental problem, whereas the neurotic person is aware
- often acutely. The serial bully's lack of insight into their behaviour and its effect on
others has the hallmarks of a psychosis, although this obliviousness would appear to be a
choice rather than a condition. With targets of bullying, I prefer to avoid the words
"neurosis" and "neurotic", which for non-medical people have
derogatory connotations. Hypersensitivity and hypervigilance are likely to cause the
person suffering PTSD to react unfavourably to the use of these words, possibly perceiving
that they, the target, are being blamed for their circumstances.

A frequent diagnosis of stress breakdown is "brief reactive psychosis",
especially if paranoia and suicidal thoughts predominate. However, a key difference
between mental breakdown and stress breakdown is that a person undergoing a stress
breakdown will be intermittently lucid, often alternating seamlessly between paranoia and seeking
information about their paranoia and other symptoms. The person is also likely to be
talking about resolving their work situation (which is the cause of their problems),
planning legal action against the bully and the employer, wanting to talk to their union
rep and solicitor, etc.

A stress breakdown is a transformational experience which, with the right
support, can ultimately enrich the experiencer's life. However, completing the
transformation can be a long and sometimes painful process. The Western response
- to hospitalise and medicalize the experience, thus hindering the process - may
be well-intentioned, but may lessen the value and effectiveness of the
transformation. How would you feel if, rather than a breakdown,
you viewed it as a breakthrough? How would you feel if it was suggested
to you that the reason for a stress breakdown is to awaken you to your mission
in life and to enable you to discover the reason why you have incarnated on this
planet? How would it change your view of things if it was also suggested to you
that a stress breakdown reconfigures your brain to enable you to embark on the
path that will culminate in the achievement of your mission? [More
| More]
Differences between mental illness and psychiatric injury

The person who is being bullied will eventually say something like "I think
I'm being paranoid..."; however they are correctly identifying hypervigilance,
a symptom of PTSD, but using the popular but misunderstood word paranoia. The
differences between hypervigilance and paranoia make a good starting point for identifying
the differences between mental illness and psychiatric injury.



paranoia is a form of mental illness; the cause is thought to be internal, eg a
minor variation in the balance of brain chemistry

is a response to an external event (violence, accident, disaster, violation, intrusion,
bullying, etc) and therefore an injury

paranoia tends to endure and to not get better of its own accord

wears off (gets better), albeit slowly, when the person is out of and away from the
situation which was the cause

the paranoiac will not admit to feeling paranoid, as they cannot see their paranoia

the hypervigilant person is acutely aware of their hypervigilance, and will easily
articulate their fear, albeit using the incorrect but popularised word

sometimes responds to drug treatment

drugs are not viewed favourably by hypervigilant people, except in extreme
circumstances, and then only briefly; often drugs have no effect, or can make things worse,
sometimes interfering with the body's own healing process

the paranoiac often has delusions of grandeur; the delusional aspects of paranoia
feature in other forms of mental illness, such as schizophrenia

the hypervigilant person often has a diminished sense of self-worth, sometimes
dramatically so

the paranoiac is convinced of their self-importance

the hypervigilant person is often convinced of their worthlessness and will often deny
their value to others

paranoia is often seen in conjunction with other symptoms of mental illness, but not
in conjunction with symptoms of PTSD

hypervigilance is seen in conjunction with other symptoms of PTSD, but not in
conjunction with symptoms of mental illness

the paranoiac is convinced of their plausibility

the hypervigilant person is aware of how implausible their experience sounds and often
doesn't want to believe it themselves (disbelief and denial)

the paranoiac feels persecuted by a person or persons unknown (eg "they're
out to get me")

the hypervigilant person is hypersensitized but is often aware of the inappropriateness
of their heightened sensitivity, and can identify the person responsible
for their psychiatric injury

sense of persecution

heightened sense of vulnerability to victimisation

the sense of persecution felt by the paranoiac is a delusion, for usually no-one is out
to get them

the hypervigilant person's sense of threat is well-founded, for the serial bully is
out to get rid of them and has often coerced others into assisting, eg through mobbing;
the hypervigilant person often cannot (and refuses to) see that the serial bully is doing
everything possible to get rid of them

the paranoiac is on constant alert because they know someone is out to get them

the hypervigilant person is on alert in case there is danger

the paranoiac is certain of their belief and their behaviour and expects others to share
that certainty

the hypervigilant person cannot bring themselves to believe that the bully cannot and
will not see the effect their behaviour is having; they cling naively to the mistaken
belief that the bully will recognise their wrongdoing and apologise

Other differences between mental illness and psychiatric injury include:

Mental illness

Psychiatric injury

the cause often cannot be identified

the cause is easily identifiable and verifiable, but denied by those
who are accountable

the person may be incoherent or what they say doesn't make sense

the person is often articulate but prevented from articulation by being traumatised

the person may appear to be obsessed

the person is obsessive, especially in relation to identifying the cause of their injury
and both dealing with the cause and effecting their recovery

the person is oblivious to their behaviour and the effect it has on others

the person is in a state of acute self-awareness and aware of their state, but often
unable to explain it

the depression is a clinical or endogenous depression

the depression is reactive; the chemistry is different to endogenous depression

there may be a history of depression in the family

there is very often no history of depression in the individual or their family

the person has usually exhibited mental health problems before

often there is no history of mental health problems

may respond inappropriately to the needs and concerns of others

responds empathically to the needs and concerns of others, despite their own

displays a certitude about themselves, their circumstances and their actions

is often highly sceptical about their condition and circumstances and
is in a state of disbelief and bewilderment which they will easily and often
articulate ("I can't believe this is happening to me" and "Why
me?" - click here
for the answer)

may suffer a persecution complex

may experience an unusually heightened sense of vulnerability to possible victimisation
(ie hypervigilance)

suicidal thoughts are the result of despair, dejection and hopelessness

suicidal thoughts are often a logical and carefully thought-out solution or conclusion

exhibits despair

is driven by the anger of injustice

often doesn't look forward to each new day

looks forward to each new day as an opportunity to fight for justice

is often ready to give in or admit defeat

refuses to be beaten, refuses to give up

Common features of Complex PTSD from bullying

People suffering Complex PTSD as a result of bullying report consistent symptoms which
further help to characterise psychiatric injury and differentiate it from mental illness.
These include:

Fatigue with symptoms of or similar to Chronic Fatigue Syndrome
(formerly ME)

An anger of injustice stimulated to an excessive degree (sometimes but improperly
attracting the words "manic" instead of motivated, "obsessive" instead
of focused, and "angry" instead of "passionate", especially from those
with something to fear)

An overwhelming desire for acknowledgement, understanding, recognition and validation of
their experience

A simultaneous and paradoxical unwillingness to talk about the bullying (clickhere to see
why) or abuse (click here to see why)

A lack of desire for revenge, but a strong motivation for justice

A tendency to oscillate between conciliation (forgiveness) and anger (revenge)
with objectivity being the main casualty

Extreme fragility, where formerly the person was of a strong, stable character

Numbness, both physical (toes, fingertips, and lips) and emotional (inability to feel love and joy)



Hyperawareness and an acute sense of time passing, seasons changing, and distances

An enhanced environmental awareness, often on a planetary scale

An appreciation of the need to adopt a healthier diet, possibly reducing or eliminating
meat - especially red meat

Willingness to try complementary medicine and alternative, holistic therapies, etc

A constant feeling that one has to justify everything one says and does

A constant need to prove oneself, even when surrounded by good, positive people

An unusually strong sense of vulnerability, victimisation or possible victimisation, often
wrongly diagnosed as "persecution"

Occasional violent intrusive visualisations

Feelings of worthlessness, rejection, a sense of being unwanted, unlikeable and unlovable

A feeling of being small, insignificant, and invisible

An overwhelming sense of betrayal, and a consequent inability and unwillingness to trust
anyone, even those close to you

In contrast to the chronic fatigue, depression etc, occasional false dawns with sudden
bursts of energy accompanied by a feeling of "I'm better!", only to be followed
by a full resurgence of symptoms a day or two later

Excessive guilt - when the cause of PTSD is bullying, the guilt expresses itself in forms
distinct from "survivor guilt"; it comes out as:

an initial reluctance to take action against the bully and report him/her knowing that
he/she could lose his/her job

later, this reluctance gives way to a strong urge to take action against the bully so
that others, especially successors, don't have to suffer a similar fate

reluctance to feel happiness and joy because one's sense of other people's suffering
throughout the world is heightened

a proneness to identifying with other people's suffering

a heightened sense of unworthiness, undeservingness and non-entitlement
(some might call this shame)

a heightened sense of indebtedness, beholdenness and undue obligation

a reluctance to earn or accept money because one's sense of poverty and injustice
throughout the world is heightened

an unwillingness to take ill-health retirement because the person doesn't want to
believe they are sufficiently unwell to merit it

an unwillingness to draw sickness, incapacity or unemployment benefit to which the
person is entitled

an unusually strong desire to educate the employer and help the employer introduce an
anti-bullying ethos, usually proportional to the employer's lack of interest in
anti-bullying measures

a desire to help others, often overwhelming and bordering on obsession,
and to be available for others at any time regardless of the cost to oneself

an unusually high inclination to feel sorry for other people who are under stress,
including those in a position of authority, even those who are not fulfilling the duties
and obligations of their position (which may include the bully) but who are continuing to
enjoy salary for remaining in post [hint: to overcome this tendency, every time you start
to feel sorry for someone, say to yourself "sometimes, when you jump in and rescue
someone, you deny them the opportunity to learn and grow"]


The fatigue is understandable when you realise that in bullying, the target's fight or
flight mechanism eventually becomes activated from Sunday evening (at the thought of
facing the bully at work on Monday morning) through to the following Saturday morning
(phew - weekend at last!). The fight or flight mechanism is designed to be operational
only briefly and intermittently; in the heightened state of alert, the body consumes
abnormally high levels of energy. If this state becomes semi-permanent, the body's
physical, mental and emotional batteries are drained dry. Whilst the weekend theoretically
is a time for the batteries to recharge, this doesn't happen, because:

the person is by now obsessed with the situation (or rather, resolving the situation),
cannot switch off, may be unable to sleep, and probably has nightmares, flashbacks and replays;

sleep is non-restorative and unrefreshing - one goes to sleep tired and wakes up tired

this type of experience plays havoc with the immune system; when the fight or flight
system is eventually switched off, the immune system is impaired such that the person is
open to viruses which they would under normal circumstances fight off; the person then
spends each weekend with a cold, cough, flu, glandular fever, laryngitis, ear infection etc so the
body's batteries never have an opportunity to recharge.

When activated, the body's fight or flight response results in the digestive,
immune and reproductive systems being placed on standby. It's no coincidence that people
experiencing constant abuse, harassment and bullying report malfunctions related to these
systems (loss of appetite, constant infections, flatulence, irritable bowel syndrome, loss
of libido, impotence, etc). The body becomes awash with cortisol which in high
prolonged doses is toxic to brain cells. Cortisol kills off neuroreceptors in
the hippocampus, an area of the brain linked with learning and memory. The
hippocampus is also the control centre for the fight or flight response, thus
the ability to control the fight or flight mechanism itself becomes impaired.

Most survivors of bullying experience symptoms of Chronic Fatigue Syndrome - seehealth page for details.

In law, gaining compensation for psychiatric injury is a long arduous process which can
take five years of more. The areas most commonly quoted are breach of duty of care under
the Health and Safety at Work Act (1974), and personal injury. There is little case law
for personal injury caused by bullying (although there have been settlements which are
subject to gagging clauses).

The most frequently quoted case is Walker v. Northumberland County Council
[1995] IRLR35 (High Court). John Walker was a social worker dealing with child abuse
cases. He suffered a stress breakdown caused by work overload, recovered and went back to
work; his employer, having been informed of the cause of his stress breakdown, took no
steps to reduce his workload and Mr Walker subsequently suffered a second stress
breakdown. The award was made by the courts on the basis of the second stress breakdown.

In May 2001 the case of Long v. Mercury
Mobile Communications Services resulted in Mr Long (the target of
bullying, in this case in the form of a vendetta)
winning his case on the basis of a first stress breakdown. This has become the
new precedent. The House of Lords judgment in Barber
v. Somerset County Council has also set a new precedent.

In July 1999 Beverley Lancaster won her case for stress against
Birmingham City Council, and in September 2000 in the case of Waters v. London
Metropolitan Police the UK House of Lords judged that an employee (or
in this case an office holder) has the
right in law to sue for negligence if bullying and harassment which the employer knew
about but failed to deal with resulted in psychiatric injury.

However, the law at present is clearly inadequate:

the better a person qualifies to pursue a claim for personal injury by
satisfying PTSD DSM-IV diagnostic criteria B4, B5, C1, C2, C3, D3, E and F, the more they
are, ipso facto, frustrated from pursuing the claim

B4. intense psychological distress at exposure to internal or external cues that
symbolise or resemble an aspect of the traumatic event;

B5. physiological reactivity on exposure to internal or external cues that symbolise or
resemble an aspect of the traumatic event.

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness:

C1. efforts to avoid thoughts, feelings or conversations associated with the trauma;

C2. efforts to avoid activities, places or people that arouse recollections of this trauma;

C3. inability to recall an important aspect of the trauma;

D3. difficulty concentrating;

E. The symptoms on Criteria B, C and D last for more than one month.

F. The disturbance causes clinically significant distress or impairment in social,
occupational or other important areas of functioning.

The Diagnostic Criteria are exacerbated by the abusive and aggressive behaviour of the
bully, the employer, and the employer's legal representatives in their defence and rejection of the claim.

In its Consultation Paper on Liability for Psychiatric Illness (No 137) the Law
Commission recommended, among other things, that

6.2 There should continue to be liability for negligently inflicted psychiatric illness
that does not arise from a physical injury to the plaintiff;

6.15 Damages for psychiatric illness should continue to be recoverable irrespective of
whether the psychiatric illness is of a particular severity;

6.20 Subject to standard defences, there should be liability where an employer has
negligently overburdened its employee with work thereby foreseeably causing him or her to
suffer a psychiatric illness.

There are a growing number of personal injury cases (for psychiatric injury caused by bullying) in the pipeline,
with the first settled out of court in February 1998. See the case law page for recent cases and settlements.
New! Bullying causes PTSD: the legal case

Many people, especially guilty parties and their accomplices and lawyers,
reject the notion that PTSD can arise from bullying. However, this research proves otherwise:

European Journal of Work and Organizational Psychology
(EJWOP), 1996, 5(2), whole issue devoted to bullying and its effects,
including PTSD. Published by Psychology Press, 27 Church Road, Hove, East
Sussex BN3 2FA, UK.

The late Professor Heinz Leymann was one of the
first people to identify the symptoms
of injury to health caused by bullying as PTSD.

Research from Warwick University, England, identifies bullying
as a cause of PTSD

Bullied workers suffer 'battle stress' and show the same symptoms
of armed forces personnel who have been engaged in war

It is common practice for employers to order targets of bullying to see a
psychiatrist of the employers' choosing and to have the employee diagnosed
as being "mentally ill" in order to provide grounds for dismissal
whilst thwarting a personal injury claim. See BMA:
ethics advice and the articles Abuse of Medical Assessments to Dismiss Whistleblowers and Battered
Plaintiffs - injuries from hired guns and compliant courts and Giving Workers the Treatment: if you raise a stink, you go to a shrink!
Incidence of PTSD and Complex PTSD

The number of people suffering PTSD is unknown but David Kinchin estimates in his book Post Traumatic Stress
Disorder: the invisible injury that at any time around 1% of the population are
experiencing PTSD. This figure is only for PTSD resulting from traditional causes such as
accident, violence or disaster.

The incidence of Complex PTSD is unknown; with estimates of the number of
people being bullied at work in the UK ranging from 1 in 8 (IPD, November
1996) to 1 in 2 (Staffordshire University Business School, 1994), the figure could be as high as 14
million - or more. The silent suffering is considerable; symptoms prevent sufferers from realising their potential and
contributing fully to society. Many sufferers are claiming benefit, often reluctantly, as people who suffer
Complex PTSD are often hard working and industrious prior to their injury. Anyone who is on benefit and unable
to work is also not paying tax and national insurance.

Within some groups of society, the incidence of PTSD must be expected to be much
higher than one per cent. Within the emergency services (fire, police and ambulance) and
the armed forces (army, navy and air force) the incidence of PTSD can be as high as 15 per
cent. It is a disturbing probability that out of every hundred police officers currently
engaged in uniformed patrol duties in our towns and cities, fifteen will be suffering from
symptoms in accord with PTSD.

David Kinchin, Author, Post Traumatic Stress Disorder


Stress is on everybody's minds these days. However, whilst almost everyone seems to
feel "stressed", most people are unaware that stress comes in two forms: positive
and negative.

Positive stress (what Abraham Maslow calls eustress) is the result of good management and excellent leadership where
everyone works hard, is kept informed and involved, and - importantly - is valued and
supported. People feel in control.

Negative stress (what Maslow calls distress) is the result of a bullying climate where threat and coercion
substitute for non-existent management skills. When people use the word "stress"
on its own, they usually mean "negative stress".

I define stress as "the degree to which one feels, perceives or believes one is
not in control of one's circumstances". Control - or people's perception of being in
control - seems to be key to susceptibility to experiencing PTSD.

The UK, and much of the Western world, adopts a blame-the-victim mentality as
a way of avoiding having to deal with difficult issues. When dealing with stress it is
essential to identify the cause of stress and work to reduce or eliminate the
cause. Sending employees on stress management courses may sound good on paper but coercing
people to endure more stress without addressing the cause is going to result in further psychiatric injury.
Stress is not the employee's inability to cope with excessive workload and excessive demands but a
consequence of the employer's failure to provide a safe system of work as required by the
Health and Safety at Work Act 1974.

Stress is known to cause brain damage. Dr John T O'Brien, consultant in old-age
psychiatry at Newcastle General Hospital, published a paper in March 1997 entitled "The
glucocorticoid cascade hypothesis in man" (and presumably woman), helpfully
subtitled "Prolonged stress may cause permanent brain damage".

If Dr O'Brien's research proves correct, then employers who encourage stressful regimes
comprising long hours, threat and coercion might soon find themselves on the wrong end of
a string of expensive personal injury lawsuits.

Further discussion of stress is on the health page.

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