1. The WBI Health Symptoms List

The list is 33-item set of symptoms that survey respondents evaluated. The responses were analyzed in two ways. First, if the items were checked at all, and any or all of the items could be checked, the percentages of target-respondents who experienced each symptom were calculated.

a.) Overall Ranking of the Prevalence of Symptoms, most to least frequent

One theme shared by nearly all the symptoms in the list is that most are Stress-Related Health Diseases. Dominating the top 13 symptoms are those that generally define General Anxiety Disorder (ranked items 1, 3, 4, 5 & 8), Clinical Depression (ranked items: 2, 3, 6, 11 & 13), and Post-Traumatic Stress Disorder (PTSD: ranked items 4, 7 & 9, see the PTSD section below).

It is noteworthy that the 25% likelihood of committing violence against others (in line with the simplistic notion that physical workplace violence is perpetrated by those once bullied) is equal to the probability that suicide (violence against the self) was contemplated.

What it could mean: This suggests that whenever workplace disputes go unresolved, the traditional and reflexive fear that the victim will lash out against those perceived as failing to pursue resolution is generally unfounded. A parallel and equally justified fear is that the disadvantaged party in such disputes will commit suicide. But suicide rarely garners headlines in the press and do not pose risks to employers.

Women targets, who comprise 80% of the respondents to the survey, were diagnosed (ostensibly by a mental health professional) slightly more frequently with Depression (41%) than men targets (37%).

There are only slight variations between overall rank order of symptom prevalence and the lists for women and men targets. Anxiety remains ranked first in both lists, Depression is 12th on both lists and the three PTSD symptom categories are among the top 10 problems.

b.) The research team also calculated the proportion of health symptoms checked. The number was simply the individual's total out of 33 possible symptoms experienced. It was expected to be a reverse index of wellness; the higher the proportion, the sicker the person. However, the diversity of the symptoms rendered the interpretation of such a summary index meaningless. It matters little if the only symptom is survival of a heart attack. The proportion of 1 out of 33 is very small, but the severity of a heart attack undermines the utility of the intended index.

Before abandoning the proportional index, gender comparisons among targets and bullies were analyzed. No significant differences emerged. Women targets had a slightly higher number of symptoms (43.4% of the 33 symptoms) than did men (42.2%). Men bullies did cause targets to suffer a slightly higher number of symptoms (44.9%) than did women bullies (42%), which is consistent with other findings from the survey that show men to inflict greater cruelty.

2. Newness of Health Problems

a.) The second way in which WBI Health Symptoms List data were analyzed used the scale given to respondents. For each symptom, people declared if they had the symptom before the bullying, and if so, did the bullying not affect the problem (scored as "0") or did it worsen the health problem (scored as "1"). The third response option was to state that the symptom was new (scored as "2"); it had not been experienced before the bullying.

Newness could indicate that the mistreatment from bullying is responsible. An absence prior to encountering the bully and allies coupled with onset only after the bullying began is the basis for inferring a causal connection. Reasonable observers would say that bullying most probably caused health problems.

Remarkably, the relevant health impact reviewers -- Workers' Compensation and Disability Insurance -- tend to deny claims of stress-related diseases when it can be shown that conditions were pre-existing, even when medically managed. Denial of the causal link is important to employers and the not-so-impartial pro-employer WC and disability systems.

The table below shows that most of the health problems in the List were experienced for the first time after being targeted for mistreatment at work. The pre-existing percentages are obtained simply by subtracting the newness percentage from 100.

1.	Heart arythmia (82%)
2.	Use of substances to cope: tobacco, alcohol, drugs, food (82%)
3.	Avoidance of feelings, thoughts, and situations that remind you of trauma (81%)
4.	Recurrent memories, nightmares and flashbacks (80%)
5.	Chronic fatigue syndrome (80%)
6.	Shame or embarrassment that led to dramatic changes in lifestyle (79%)
7.	Feeling edgy, irritable, easily startled and constantly on guard (paranoia) (78%)
8.	Obsession over details at work (77%)
9.	Panic attacks (77%)
10.	Exhaustion, leading to an inability to function (76%)
11.	Compulsive behaviors (75%)
12.	Ulcers (74%)
13.	Thinking about being violent towards others (73%)
14.	Hair loss (73%)
15.	Fibromyalgia--inflamed joints and connective tissue (71%)
16.	Racing heart rate (70%)
17.	Loss of concentration (69%)
18.	Skin changes, e.g., shingles, rashes, acne (69%)
19.	Irritable bowel syndrome (colitis) (69%)
20.	Angina (69%)
21.	Disrupted sleep (68%)
22.	Stress headaches (68%)
23.	Suicidal thoughts (68%)
24.	Anxiety, stress. excessive worry (66%)
25.	Diagnosed depression (65%)
26.	Significant weight change (loss or gain) (65%)
27.	High blood pressure/hypertension (62%)
28.	Migraines (57%)
29.	Body aches--muscles or joints (55%)
30.	Chest pains (55%)
31.	Asthma or allergies (54%)
32.	TMJ (jaw tightening/teeth grinding) (54%)
33.	Heart attack(s) (50%)

The ranked list of new symptoms reveals two trends. First, Post-Traumatic Stress Disorder (PTSD: symptoms 3, 4 & 7) was new to about 80% of all targets. That means that they had never before been overwhelmed by psychological distress as they strongly experienced it after the bullying.

b.) The second set of observations is about pre-existing conditions and gender.

1. We looked for differences in pre-existing conditions based on target gender. Depression was new to both men and women targets, with exactly 35% having had prior bouts of it.

All three symptom categories of PTSD had been experienced by men more than women targets. Recurrent memories, nightmares and flashbacks (hereafter called Thought Intrusions) prior to bullying were reported by 30% of men but only 18% of women. Feeling edgy, irritable, easily startled (called Hypervigilance) was familiar to 27% of men and 21% of women. Avoiding previous thoughts, situations and locations to escape the fear (called Avoidance in the PTSD lexicon) was something 25% of men and 18% of women had done before being bullied. Of course, the vast majority experienced these PTSD symptoms for the first time.

2. When analyzing differences in newness of health problems attributed to gender of the bullies, several statistically significant differences emerge. According the target respondents, women bullies more than men bullies were responsible for greater interference with concentration (74% women bullies vs. 62% men bullies, respectively), for more anxiety (70% vs. 59%), racing heart rate (75% vs. 61%), depression (70% vs. 58%), onset of asthma (63% vs. 40), TMJ (63% vs. 44%), hair loss (80% vs. 55%), and heart arythmia (68% vs. 30%).

Additionally without meeting the strict standard of statistical significance, women bullies, more than men, were found to have triggered the following health problems: Hypervigilance (one of the PTSD symptoms), sleep disturbances, stress headaches, skin problems, compulsive behaviors, panic attacks, thinking about violence toward others, suicidal thoughts, body aches, Fibromyalgia, chronic fatigue syndrome, exhaustion, colitis, ulcers, chest pains, angina, hypertension and heart attacks.

Men bullies more than women bullies were responsible for statistically more obsessiveness by targets (84% vs. 73%, respectively). Other non-significant differences were that men bullies generated more first-time shame and embarrassment, Thought Intrusions and Avoidance (two of the PTSD symptoms), and migraines.

Women and men bullies equally affected targets' lives such that 65% of target weight changes accompanied the bullying experience.

3. Bullying and PTSD

a.) Post-Traumatic Stress Disorder may be diagnosed by the presence of one or more of three commonly accepted symptom categories, each of which was represented directly in the survey with a single item on the WBI Health Symptoms List :

Hypervigilance (feeling edgy, irritable, easily startled) characterized by 60% of all survey respondents as indicative of their current health status

Thought Intrusions (recurrent memories, nightmares and flashbacks) -- 49%

Avoidance (avoiding previously fearful thoughts, situations and locations) -- 47%

b.) Gender differences in PTSD symptomatology were reported in Section 2b1 above.

c.) We included in our survey, a limited set of subscales derived from the Trauma Symptom Inventory (TSI) written by John Briere. The TSI is a statistically reliable and valid instrument with 100 brief descriptions of emotional experiences or behaviors asking respondents to rate the frequency of their experiences (never to often) during the last 6 months. Sample items were "periods of trembling and shaking," "suddenly remembering something upsetting from your past," "trying to block out certain memories," and "feeling afraid you might die or be injured." TSI subscales most relevant to the WBI research were:

Anxious Arousal (AA): 8 items measuring symptoms of anxiety, especially those associated with posttraumatic hyperarousal

Intrusive Experiences (IE): 8 items measuring thought intrusions

Defensive Avoidance (DA): 8 items measuring both cognitive (pushing painful thoughts and memories out of one's mind) and behavioral (avoidance of stimuli reminiscent of a traumatic event)

We scored the subscales in an unorthodox way. We calculated each individual's proportion of the total possible scores on each of the subscales. That is, if 24 points was the maximum possible, the individual's score was the raw score divided by 24. Of the 1,000 WBI survey respondents, only 119 completed the TSI subscale section, therefore limiting the conclusions that can be drawn from the data.

Target gender and PTSD as measured by the TSI. Bullied men had a higher and statistically significant greater proportion of trauma on all three indices. Men experienced more anxious arousal (hypervigilance) (75.6%) than women (63.7%); men had more intrusive experiences (64.4% vs. 48.4% ); men had showed more avoidance (77.5% vs. 53.9%).

Bully gender and trauma as measured by the TSI. Though women bullies tended to cause more trauma as defined by the AA, IE and DA scales, the proportions of impact when compared to men bullies were not statistically significantly higher.

WBI Health Symptom List items and the TSI. Each of the relevant TSI subscales contained 8 items depicting aspects of the three PTSD symptom categories. There was a 1:1 correspondence between the three PTSD items on our Health Symptom List and the three categories. Clearly the TSI should yield a more complete picture of PTSD symptomatology. The correlations between proportion scores on the TSI subscales and the WBI individual PTSD items were weak (showing a nearly zero association) and not significant. This could be explained by the small sample of respondents who completed the TSI subscales. However, the strong interitem correlations within the TSI subscales suggest that the more trustworthy measure of PTSD symptoms was the TSI even with the small sample.

4. Acute Anxiety

Based on the anecdotal history of callers to the WBI seeking help, bullied targets experience high levels of anxiety. Severe anxiety was reported by the highest percentage of survey respondents (76%). So, we included in the survey a reliable instrument that assesses anxiety in a non-clinical sample (people not psychiatrically hospitalized) -- the Beck Anxiety Inventory (BAI). The BAI is more a measure of anxiety as a state (a temporary condition)than a measure of a stable, relatively constant, personality trait or characteristic. That is, anxiety induced by bullying can pass if conditions change.

The BAI is a 21-item list of adjectives rated by respondents with regards to how "bothered" they were "during the past week, including today." Bothered ratings ranged from "not at all" to "severely bothered." Some descriptors of anxiety included "wobbliness in legs," "terrified," and "fear of losing control."

Target gender and the BAI. Both women and men targets' average BAI scores fell into Beck's standardized "Moderate to Severe" Anxiety score range. Bullied women average BAI score was 24 (out of 63 maximum); bullied men's average was 21. However, the BAI traditionally finds that women score an average of four points higher than men. This pair of BAI results confirms that anxiety is a major component of the health impact of bullying.

Bully gender and the BAI. Men bullies induced a slightly higher level of acute anxiety (mean BAI score of 25) than did women bullies (23.4). Note that women bullies generated more trauma but men created more general anxiety.

© 2003 Gary M. Namie, All rights reserved.