Complaints about bullying at the workplace are related to fantasies of aggression in psychosomatic patientss

1 Introduction

The workplace can be associated with many social stressors such as rivalries, conflicts, and demands [1–3]. About 10%to 15%of employees in Europe report to have experienced bullying, often resulting in serious consequences for the person and the environment [1, 4–6]. Bullying at work “means harassing, offending, or socially excluding someone or negatively affecting someone’s work” [6, p. 22]. The victim “ends up in an inferior position and becomes the target of systematic negative social acts” [6, p. 22]. This behavior “has to occur repeatedly and over a longer period of time“ [6, 7]. Bullying is not only seen in the workplace but can also occur in schools, families, relationships, prisons, and cyberspace [8].

Psychological processes of bullying include injustice, vilification, humiliation, and breach of trust. All people hold the “belief in a general just world” and the “belief in a personal just world” [9, p. 31], which is a resource in mastering the world [10, 11]. Injustice is experienced as an aggression and threatens the inner standards and values of a person, who afterwards has to fight back in order to restore justice and one’s self-worth [12–15]. Organizational justice or injustice are of great importance at the workplace [16, 17]. Vilification includes negative behavior (verbal aggression, disrespectful or exclusionary behavior, isolation/exclusion, threats or bribes, and even physical aggression) towards others [18, p. 436] and a form of emotional abuse, relational victimization, and aggression at the workplace [18–20]. Humiliation is a “traumatic emotional state triggered by narcissistic injury of disrespect” [21, p. 657]. Breach of trust is the experience that others do not stick to their commitments and instead take advantage of the person when there is an opportunity [22].

Reactions to workplace conflicts such as bullying can manifest themselves at a group or organizational level with endangered team and organizational performance, and at societal level with unemployment or legal costs. Consequences on an individual level with impairment of psychological and physical well-being, absenteeism, intent to leave, job satisfaction, aggression, and even suicide are of importance [5, 23]. Victims of workplace conflicts can become sick and possibly require professional help because of posttraumatic stress disorder [2, 24–26], depression, anxiety [2, 28], and persisting embitterment [29–34]. Embitterment is of special importance, as it is a burning feeling of having been treated unfairly, with an urge for revenge, impairment of well-being and even dysfunctional aggressive behavior [35–37].

The aim of the present study was to investigate the relation between work-related problems and fantasies of aggression. The hypothesis is that aggressive acts like bullying are reflected in aggressive fantasies of the victim, in contrast to non-aggressive workplace problems like job insecurity.

2 Method

3 Results

A total of 3300 patients were admitted to the hospital during the observation period. Out of all patients, 106 (3.2%) showed clinically relevant signs of aggression. Three patients had missing values in regard to aggressive ideations and one patient a clinical diagnosis of “schizophrenic disorders” (ICD-10 F20-29). There were 102 patients with aggressive ideation left for our analyses, and another 3109 without.

Of the 102 patients with aggressive ideations 27.5%had fantasies of “minor harm”, 37.3%patients ideations of “serious harm without bodily harm” and 35.3%ideas of “bodily harm”.

Patients had on average a very high score of 3.04 (SD = 0.68, n = 91 because of 11 missing data on the PTED scale) on the embitterment scale. Furthermore, we found a significant correlation between the sum score of aggressive ideations in the interview and the embitterment scale (r = 0.250, p = 0.017).

There were significant differences between control patients and patients with aggressive ideation for age (F _(3,3207)  = 3.27, p = 0.021) and intelligence (F _(3,2892)  = 3.18, p = 0.023) with no significant difference according to the post hoc Scheffé tests between aggression groups. There were no group differences for the other sociodemographic data (Table 1). Differences emerged with aggression patients suffering less often from “affective disorders” (χ² ₍₃₎  = 12.19; p = 0.007) and more often from “neurotic, stress-related and somatoform disorders” (χ² ₍₃₎  = 27.35; p < 0.001).

There is a significant difference in regard to overall psychological distress. Analyses of variance showed a significant difference between severity of aggressive ideations and the GSI (F _(3,3187)  = 6.92, p < 0.001). The post-hoc Scheffé test shows that preferably patients with ideas of bodily harm (p = 0.001) differ from controls. Similar differences are found for the subscale “aggression/hostility” of the SCL-90 (F _(3,3183)  = 11.94, p < 0.001). Post-hoc Scheffé test shows that patients with ideas of bodily harm have higher values than controls (p < 0.001) and patients who reported ideations of serious harm without bodily harm (p = 0.017) have lower values than patients with ideas of bodily harm.

There are significant differences between the severity of aggressive ideations and sick leave in the last 12 weeks (F _(3,3170)  = 3.80, p = 0.01) (Table 1). Patients with aggressive ideations reported more workplace bullying than patients without aggressive ideations (χ ²  ₍₃₎  = 44.2, p < 0.001). For “sick leave” and “workplace bullying”, there is a linear increase with the severity of aggressiveness.

The data show no differences between patients with and without aggressive ideation in regard to gender, education, family and living status. This suggests that the reported differences can be attributed to the workplace and cannot be explained by common sociodemographic factors. A difference in this regard is that lower intelligence, as measured with the standardized IBF, is related to more aggressive tendencies. This result is consistent with findings which show that low intelligence can be a risk factor for aggression [41, 42].

As one might expect, there are significant overall differences between groups in regard to aggression/hostility on the respective SCL-90-subscale. Most important is the relation with bullying. The more intensive aggressive ideations are, the more patients complain about bullying. This suggests that bullying can be a trigger for aggressive fantasies. This is in contrast to other workplace problems such as job insecurity and inability to work. Aggression is mostly a “reactive emotion”, so that it is not surprising that bullying leads to aggressive fantasies in the victim. This is also supported by the differences in clinical diagnoses. The more severe aggressive fantasies, the more frequent the clinical diagnoses has been “stress-related disorders” (F40-48), while depression (F30-39), which in contrast commonly includes giving up and withdrawal, is less frequent in aggressive patients. The results of the GSI show that aggressive patients are suffering themselves. There is also a prolonged duration of sick leave. This can be explained by the fact that patients, who suffer because of maltreatment by others, expect an improvement of their situation by a change in the behavior of others. They do not see the need to ask for help themselves. At the same time, being out of work may vice versa stimulate even more aggression [43]. Furthermore, it is well known that bullying and also organizational injustice in particular can be associated with absenteeism [44]. In this context, one can explain the higher age of aggressive patients by the fact that older employees may have higher aspirations in regard to what they deserve or how they should be treated. This may be a risk factor for disappointment, feelings of injustice, and conflicts.

When talking about aggressive fantasies, special attention should be paid to the severity. Fantasies are not real actions. However, fantasies can be a risk factors for acting out such ideas [45–48]. Minor aggressive acts such as scratching along the side of a car are bad, but in the end only a nuisance. Severe aggression like sabotage and destruction of machinery are severe criminal acts which can harm not only other parties, but the patients themselves. This has to be taken seriously. This is even more important, when there are fantasies to attack the other persons physically. Of our patients with aggressive ideations, 72%had dangerous and very dangerous fantasies. This aspect has so far found no sufficient recognition in the literature, but is of utmost importance. It is unclear and in need of further research when fantasies become real actions and how this can be prevented. In any case, these findings are in accordance with other publications which argue that bullying at the workplace must be taken serious and that organizational measures should be implemented to prevent such negative occurrences [49].

Limitations of the study are that the study was done in a rehabilitation hospital and therefore with a special group of patients. A generalization of the data to other populations is therefore only possible to a limited extent. Assessments were made under conditions of routine care and data were analyzed retrospectively, so that rigorous procedural controls were not possible. In any case, further research should include other patient samples and more sophisticated measurements.

5 Conclusion

In summary, our data suggest that aggressive fantasies in psychosomatic patients are associated with bullying and increased general suffering. Due to the increased suffering, aggressive fantasies should be addressed in diagnostic interviews specifically with the patients who complain about work problems in order to recognize possible dangers early on and to be able to initiate interventions. This should be recognized in the treatment of patients with workplace problems and especially those who complain about bullying.