PTSD resulting from accident, disaster, war, terrorism, torture, kidnap, etc has been extensively studied and literature is available elsewhere. The first written reference to PTSD symptoms comes from the sixth century BC; Post Traumatic Stress Disorder is nothing new – and neither is the willingness of some people to discredit and deny the existence of the disorder.
This section of Bully OnLine focuses on PTSD and Complex PTSD resulting from bullying, primarily in the workplace, however anyone suffering PTSD (however caused) will find this page enlightening.
Most of the information on this page and web site is relevant to other types of bullying, eg at school, in relationships (including domestic violence), by families, by neighbours or landlords, in the care of the elderly, in the armed services, etc.
Bullying is behind harassment, discrimination, prejudice and persecution, therefore targets of repeated sexual harassment or racial discrimination or religious or ethnic persecution will also identify with the symptoms. The insight about bullying on this web site is therefore also relevant to more serious issues including physical abuse, repeated verbal abuse, sexual abuse, violent crime, kidnap, abduction, rape, war, terrorism, torture, and denial and abuse of human rights. Those exploring Contact Experience may also find this page helpful.
PTSD, Complex PTSD and Bullying
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 a psychiatric 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, e.g. 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 – see separate 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?
- 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, e.g. 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.
- 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, e.g. 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 hyper sensitized and now unwittingly and inappropriately perceives almost any remark as critical.
- Recovery from a bullying experience is measured in years. Some people never fully recover.
- 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
hyper vigilance (may feel like paranoia, but see HERE for key differences between paranoia and hyper vigilance)
- 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