Workplace phobia

According to the general definition of specific phobias in DSM-IV or ICD-10, workplace phobia can be stated when an actual or imagined confrontation with the workplace or certain stimuli at the workplace (e.g. persons, objects, situations, events) causes a prominent anxiety reaction in a person. Secondly, avoidance behaviour towards the workplace or associated stimuli has developed. In some cases, workplace phobia may be a kind of social phobia, social anxiety or extreme shyness.[1]

Symptoms

When approaching or being at the workplace, or even when intensively thinking of the workplace, anxiety rises. This goes along with increased physiological arousal, typically with symptoms of accelerated heartbeat, sweating, trembling, hot flushed, chest pain, which might even result in a panic attack. Also could have violent behaviour toward the person who is incharge, due to anxiety

When avoiding or leaving the feared workplace, arousal and anxiety decrease. This functions as a classical negative reinforcement: The avoidance reaction is rewarding as it reduces anxiety, reinforcing avoidance behaviour.

Avoidance

In consequence of workplace phobia, avoidance of the workplace through “sick leave” certified by a medicine is a regularly found phenomenon.

There is a tendency for generalisation of avoidance behaviour, like avoiding passing the street where the workplace is situated, avoiding going to public places (like the supermarket) where one could meet colleagues or superiors, or even developing panic attacks and anxiety when only speaking of the workplace.

Aetiology

Anxiety related to the workplace can be released through situational factors at the workplace itself (Mobbing, experiencing a traumatic event, sudden changes in work organisation or work content, workplace environmental factors). On the other hand, it can also be the consequence of a primary conventional mental disorder (especially anxiety disorder) which was primarily not related to the domain of work. In this case, anxiety manifests at the workplace in a specific quality. Mostly there are interactions between a general level of anxiety and workplace-related anxiety. Workplace phobia often develops after structural changes in the work environment or in work contents, or after changes in personnel and social conflicts at work.

Socio-medical meaning

Workplace phobia is a complex clinical phenomenon with an own clinical value, with specific aetiology factors and specific requirements for therapy. This is due to the special characteristics of the anxiety-provoking stimulus:

Therapy

The special problem about workplace phobia treatment is that a controlled stepwise exposition to the anxiety-provoking stimulus is hardly possible. The situational conditions cannot be controlled therapeutically, the workplace cannot be entered anonymously, events happening there cannot be foreseen. With such great variety of possible disturbing factors, an exposition might even result in strengthening the phobic disorder.

More adequate treatment methods are descriptions and analysis of situation and behaviour, development of coping strategies for reducing the general feeling of insufficiency, reframing and symptom management, clearing conflicts and exposition in sensu. A specific therapeutic instrument is the "vocational capacity test“ recently developed in the context of psychotherapeutic rehabilitation clinics. Hereby inpatients attending a rehabilitation therapy are sent to cooperating firms for hospitation for some days, under therapeutic supervision. By this, patients who have been away from work for a longer period can do first steps into a public work environment, may carefully test and be observed concerning their capacities at the same time.

Diagnostic status

It can be discussed whether workplace phobia may be seen as a proper mental disorder for itself or as a symptom of another conventional (i.e. not work-related) disorders, such as social anxiety disorder ("social phobia"), obsessive-compulsive disorder and post traumatic stress disorder. Due to the specific characteristics of workplace phobia, especially its clinical and socio-medical consequences and the requirements for treatment, it seems to be senseful to treat and name it as a proper disorder. This can be understood in analogy to a heart attack which does also appear “only” as an additional symptom within a metabolic syndrome, but nevertheless gets an own status of disease because of special symptomatic, consequences for participation and prognosis, and therapeutic requirements.

See also

References

  1. ↑ Ronald C. Kessler, Ph.D., Murray B. Stein, M.D., and Patricia Berglund, M.B.A. Social Phobia Subtypes in the National Comorbidity Survey, Am J Psychiatry 155:613-619, May 1998

Further reading

External links

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