A number of internationally well-documented diagnostic instruments used in catastrophe psychiatry can be used to examine a mobbing victim.

1. Brief Psychiatric Rating Scale (BPRS by Overall & Gorham - an expert observation rating scale: Overall and Beller published two articles (1984): "The Brief Psychiatric Rating Scale (BPRS) in Geropsychiatric Research: I. Factor Structure on an Inpatient Unit" and "The Brief Psychiatric Rating Scale (BPRS) in Geropsychiatric Research: II. Representative Profile Patterns" (Beller & Overall, 1984).

2. Sleep and Alertness (The Caroline Institute Sleep Laboratory): The questionnaire which we use is a shortened version of that used at the Caroline Institute´s Sleep Laboratory. Although the clinical experience behind the questionnaire is extensive, no metrical or statistical studies exist regarding the questionnaire's validity or reliability.

3. General Health Questionnaire (GHQ by Goldberg, 20-version): The questionnaire's original version comprises 60 questions. For our diagnoses, a shortened version with 20 questions was used. Validations that were carried out by Norwegian researchers are by Malt (1989), "The Validity of the General Health Questionnaire in a Sample of Accidentally Injured Adults" and by Holen (1990), "A Long-Term Outcome Study of Survivors of a Disaster." The original study was carried out by Goldberg 1985), "Identifying Psychiatric Illness Among General Medical Patients" and by Goldberg and Williams (1988), "A User's Guide to the General Health QuestionnaireÒ.

4. Beck's Depression Inventory (BDI by Beck, 13-version): The questionnaire exists in different versions. The original version has 21 questions, but the version used in our diagnoses was shortened to 13 questions. The first publication was already released in 1961 by Beck, Ward, Mendelsohn, Mock and Erbaugh.

5. Impact of Event Scale (IES by Horowitz et al. 15 version): The questionnaire scale represents a deepening of the criteria included in the conditions for diagnosis in the psychiatric diagnostic manual DSM III R (1987), upon which this scale has been based. The scale was evaluated by Zilberg, Weiss and Horowitz (1982), at the Langley Porter Psychiatric Institute at the University of California, San Fransisco. The scale was originally published by Horowitz, Wilner and Alvarez (1982), "Impact of Event Scale: A Measure of Subjective Distress".

6. Post-Traumatic Symptom Scale (PTSS-10 by Malt): The scale is described in Raphael, Lundin and Weisaeth (1989), "A Research Method for the Study of Psychological and Psychiatric Aspects of Disaster."

7. Middlesex Hospital Questionnaire (MHQ, 40-version): A large number of scientific articles about this questionnaire have appeared. A survey of the research is found in Crown Sidney, "The Middlesex Hospital Questionnaire (MHQ) in Clinical Research: A Review" (in Pichot & Olivier-Martin, 1974). A newer article is found in Pallecchi, Nicolau, Biagi & Nardini (1990), "The Middlesex Hospital Questionnaire (MHQ) Compared with the MMPI: Study of Internal and Reciprocal Correlations Between the Psychodiagnostic Scales."

8. Original PTSD diagnosis according to DSM and ICD-10: This list of criteria was taken directly from these two diagnostical manuals and used as a diagnostic summary of the seven questionnaires mentioned above.

The Diagnosis Method

The diagnosis procedure was carried out following the patient´s having undergone occupational-social anamnesis. This included a chronological description of the traumatic course of events which had taken place during the past years. The anamnesis served as the basis for the diagnosis criteria shown in part A, provided that the diagnosis showed psychological traumatic injuries. These anamneses were carried out during interviews lasting approximately 4 to 10 hours. You will find some examples of anamneses of this kind in my homepage.

The patients were informed that the diagnosis would be performed with the help of standardized questionnaires. During the course of the interviews, as soon as the questionnaire was completed, the patient was notified about what type of information had been collected. Furthermore, patients were immediately informed about the results of his or her responses. Thus, the questionnaire was evaluated immediately and continuously throughout the ongoing interview. Even the diagnostic "yesÒ to the questions concerning a decline in sexual interest, difficulties in making decisions, difficulties in starting everyday duties, etc., he was immediately given an explanation for the meaning of his or her depressiveness. The patient was thus not left with unanswered questions about what his or her answers really mean for his or her emotional state. You will find some examples of diagnoses in my homepage.

This method of diagnosing and simultaneously informing the patient thoroughly about the character and meaning of his or her answers may actually be regarded as a first cognitive behavioral therapeutic contribution, even at this early stage of our contact with the patient. The diagnosis takes approximately 2 to 4 hours to complete. Patients are also informed what the different criteria groups of the PTSD diagnosis mean and how they give rise to the psychosomatic symptoms in the diagnosis criteria group D.

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