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    Personality Disorders in the Workplace: The Impulsive, Divisive Employee

     

    Personality Disorders in the Workplace: The Impulsive, Divisive Employee

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    By Mark P. Unterberg, MD

    Subtly influencing coworkers, employees with borderline personality traits can prove a real challenge for management.

    This is the fifth of seven articles that deal with personalities, personal style and trouble getting along in the workplace. Click here for an archive of the entire series. Each of the personality disorders discussed includes at least three elements. First, the behavior patterns are both inappropriate and painful to the self or to others. Second, the maladaptive patterns are substantially unaffected by external inducements to change. And third, little by little, the patterns create problems for the organization and for coworkers. The workplace effects of personality disorders and styles are initially more subtle than the effects of such more overt problems as depression or alcoholism.

    Previous installments dealt with obsessive compulsive, histrionic, antisocial and paranoid personalities. Subsequent installments will discuss narcissistic and passive-aggressive traits. All are adapted from the newly published book, "Mental Health and Productivity in the Workplace: A Handbook for Organizations and Clinicians," edited by Jeffrey P. Kahn, MD, and Alan M. Langlieb, MD, published by Jossey-Bass (a Wiley imprint) and noted in publications as diverse as HR Magazine, Inc., and the New York Times.

    The case

    Jane Tryen is a 37-year-old somewhat overweight former sales clerk, who joined Paycash Stores at an entry-level management position. She had always been an underachiever, but got this new job through hard work, intelligence and because of a company effort to have well-seasoned sales personnel in lower management. A few months later, her office seemed to be struggling with morale. Projects that required teamwork and collaboration were falling behind. When employees were interviewed individually about the problems, they kept mentioning Tryen.

    Tryen would take provocative and angry positions against opposing views, while at the same time gathering passionate supporters for her side. In effect, she played people against each other. Even in social interactions, co-workers would sometimes feel angry at each other until they realized that Tryen had somehow set up their disagreement. Tryen liked to gossip about people but was pretty much unaware of her effects on them or the extent of their discussion about her. She did feel that there were co-workers who were causing problems for her but would laugh and gossip with them, even while campaigning secretly for their dismissal.

    Tryen felt that any criticism of her was unfair, especially considering her current personal crises. After her recent third divorce, her ex-husband was not making alimony payments. They would sometimes argue late into the night, and Tryen would be tired and tense the next day at work. Actually, she always had a complicated personal life. Her emotions would shift from one extreme to the other; it took little to provoke her anger, and there was always the desperate loneliness. Increasingly estranged from co-workers and spending her limited funds on appropriate business attire, Tryen now felt both emotionally and financially impoverished. Eventually, she became so enraged that she abruptly threw some of her files across the room. Later that week, she stormed out of a meeting with her supervisor and left for home.

    The supervisor realized that Tryen had become an increasing liability and a cause of other employees’ dissatisfaction. Co-workers were spending enormous amounts of time and energy dealing with Tryen and with the results of her actions. Even so, the company had invested considerable time and energy in her training, and she had completed some successful projects. When Jane Tryen was referred for consultation, she loudly ridiculed the idea to anyone in the office who would listen.

    Diagnosis

    Borderline personality traits can cause seriously disruptive effects in the workplace. Intense emotions, impulsive behavior, subtle divisiveness and disaffection all contribute to discord and disunity. Causes of borderline personality are thought to include unstable or disruptive early childhood relationships, as well as comorbid anxiety and depressive disorders. Panic disorder is especially common.

    Theorists have also pointed out that borderline personality disorder is associated with certain characteristic styles of emotional defenses. For instance, hidden anger at expectations of emotional rejection and despair is diffused through such mechanisms as splitting (divisiveness) and over-idealization or devaluation (seeing people as all good or all bad).

    Diagnostic Criteria:

    Borderline Personality Disorder

    Pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

    1. frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
    2. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
    3. identity disturbance: markedly and persistently unstable self-image or sense of self
    4. impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
    5. recurrent suicidal behavior, gestures or threats, or self-mutilating behavior
    6. affective instability due to a marked reactivity of mood (e.g., intense episodic-dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days)
    7. chronic feelings of emptiness
    8. inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
    9. transient, stress-related paranoid ideation or severe dissociative symptoms

    Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Copyright 2000 American Psychiatric Association.

    Workplace management and referral

    Employees with borderline personality traits are challenging for management. Although there can sometimes be overt evidence of impulsive or disruptive behavior, the problems are more often manifest in more subtle ways. Unwittingly, the employee can have a divisive influence on coworkers — for instance, by persuasive and emphatic expression about how other people have been either always helpful or always harmful to them.

    Appropriate limit setting is essential, with a focus on proper workplace conduct, completion of assigned tasks, and due consideration of coworker feelings. The supervisor must also be ready for angry protests and even tolerant of the possibility that the employee will be angry at him or her. Problems and complaints should be discussed specifically and with specific suggestions for improvement. Supervisory meetings should not deteriorate into arguments.

    Psychiatric management

    Treatment of borderline personality disorder is always a complex process. Because circumstances and other people tend to be seen in all good or all bad terms, there can be difficulty in recognizing that most people have both strengths and weaknesses. Impulsive and angry behaviors are also common complications. Intense emotions combine with inner despair and limited self-control of behavior to make for behavioral problems in all relationships, and the therapeutic relationship will similarly follow a stormy course. The psychiatrist will be seen alternately in idealized and highly critical ways.

    One early goal of therapy is to foster a therapeutic alliance and point out that other people should be viewed in a more realistic way. Ultimately, the underlying mistrust of relationships and consequent anger at other people must be explored. It should be noted that depressive and anxiety disorders are extremely common in these patients but usually unrecognized. Psychotherapy without appropriate medication for those syndromes will usually have quite limited benefits.

     

    Click here to view the archive of this entire personality series, with links to each specific article.

    Mark P. Unterberg, MD, is former chairman of the board and executive medical director of Timberlawn Mental Health System, Dallas. He is board certified in adult psychiatry and addiction psychiatry, and a fellow of the American Psychiatric Association. He is a clinical professor of psychiatry at the University of Texas Southwestern Medical School and teaching instructor at the Dallas Psychoanalytic Institute. He is currently team psychiatrist for the Dallas Cowboys and treating clinician for the National Football League Player Association’s Program for Substance Abuse. He can be reached at Munterb@AOL.com.
    Jeffrey Kahn, MD, is president of WorkPsych Associates, which provides executive assessment, development, coaching and treatment, as well as management, human resource, organizational and benefits consultation for a wide range of corporations and individuals. He is also past president of the Academy of Organizational and Occupational Psychiatry and a clinical assistant professor of psychiatry at the Weill Medical College of Cornell University in Manhattan. He can be reached at JeffKahn@aol.com.
    Alan Langlieb, MD, MBA, has broad experience in increasing public awareness of mental health issues, especially in business and through the media. He is an assistant professor of psychiatry at Johns Hopkins School of Medicine in Baltimore. He can be reached at alanglie@jhmi.edu.

    References and Additional Sources

    American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

    Bellak, L., & Faithorn, P. (1981). Crises and special problems in psychoanalysis and psychotherapy. New York: Brunner/Mazel.

    Colarusso, C. A., & Nemiroff, R. A. (1981). Adult development. New York: Plenum Press.

    Freud, S. (1954). The standard edition of the complete psychological works of Sigmund Freud. London: Hogarth Press.

    Gabbard, G. O. (1994). Psychodynamic psychiatry in clinical practice: The DSM-IV edition. Washington, DC: American Psychiatric Press.

    Kaplan, H. I., & Sadock, B. J. (1997). Synopsis of psychiatry (8th ed.). New York: Lippincott Williams & Wilkins.

    Kernberg, O. F. (1975). Borderline conditions and pathological narcissism: New York: Jason Aronson.

    Kernberg, O. (1984). Severe personality disorders: Psychotherapeutic strategies. New Haven, CT: Yale University Press.

    Levinson, D. J. (1978). The seasons of a man’s life. New York: Ballantine Books.

    Nicholi, A. M. Jr. (1988). The new Harvard guide to modern psychiatry. Cambridge, MA: Belknap Press.

    Vaillant, G. E. (1977). Adaptation to life. New York: Little, Brown.

     



    Mark Unterberg. Personality Disorders in the Workplace: The Impulsive, Divisive Employee. Business and Health Sep. 1, 2003;21.