Personality Disorders in the Workplace: The Distrustful, Suspicious Employee


Misinterpreting friendly efforts and fueling mistrust between friends, coworkers and family, the paranoid employee has a hair-trigger response to perceived anger or harm.


Personality Disorders in the Workplace:
The Distrustful, Suspicious Employee

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Choose article section...The caseDiagnosisDiagnostic Criteria: Workplace management and referralPsychiatric management

By Mark P. Unterberg, MD

Misinterpreting friendly efforts and fueling mistrust between friends, coworkers and family, the paranoid employee has a hair-trigger response to perceived anger or harm.

This is the fourth of seven articles that deal with personalities, personal style and trouble getting along in the workplace. This is the fourth of seven articles. 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 the obsessive compulsive and histrionic personalities. Subsequent installments will discuss paranoid, borderline, 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

Ethan Waterman is a 34-year-old married man who was recently elected union shop steward after seven years at his firm. Waterman was known as a good worker, but had always seemed quiet, humorless and a bit discontent. Although he was cordial to his superiors, he tended to keep his distance and was more comfortable talking to one or two people than in a larger group. Even before his election, Waterman would get angry about management and occasionally raise questions that imputed prejudiced motives. After he became enraged during a meeting with company managers, he was referred for a confidential consultation.

After several interviews, it was clear that Waterman harbored tremendous resentment of authorities at work, within his union, in politics and in his family. His questions of the psychiatrist were at first belligerent and accusatory. He felt that there was no relationship between his intensified anger and the near simultaneous arrival of elective office and of a first child. He said that his anger had increased because of a new realization about the depth of company efforts against him. Waterman saw no reason to continue treatment.

Waterman was convinced that the company exploited and harmed union employees. He often used the power of the union shop to deliver attacks without any real basis in reality. Much of his angry fire was directed at managers who had previously offered him advice, helpful supervision or constructive criticism. He was also spending far more time rallying workers against the company than trying to resolve the perceived problems. He spent even less time completing his work assignments. Finally, Waterman angrily threatened to sue the vice president for human resources. In front of other people, he also made obscene comments and appeared physically intimidating.

Faced with the prospect of termination and aware now that something was troubling him, Waterman agreed to enter treatment. Discussions of his earlier combativeness with the psychiatrist led to some awareness of his adversarial view of authority figures. He realized that his view of management had been colored by emotions from his personal life and upbringing. Gradually, he became better able to separate his emotions from his perceptions of the company. Although Ethan Waterman remained more suspicious of company motivations than others did, he could now assess each situation individually.


Paranoid personality traits are more commonly heightened by accomplishments than by criticisms. The newly elevated role feels more precarious and subject to the malevolence of others. This can be a realistic perception to some extent, because managers and leaders draw more attention than employees with less authority. But a paranoid perception can make newly found attention feel like attack.

Paranoid personality disorder is different from paranoid psychosis. Psychotic disorders allow little capacity for reality testing, are more likely to appear bizarre, pose a greater risk of danger, and usually need medication or hospitalization. A psychotic employee, who talks to others solely through his own fantasies, is often recognizable to everyone.

Paranoid personality traits, which lead to constant concern about potentially harmful environments and people, are thought to derive from early failure of intimate relationships. Rather than risk feeling abandoned by other people, an individual with paranoid traits substitutes an adversarial attachment. But there is an ongoing mistrust of friends, colleagues and family. Feelings are strongly projected onto others, with the possibility of hair-trigger reactions to perceived anger or harm. Since the anger can be palpable to others, it can lead unwittingly to adversarial relationships, and thus become a self-fulfilling prophecy. Paranoid personality traits make some appear like "lone wolves." Kindness and a soft underside beneath the angry exterior can invite friendship and helpfulness. Unfortunately, paranoid traits carry a deeply felt fear of hostile intentions, and friendly efforts sometimes stir up an angry reaction.

Hypervigilance and self-protective data gathering can also be a major asset. High-functioning employees with paranoid traits are often able to make accurate observations about other individuals. These are commonly critical observations, perceived from a hostile position, conveyed as objective truth and designed for self-protection. Colleagues may find it difficult to determine the frame of reference, especially of someone in a position of power. And apprehensiveness about people in general can include particular mistrust of those who are more trusting.

Diagnostic Criteria:

Paranoid Personality Disorder

A. Pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

B. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, or another Psychotic Disorder and is not due to the direct physiological effects of a general medical condition.

Note: If criteria are met prior to the onset of Schizophrenia, add "Premorbid," e.g., "Paranoid Personality Disorder (Premorbid)."

Workplace management and referral

People with paranoid traits are often most comfortable in a relationship that is supportive, consistent, fair and emotionally non-intimate. That kind of anchoring relationship offers a degree of emotional stability and reality testing. Although a treating psychiatrist can fill that role, treatment also involves ultimate discussion of deeper emotional concerns. In the workplace, a manager can set up periodic brief meetings to discuss ongoing projects and organizational concerns. Those meetings also serve as a safe place to express grievances confidentially without fear of reprisal. Unlike a therapy session, the focus is entirely on work projects, without consideration of emotional relationships at home or in the workplace.

Objective data collection and feedback are often reassuring. This kind of process can be effective only if the paranoid employee has sufficient trust in the supervisor to tolerate a differing opinion. Care must be taken not to get caught up in paranoid beliefs. Although optimal treatment and management may still leave some continuing fears of persecution, consistent reality testing can keep them in check and minimize effects on workplace relationships.

Psychiatric management

As with any other personality style, the initial task of treatment is formation of a treatment alliance, based on the therapist's ability to instill a sense of trust, stability and reliability in the relationship. The task is complicated because the general mistrust of others applies to therapists too, though careful perseverance can allow even this obstacle to be minimized. It is helpful to acknowledge how real the mistrustful perceptions are, but without challenging their accuracy.

After an alliance has been formed, work can begin on recognizing the general mistrust of others and the reality that not everyone is actually hostile or even paying attention. A focus is also placed on learning to differentiate between reality and fearful perceptions. Greater change is accomplished through further understanding of hidden emotions and their childhood origins. Not infrequently, concurrent depressive or anxiety disorders require use of medication.

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
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
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

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 Distrustful, Suspicious Employee.

Business and Health

Aug. 15, 2003;21.

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