Personality Disorders in the Workplace: Loving Me, Myself and I

By Mark P. Unterberg, MD

Despite being creative and motivated, narcissistic employees are only in it for themselves, and will stop at nothing to reach their goals.

This is the sixth 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, paranoid and borderline personalities. The final installment will discuss 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

Bill Chang is a 41-year-old vice president of manufacturing operations. He had been promoted over several other managers after only 10 years with the company. More than a few colleagues had the feeling that Chang's prestigious position came more through office politics and ingratiation of the president than it did from significant personal accomplishment. Although a few people were resentful, most were impressed by his looks, bearing, charm and achievement. Chang's wife is extremely attractive, well positioned in society and the mother of their two beautiful children. Rumor has it that his expensive cars, showy house and exclusive country club membership were paid for more by his wife's family than by his own income or investments.

Gradually, there were increasing complaints from Chang's subordinates. They thought that Chang was unconcerned about their well-being. They also thought that their assignments seemed mostly designed to advance Chang's position and that he was sacrificing production quality and efficiency for his own short-term benefit. Chang sometimes used departmental meetings as a platform for his grandiose ideas or even for outright discussions of his personal power, brilliance and future success. And despite his dazzling success, he was hypersensitive to criticism. Almost everyone agreed that he was intolerant of even the most constructive advice. Still, Chang had quite a following. He sought out those in positions of power. Although he tolerated subordinates who might be useful to him, he had little apparent concern for anyone beneath him. Those who would feel appreciated for a while would eventually end up feeling used.

After several months of growing complaints, the president realized that some of Chang's character traits had been exaggerated by the promotion. Besides the obvious impairment of departmental enthusiasm and morale, there were questions about management style and direction. He shared his concerns with Chang and referred him to a consulting psychiatrist. Although the president figured that Chang needed work on some superficial behaviors, his overall respect for him was undiminished. Bill Chang, though, felt rejected and a bit humiliated at first. Later, he realized the importance of the president's referral. In the near term, he was able to start paying more deliberate attention to his subordinates' concerns and to long-term planning for his department. Only much later did he start to understand how his emotional sensitivity had made him seek admiration as a substitute for affection.

Diagnosis

Narcissistic individuals can have strongly detrimental effects on the workplace. Through charm, intelligence and very real contributions, they can advance a highly personal agenda that precludes actual concern for others or for organizational goals. Recognition of the problem can be difficult, especially of narcissistic traits in powerful individuals. Ultimately, destructive self-serving behavior creates significant adverse consequences, so it is usually better to handle the problems sooner than later. At the same time, it is important to remember the significant difference between ambition and healthy self-advancement on the one hand and destructive self-aggrandizement on the other.

Narcissism is best thought of as a reflection of an underlying inability to find or tolerate emotional intimacy. Instead, narcissistic traits develop as protection against underlying loneliness, fear and anger. At the same time, they offer means of finding substitutes for the missing affection. The replacements can range from preoccupation with power, wealth or material things or with such personal assets as intelligence, beauty or physical strength. These reassurances offer a fragile stability, but are subject to disruption by their loss or by almost any manner of life changes. Major depression and self-destructive behavior are common consequences.

Diagnostic Criteria:

Narcissistic Personality Disorder

Pervasive pattern of grandiosity (in fantasy or behavior), need for admiration and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

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

Narcissistic individuals often present organizations with a real dilemma. They can be very motivated and creative and have much to contribute. But ultimately, whatever they do, it is really for themselves. They may see themselves as indispensable and others as unimportant. They may feel such a need to appear perfect that they can't let themselves seek help.

The narcissistic employee needs to be approached in a gentle, non-threatening manner to prevent further blows to his ego and avoid further reaction. Correction should be put in a constructive light and must be balanced by positive input from the supervisor. It is always important to leave this individual with something positive, particularly self-respect.

Psychiatric management

Psychotherapy initially fosters a therapeutic alliance and then focuses on developing a fuller lifestyle. The narcissistic preoccupations are not challenged directly. Rather, they ultimately fade in importance as the quality of emotional relationships improves. At the same time, though, initial reality testing is often important. Helping patients see that their behaviors and emotional distancing have effects on other people, and that those effects can hurt them in turn, is essential for their future success. Frequently, it can be helpful to point out conscious conflicts of narcissistically related behaviors with personal moral or religious beliefs.

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: Loving Me, Myself and I.

Business and Health

Sep. 15, 2003;21.