Personality Disorders in the Workplace: Reviewing the Drama Queen

By Mark P. Unterberg, MD

Attractive and engaging at first, the histrionic employee can cause chaos by overreacting and constantly demanding attention.

This is the second 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 co-workers. The workplace effects of personality disorders and styles are initially more subtle than the effects of such more overt problems as depression or alcoholism.

The previous installment dealt with the obsessive compulsive personality. Subsequent installments will discuss antisocial, 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

Sandra Green is a 27-year-old single woman who was hired for a middle management position in marketing. She came with excellent references and had impressed the head of marketing with her intelligence, quick wit and extremely attractive appearance.

Green quickly became part of the group. Within days, she had personally sought out each of her colleagues, introducing herself and winning them over with her humor, personality, style and helpfulness to the department. She dressed better than anyone else at the office, and her male co-workers particularly liked her. She swiftly established herself at meetings by presenting novel ideas that needed lengthy discussion. Even so, Green didn't actually seem to get much done.

Over the next few months, it became increasingly clear to some co-workers that Green needed inordinate amounts of attention. She kept finding ways to put herself on center stage. She started to date three male co-workers simultaneously, while at the same time her female colleagues found her increasingly competitive, uncooperative and unsympathetic. A crisis developed when Green complained hysterically to her male supervisor that the other women in the office had not invited her to a Friday evening happy hour. She angrily decried how badly they treated by her, despite her own unusually considerate efforts. In dramatic terms, Green said she was a helpless victim of "jealous and competitive" female colleagues. She was very convincing.

The supervisor called an office meeting. Green subtly castigated some other employees for not appreciating her work. Several people asked her not to monopolize discussion time at business meetings. Some also complained that she spent more time at coffee breaks with men than on group projects. After the meeting, Green stormed into the supervisor's office. She demanded that a couple of people be threatened with termination if they tried to interfere with her performance or social life. She also suggested that a closer relationship with the supervisor could help them both and suggested continuing the discussion over lunch or dinner. Flattered at first, the supervisor suddenly became aware of Green's seductiveness and her effects on morale. He realized, too, that her work lacked the quality and depth that her references and initial plans had seemed to predict. The next week, he asked her to seek a consultation.

In consultation, the psychiatrist recognized the full spectrum of histrionic personality traits, as well as symptoms of a chronic mild atypical depression. Importantly, he also discovered that she had left her previous job after a failed long-term romance with a colleague there. Although that relationship had always been rocky, she felt devastated by the breakup and increasingly despondent about her future social prospects. Green was referred for individual and group psychotherapy and started on phenelzine, an antidepressant. When her mood started to improve within three weeks, there was a marked reduction in office tensions.

Even so, Green had great difficulty recognizing and accepting that she played a significant role in her problems. When she was able to see this as a product of early childhood fears and wishes, though, she gradually began to make corrections. Her dress became more appropriate, and she no longer needed quite so much attention. She became increasingly aware of her oversensitivity to others and was able to respond appropriately.

In less than a year, co-workers were well aware of the changes that Sandra Green had made. Her work improved, and her romantic life was conducted outside the office. Although she still took up a lot of meeting time, she could catch the hint to finish and would often end a speech with humor.

Diagnosis

Employees with histrionic traits may initially come across as particularly attractive or seductive. Their dress, behavior and demeanor all contribute to an emotional, even sexual, allure. Without awareness, they often use their attractiveness to achieve other goals or wishes. Co-workers often perceive an immature or infantile inability to recognize failings or even to acknowledge the potential validity of other people's observations. Instead, there appears to be an insatiable appetite for attention and a dramatically embellished manner of speaking. More problems arise in the workplace when exaggerated emotions bother other employees, stir up competitive and jealous feelings, lead to excessive controversy or contribute to overblown promises and incomplete assignments.

Histrionic personality traits are commonly demonstrated through overly emotional reactions to everyday situations. Tension and emotional excitability are combined with inappropriate exaggeration of relatively normal happy, sad or angry feelings. Histrionic traits are commonly exaggerated under the stress of personal or work problems, or if there is a concurrent depression or anxiety disorder. In particular, atypical depression can be associated with exacerbated histrionic traits. Nevertheless, these two syndromes are thought to have differing causes and treatments.

Diagnostic Criteria:

Histrionic Personality Disorder

A pervasive pattern of excessive emotionality and attention seeking, 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

Histrionic personality traits give an appearance of immaturity. An employee may feel that his attractive qualities entitle him to special treatment and may feel angry at a more emotionally stable supervisor. That anger can lead to unwitting manipulations designed to attract attention from those in authority.

Initially, management should help to set boundaries by providing the employee with clear rules, expectations, feedback and modeling. Here, too, referral for consultation can be useful when problems persist. As with other personality disorders, histrionic employees may take the stance that their problems are caused by other people. It may be especially difficult in the workplace to address any problems of inappropriate relationships, personal dress or seductive style. The prognosis is quite good when there are strengths that can enhance social and work activities and a capacity to develop introspection and change.

Psychiatric management

When therapy begins, the patient often feels upset about undeserved criticisms or losses. There may be substantial, if partially unwitting, attempts to convince the therapist to offer sympathy for the perceived victimization. Unprovoked, behaviors and perceptions from outside soon start to appear within the therapy itself. Drawing a parallel to behaviors at work and at home, the patient can now begin to recognize counterproductive behaviors and painful underlying emotions.

It is important for the therapist to remain empathic with the patient's distress yet not be unduly influenced by the intensely expressed emotions. In fact, therapist awareness of some of the feelings generated will provide information about how others react to the patient outside the therapeutic setting. Gradually, by using observation of behaviors along with exploration of how these may be connected with the past, the therapist can eventually help address the self-destructive traits, while recognizing the positive and engaging elements.

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: Reviewing the Drama Queen.

Business and Health

Jul. 15, 2003;21.