Personality Disorders in the Workplace:
Shaking Down the Con Man

By Mark P. Unterberg, MD

Always trying to beat the system, the aggressive antisocial employee can wreak havoc in the workplace by guiltlessly satisfying his own sense of entitlement

This is the third 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.

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

Phil Dixon is a 35-year-old recently divorced shipping department employee who had impressed the job interviewer with his intelligence and style. Dixon worked hard at first and impressed his supervisor, but within a few months he started a pattern of calling in sick and taking family leave days. Sometimes his job assignments got fouled up or had to be completed by someone else, and there were increasing reports to the supervisor about Dixon's lack of consideration for co-workers. Meanwhile,several expensive items had disappeared from the shipping department.

Still, Dixon was a likeable man who socialized with the others. He found it easy to get personal loans from co-workers, as well as advances on his salary, but that was partly because people wanted to avoid the irritability and aggression that surfaced easily if they disagreed with him or crossed hm.

Dixon's difficulties culminated when housekeeping discovered some of the missing items in his locker during routine cleaning. When Dixon was confronted, he claimed that someone must have planted the items to sabotage his job status. He was so tearful and convincing that the supervisor thought he was telling the truth. But co-workers had long suspected Dixon and had not had much luck getting their money back. Some of their own things were missing too. When Dixon met with the supervisor again, he became irate and threatened to walk off the job.

Feeling confused and threatened, and recognizing a significant personality problem, the supervisor asked Dixon to see a psychiatric consultant. Dixon said that he was going for therapy, but it was nearly a month before the supervisor realized that Phil Dixon never even went for the consultation.

A second case

At age 46, Tom Newman was a senior vice president of the Zeilig Manufacturing Company. The busy CEO had recognized his accomplishments, and Newman had risen rapidly through the ranks. Although there had long been quiet rumors about Newman's engaging in improper activities, most of the stories came from disgruntled former subordinates and were passed off by the preoccupied CEO. Eventually, a former female employee filed suit against Newman and the company, claiming he had intimidated her into a sexual relationship. Four similar stories from four other past and current employees quickly surfaced.

Further investigation included review of Newman's extravagant travel expenses. He had apparently padded as much as $80,000 over four years. A careful second look at his initial job application revealed that he had been suspended twice from college for cheating and theft, that he hadn't actually gone to graduate school at all, and that he had failed to acknowledge a conviction for tax evasion in his 20s. Confronted with these allegations, Newman denied any impropriety. When his explanations were questioned, he became irate and implored the CEO to fire the individuals who had confronted him and even tried to fire a few of them himself. As the file on Newman grew, the CEO put him on leave and considered legal action.

Diagnosis

Sociopaths in an organization want to beat the system. They will try to satisfy their own sense of entitlement, with little concern for the personal or professional effects on others. Notably, there is an apparent absence of guilt about these behaviors.

Assessment of antisocial personality must consider past history, as well as recent events. The pattern begins in adolescence and typically encompasses all spheres of activity. Antisocial patterns are likely to be present from school, other employers and at home. It is important not to confuse isolated dishonest behavior under emotional stress with the more pervasive and intractable behaviors of antisocial personality.

Causes for antisocial personality disorder are uncertain. Antisocial patterns may partially reflect maladaptive adult role models from childhood or adverse socioeconomic factors. They may also be an extreme variant of narcissistic personality traits, with cold detachment from other people and feelings of angry entitlement. An inherited component has been suggested, possibly associated with somatization disorder.

Diagnostic Criteria:

Workplace management and referral

Antisocial personality traits wreak havoc in the workplace. Not only are the behaviors themselves destructive, but their occurrence can insidiously undermine morale. Manipulations, cons and improper conduct are hidden at first, then earnestly denied. The apparent lack of guilt about harm to others can be especially destructive. Workplace recognition usually follows the overt association of a problem or pattern of problems with the responsible party. When the responsibility does become clear, management must be quite firm and set clearly defined rules of conduct. If the employee stays with the organization, close supervision and carefully structured work responsibilities are a necessity. In particular, the employee should not be allowed to make unsupervised decisions that could hurt other employees or the organization. Significant antisocial personality traits are an indication for prompt referral for nonjudgmental treatment.

Without treatment and careful reinforcement of workplace rules, there is little hope for change in antisocial personality disorder. Even so, prognosis is always guarded, since there is limited ability for those with these traits even to recognize that a problem exists and few internal safeguards to prevent manipulation of the treatment itself. Return to work is possible only when the damage done is minor and future risk is small. Otherwise, morale can be seriously affected by the anger of co-workers and supervisors over past behaviors and ongoing concern about continuing lack of concern and betrayal of others. Prognosis is far better when there has been only an isolated episode of dishonesty, in the absence of true antisocial personality.

Psychiatric management

True antisocial traits present a problem for psychotherapy. These employees may agree to therapy solely because it is less painful than losing a job or going to jail. Characteristically, these employees present with pseudocompliance as a conscious resistance to treatment. It is important, then, to have as much clinical information as possible from outside sources (which does not necessarily mean breaching patient confidentiality).

Because antisocial individuals do not always share the same emotional and behavioral monitoring system as others, they can quite readily agree with any interpretations and comments about their behavior. This gives the appearance of participation in therapy but without true introspection, insight or change. Ultimately, change requires that the patient realize intellectually that existing behavior patterns will lead to dreadful pain and suffering. Antisocial patients are far more likely to be concerned about their own pain than they are the pain they cause others. At least a year of consistent therapy is usually needed for any chance of deep emotional change. Ideally, treatment also enables the patient to incorporate some of the psychiatrist's values through emotional attachment and emulation.

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: Shaking Down the Con Man.

Business and Health

Aug. 1, 2003;21.