Personality Disorders in the Workplace:
The Overinvolved, Underachieving Manager

By Mark P. Unterberg, MD

Obsessive compulsive employees may work impressively long hours and pay intense attention to details, yet still not produce the results a company needs. In fact, they may be the source of counter-productive disruptions among fellow workers.

This is the first 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.

Subsequent installments will discuss histrionic, 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

Herbert Kroft is a 34-year-old single man who was hired to head up the accounting section of a medium-sized firm. He replaced a recently retired, popular manager and was assigned the task of revamping the department's collection methods. He dressed impeccably and spoke with precision.

After six months, four out of nine employees in his department had tendered their resignations. They complained that Herbert was impossible to work with. No matter what they did, it was never good enough for him. Management and Herbert's supervisor found that their own interactions usually went well and that a major overhaul of the department was proceeding quickly and precisely.

In the next six months, Kroft continued to impress management with his marathon work hours, but his leadership reputation suffered. Three more people left, two of them complaining that the office atmosphere was oppressive. Kroft's accusers called him moralistic, judgmental and tyrannically perfectionistic. They felt that his only concern was for the production of his section, with little thought for employee morale. He would cancel vacations on short notice and was clearly irritated by leave requests for personal problems.

Despite Kroft's long work hours, over the next year, more and more of his reports and projects were late. Kroft also started a pattern of frequent visits to his supervisor's office to discuss minute details of accounting system flaws, sometimes in heated terms. He was starting to miss the big picture.

Events came to a head on the day his department threatened to resign en masse if the supervisor didn't do something about department morale. The supervisor called Kroft to his office, and as usual, Kroft didn't budge. He figured that his subordinates were only trying to shirk their responsibilities. He couldn't see their point of view or even acknowledge that they might have some legitimate grievances. After talking with the CEO, the supervisor recommended that Kroft see a consulting psychiatrist or accept suspension until the situation was reviewed.

In treatment, Kroft began to understand that he had a problem. With much work, he was able to start changing his approaches to people at work. Gradually, his behavior became more appropriate and less of a problem for his supervisor. He was still more concerned with fine details than others, but therapy helped him to use this skill for productive work. He also learned to recognize that even his less obsessional subordinates could do first-rate jobs if only he let them. Although his workers gradually noticed the change in him, his reputation lingered. Kroft stayed in individual therapy for a year and a half. He was happy enough with his experience to recommend treatment to others.

Diagnosis

Obsessive-compulsive personality style is usually an asset to a business, because of the intense dedication to work that it may entail, often to the exclusion of family and other outside life. When the traits become excessive, however, there can be a detrimental increase in inflexibility and perfectionism and an emotional need to make the world conform to a personal perception. Since obsessional traits make it hard to see what went wrong, further difficulties can result from confrontation, isolation or termination.

Obsessive-compulsive personality is not the same as obsessive-compulsive disorder, which grossly interferes with functioning and is accompanied by intense anxiety. In fact, the personality style is felt as quite appropriate, while others are blamed for any problems.

The etiology of obsessive-compulsive personality disorder is uncertain, but is thought to derive primarily from early difficulties in dealing with the emotional environment. In the workplace, traits can be exacerbated by increasing intensity, complexity or importance of work or by a perceived decrease in support from superiors. There is always a push for perfection, and with more variables it gets harder to achieve that end. Perhaps more important, a perceived loss of support intensifies inner emotions and need for perfection. Too often, the forest can't be seen for the trees. Increasing brittleness and tension begins to have a strong effect on co-workers, who then see a humorless, difficult, moralistic or aggressive colleague.

Diagnostic Criteria:

Obsessive-Compulsive Personality Disorder

A pervasive pattern of preoccupation with orderliness, perfectionism and mental and interpersonal control, at the expense of flexibility, openness and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (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

Obsessive-compulsive employees are difficult to recognize in the workplace. They usually work hard, see themselves as productive and appropriate, and blame others whom they see as less than perfect. Problems are most commonly pointed out by co-workers and subordinates, and less often are immediately recognizable in the obsessive-compulsive employee by their superiors. And it is not always easy to discuss the problems with someone who sees the causes lying elsewhere. When usual performance evaluation and management approaches are not sufficient, referral for psychiatric evaluation may be helpful.

The prognosis for introspective employees is good. The ability to recognize their contribution to the problems is essential to their understanding and then modifying their counterproductive behavior. In fact, modification of personality defenses will often permit a higher level of productivity and personableness than before. Recognition of change requires careful supervisory awareness, as well as attention to possible future problems.

Psychiatric management

The initial consultation reviews the current problem and past history, and looks for associated life events and mood disorders that may have made things worse. Once a need for psychotherapy has been established, the initial phase of therapy is used to establish a nonthreatening atmosphere.

Obsessive-compulsive traits have typically been used for emotional self-protection since childhood. The early phase of treatment also allows initial recognition of counterproductive behaviors and associated emotions. The counterproductive traits are often intensely driven psychological defenses against threatening hidden emotions and fears.

A central goal of psychotherapy is to uncover fears of what would happen if behavior is modified and if a more balanced life is then attempted. In particular, therapy focuses on interactions with other people.

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 Overinvolved, Underachieving Manager.

Business and Health

Jul. 1, 2003;21.