Personality Disorders in the Workplace:
The Underachieving, Compliant Employee

By Mark P. Unterberg, MD

Unaware of the surrounding anger and irritability he's caused, the passive-aggressive employee is content at doing less when asked for more.

This is the seventh and final article that deals 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, borderline and narcissistic personalities. 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

Richard Sanders is a 45-year-old heavy-set man who has been with the company for over 20 years. He has held the same secure clerical position for the past 10 years, and his career advancement has probably peaked. His section, which had fallen behind in a changing business environment, needed to be turned around. After 15 years on the job, the old supervisor was terminated for poor departmental productivity and his inability to recruit fresh talent.

Sanders was not getting along well with the new supervisor, who was trying to reorganize the department and complained to human resources that Sanders was one of the main impediments to change. He felt frustrated by Sanders' apparent avoidance of work and even more frustrated because he couldn't really document the details. Sanders would be quite agreeable to supervisory advice, but there was always a slackening of his output afterward.

On the surface, Sanders got along fairly well with others in the department. He had even evolved into a kind of leadership position, although it was unclear exactly where he was leading everyone. His inactivity seemed to inspire it in others. He had little investment in initiating and completing his assigned tasks and seemed to take longer with his work and turn it in later than anyone else — although always with a plausible explanation. At times, he could be difficult to deal with, coming in late to work or leaving essential papers at home. And his computer had many more destructive hard drive crashes than anyone else's in the office. But because of his positions at both the company and the union, extra information would be needed to terminate him. So far, it had been difficult to document that he was avoiding or resisting work. Mostly, he just left people feeling angry at him.

Recently, the supervisor proposed a new and potentially exciting direction for the department. Sanders' silent opposition to these changes made it difficult to maintain enthusiasm and excitement from everyone else. Moreover, the supervisor noticed that Sanders' activities were focusing more and more on gathering support for his resentment and oppositionalism. When Richard Sanders was eventually referred for counseling, he had to be pushed for weeks before he made an appointment.

Diagnosis

Passive-aggressive traits are difficult to recognize, since most of the resistance is hidden. A key characteristic is the increasing frustration of co-workers and supervisors who try to encourage more productive activity. Meanwhile, the passive-aggressive employee seems to move calmly on, apparently unaffected by the surrounding inefficiency and irritation. The employee will seem unaware of creating anger or expressing aggression by passivity and will be surprised by any confrontation about his or her behavior.

Diagnostic Criteria:

Passive-Aggressive 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

Employees with passive-aggressive traits can be difficult to manage. The harder you try to push them, the less they seem to get done. There may be very reasonable explanations for individual episodes, but in the long run, the supervisory process feels more and more frustrating. To make matters more complicated, the employee is usually unaware of the subtle aggression in his or her inactivity.

Documentation of complaints, low productivity, effects on co-workers and resistance to change is important. In particular, this information is useful in giving feedback to the employee on his or her behavior and its effects. It is also essential when further action is indicated, such as referral for treatment or probationary work periods.

Sometimes it is easier for an employee to understand the problem if there is similar feedback from co-workers. At other times, this can also lead to greater feelings of resentment and passivity.

Psychiatric management

Although all personality styles tend to be self-perpetuating, passive-aggressive traits may lead to particularly heightened passive resistance in response to advice or initial psychotherapeutic efforts. Since passive-aggressive personality traits are usually positively self-perceived, the impetus for change does not originate inside the patient. As a result, the best way to initiate therapy is to point out behaviors that will lead to difficulties and suffering. Appealing to concern for others is usually fruitless. As long as other people are seen as uncaring or hostile, it is hard to elicit sincere empathic behavior. Eventually, though, intelligence and self-preservation allow most to seek more flexible and adaptive personality traits.

Objective data about maladaptive behavior are especially important early in treatment. Otherwise, the patient will try to rationalize away the details, minimize the nature of the problem, and justify a lack of commitment to treatment and change. Genuine change is no small feat. Childlike emotional defenses need to be discussed in a clear and unembarrassing manner, pointing out when current problems are a reenactment of early childhood relationships. In varying degree, the difficulties tend to occur in all relationships: at work, socially and at home. Effective psychotherapy will be a gradual process, sometimes over an extended period. Changes in passive-aggressive behavior are significant for both the organization and the employee.

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 Underachieving, Compliant Employee.

Business and Health

Oct. 15, 2003;21.