Personality Disorders

Personality disorders fall at the severe end of the stress spectrum. They are chronic and ingrained character traits associated with varying degrees of inflexibility and maladaptive patterns of interpreting situations and relating to others and the environment. Personality disorders are typically associated with a significant degree of impairment in personal, social or vocational functioning. The degree of dysfunction may be pervasive and evident in all life areas, or may be restricted to certain domains such as interpersonal relations.

There are currently eleven recognized major types of personality disorders. Specific personality disorders are generally grouped into three more inclusive groups which are distinguished as follows: (a) odd and eccentric behaviours; (b) dramatic, emotional and erratic behaviours; and (c) anxious, withdrawn or fearful traits.

Over time, individuals with personality disorders tend to exhibit fluctuations in personal and vocational functioning irrespective of occupational factors. These individuals also have a heightened vulnerability to experiencing episodes of stress and adjustment difficulties in response to ostensibly mild situational pressures.

By definition, there cannot be a work-caused personality disorder. Workplace factors may aggravate a pre-existing personality disorder or accelerate its manifestation but do not cause it. The causes of personality disorders are thought to reside in emotionally disruptive and stressful childhood experiences, and possibly a contribution from genetic disposition.

Personality disorders are often not well diagnosed. Among individuals reviewed for fitness for continued duties, there are a number of undiagnosed personality conditions which give rise to long-term low level interpersonal and vocational difficulties.

Personality disorders also present a major challenge in making liability determinations. This is because, as already noted, some personality conditions may be associated with episodic reductions in personal and vocational functioning, irrespective of current employment conditions. There are also complex presentations where the personality of some individuals is itself an operative factor in generating interpersonal conflict with colleagues and supervisors. The reactions of others may then appear (inaccurately) to be causal in the onset of stress symptoms in that individual.

The assessment of personality disorders is an area undergoing rapid development and there are now a range of structured interview and psychological test procedures employed by clinical psychologists and psychiatrists in identifying these conditions.

Personality disorders are difficult to manage and treat. Individuals with these problems are often reluctant to seek treatment and tend to deny their difficulties. They generally do not respond to support counselling or stress management training. Those that are responsive to treatment typically require long-term psychotherapy from a specialist mental health practitioner. The duration of such therapy often extends between eight and thirty-six months of regular consultations.

Workplace interventions for personality disorders are limited in scope. The most useful interventions involve educating co-workers to minimize their reactive stress and assist them in recognizing the early signs of an episode so that impact minimisation strategies may be implemented or an early referral to treating practitioners made.