PI Brief Update

Personality disorder (PD) in Occupational Health - Dr Mark Burgin

27/05/24. Dr. Mark Burgin BM BCh (oxon) MRCGP considers how disability analysis reports on personality disorder PD can assist the tribunals assess capability to work.

The descriptions of personality disorders PD sound like insults - emotionally cold, aggressive, unstable, suspicious and there are many experts who question their usefulness.

Describing behaviours rather providing explanations for those behaviours has little value in helping patients with these labels, leading to a belief that there are few effective treatments.

Under pressure we all show signs of personality disorders which suggests that rather than being a disease to be treated, they are defence responses to be understood.

Disability analysts take a neutral view of personality recognising that for instance anybody who faces death in their work must be, by definition, a bit odd (e.g. surgeons).

Personality as a burden

Most jobs have requirements that can cause problems for a personality to perform that role but there is little correlation between personality disorders (PD) and fitness for a role.

This is because PDs were developed for use in forensic medicine and focus on the difficulties that the personality has with interacting with legal and medical services.

Doctors typically have perfectionist traits which make them peculiarly vulnerable to burnout and they struggle emotionally if they make mistakes.

This does not mean that a non-perfectionist cannot become an effective doctor, any more than all those who have Anankastic (perfectionist) traits should become doctors. 

Personality as a gift

For each negative aspect of a personality there are corresponding positive aspects which are in balance, aggressiveness can be positive if expressed appropriately e.g. sport.

Psychopathic (antisocial) personalities are found in prisons but they are also found at the top of successful organisations, where traits such as lack of guilt can be useful.

Some of the most successful people have jobs that seem unsuited to their personalities but their sensitivity to that aspect motivates them to reach a higher performance.

Workplaces benefit from diversity and a person with an unusual personality will bring something new to any workplace that makes reasonable adaptions.

Treating a Personality

The main reason why therapy for personality disorders has limited effectiveness is because the personality is those fixed aspects that do not change.

Showing a person that they have a choice of behaviours in a scenario has limited benefit if the choice does not coincide with the way they look at the world.

In occupational health the expert uses disability analysis to find functional restrictions for which reasonable adaptions can be made so they can thrive.

An Avoidant TV presenter may suffer from disabling anxiety which can be managed by having a supportive assistant who can protect against criticism when vulnerable.

Conclusions

Although it may be helpful for someone labelled as a Schizoid to consider a career in writing rather than sales, it is their abilities that dictate whether they are suited to their occupation.

The expert must determine the functional restrictions and understand how the person uses their traits to perform their job role to make an opinion on fitness and recommendations.

Personality analysis of a workplace can be useful in recognising that productivity is being restrained by a lack of diversity but cannot be used to predict which personality type should be added.

The disability analyst has a central role to prevent witch hunts from removing talented individuals on the basis of their personality by explaining how to make reasonable adaptions.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is on the General Practitioner Specialist Register.

Dr. Burgin can be contacted This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 website

This is part of a series of articles by Dr. Mark Burgin. The opinions expressed in this article are the author's own, not those of Law Brief Publishing Ltd, and are not necessarily commensurate with general legal or medico-legal expert consensus of opinion and/or literature. Any medical content is not exhaustive but at a level for the non-medical reader to understand.

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