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Difficult Personalities: It’s not you - it’s them

Difficult Personalities:  It’s not you - it’s them

Kathleen Zoppi, PhD, MPH | AIAMC Roles: Member AIAMC Board of Directors

For anyone who has been trained clinically to work with patients or as a treatment professional, Difficult Personalities:  It’s not you - it’s them may be light on diagnostic information - alternative resources available at end of this blog.  But for those of us who work with learners, colleagues, people we supervise, this book is invaluable as a resource because of the useful advice it embodies.

William O’Donoghue PhD is a clinical psychologist who served on the American Psychological Association DSM criteria committee and is professor at University of Nevada, Reno.  As a reader, I remain grateful for this reference resource.

The book takes a personal and helpful tone, coaching the reader to identify the areas of trouble and differentiating between preferences and truly harmful or toxic behaviors that affect working or personal relationships.  O’Donoghue’s expertise in abusive and neglectful relationships is particularly evident as he advises readers to avoid some ways of responding to difficult interactions, while suggesting alternatives that might result in better outcomes. All the while consistently acknowledging that every relationship includes a contribution from each person, and that the reader remains responsible for his/her/their response as much as the person identified as the other.

O’Donoghue acknowledges the personal and professional costs of trying to relate to others without a clear understanding of the consequences of their personality disorders.  In his own words: “Nothing in this book is meant to demonize these difficult and toxic individuals.  This book is meant to help you identify them and…  give you some basic facts and practical strategies. “

Book Structure: The book is organized by diagnostic clusters:  antisocial, borderline, histrionic and narcissistic personalities; anxiety/fearful personalities, including obsessive compulsive and dependent, avoidant personalities; and paranoid, schizoid personalities.  The chapters are short and include both descriptive tables with examples (including comparisons between health personalities and diagnostic groups) which helps to differentiate between normal and extreme behaviors.  This differentiation helps the reader to identify extremes and perhaps more clearly identify the dysfunctional aspects of the behavior. 

For example, in the chapter on narcissism, an expert:

Healthy personalities

Narcissistic personalities

Have desires to do well in life and be respected by others

Fantasize about unlimited success, power, brilliance, beauty, or ideal love

Are concerned about the wants and needs of others

Lack empathy and use others to get their needs met

May experience some feelings of jealousy from time to time

Are very competitive and envious of others

Put themselves before others from time to time

Are very selfish


In a time when terminology is loosely used, and social media articles offer advice - has anyone else seen the articles on narcissism authored by Tina Fey? It is useful and grounding to have advice in plain straightforward language with examples. 


I particularly appreciate the “don’t try this” examples.  Illustrative failed responses or strategies, some from the author’ own experiences, emphasis the need for reflection and self-management when confronting a person whose personality characteristics are extreme.  In many healthy relationships, trusting conversations can lead from difficulty to improvement.  In this book, Dr. O’Donoghue describes when to address difficulties, when to avoid such discussions, and what to expect as outcomes.  For anyone who has worked with a difficult colleague, learner, supervisor, or coach, this reference is clear, down to earth, and useful, and may save time and energy better spent elsewhere.


For more technical diagnostic reading:

·         Interpersonal Diagnosis and Treatment of Personality Disorders.  Lorna Smith Benjamin, Guilford Press, 2002.

·         Psychoanalytic Diagnosis, Nancy McWilliams, Guilford Press, 5th edition, 2011.

Dr. Zoppi is a medical educator and leader trained in communication research.  She serves on the AIAMC board, the Dean’s advisory Council for Butler University College of Pharmacy and Health Professions, and on the Marian University College of Osteopathic Medicine Admissions Committee.  She is also a founding member of the Indiana Health Advocacy Coalition, a medical legal collaboration.

She has been the Senior Vice President, Chief Academic Officer and Designated Institutional Official at Community Health Network in Indianapolis and has taught behavioral medicine in family medicine residency programs.