Difficult Personalities: It’s not you - it’s them
Personalities: It’s not you - it’s them
Kathleen Zoppi, PhD, MPH | AIAMC Roles: Member AIAMC Board
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.
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:
to do well in life and be respected by others
about unlimited success, power, brilliance, beauty, or ideal love
about the wants and needs of others
and use others to get their needs met
experience some feelings of jealousy from time to time
competitive and envious of others
themselves before others from time to time
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.
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
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.