Accommodation and Compliance Series:
Employees with Personality Disorders
JAN's Accommodation and Compliance Series is designed to help employers determine effective accommodations and comply with Title I of the Americans with Disabilities Act (ADA). Each publication in the series addresses a specific medical condition and provides information about the condition, ADA information, accommodation ideas, and resources for additional information.
The Accommodation and Compliance Series is a starting point in the accommodation process and may not address every situation. Accommodations should be made on a case by case basis, considering each employee's individual limitations and accommodation needs. Employers are encouraged to contact JAN to discuss specific situations in more detail.
For information on assistive technology and other accommodation ideas, visit JAN's Searchable Online Accommodation Resource (SOAR) at http://AskJAN.org/soar.
Information about Personality Disorders
How prevalent are personality disorders?
A study funded by the National Institute on Mental Health (NIMH) in 2007 found that approximately 9.1 percent of American adults has at least one personality disorder (Lenzenweger, Lane, Loranger, & Kessler, 2007).
What are personality disorders?
The DSM-5 (the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is published by the American Psychiatric Association (APA), provides diagnostic criteria for personality disorders. According to the DSM-5, a personality disorder is:
an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment (APA, 2013).
How are personality disorders treated?
Personality disorders are primarily treated through a combination of psychotherapy and medications.
What are the different types and symptoms of personality disorders?
According to the DSM-5, there are 10 specific personality disorders. They are as follows:
- Paranoid personality disorder – a pattern of distrust and suspiciousness such that others' motives are interpreted as malevolent.
- Schizoid personality disorder – a pattern of detachment from social relationship and a restricted range of emotional expression.
- Schizotypal personality disorder – a pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior.
- Antisocial personality disorder – a pattern of disregard for, and violation of, the rights of others.
- Borderline personality disorder – a pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity.
- Histrionic personality disorder – a pattern of excessive emotionality and attention seeking.
- Narcissistic personality disorder – a pattern of grandiosity, need for admiration, and lack of empathy.
- Avoidant personality disorder – a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.
- Dependent personality disorder – a pattern of submissive and clinging behavior related to an excessive need to be taken care of.
- Obsessive compulsive personality disorder – a pattern of preoccupations with orderliness, perfectionism, and control (APA, 2013).
Personality Disorders and the Americans with Disabilities Act
Are personality disorders considered disabilities under the ADA?
The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet (EEOC Regulations . . ., 2011). Therefore, some people with personality disorders will have a disability under the ADA and some will not.
A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having an impairment (EEOC Regulations . . . , 2011). For more information about how to determine whether a person has a disability under the ADA, visit http://AskJAN.org/corner/vol05iss04.htm.
Where can employers get additional information about personality disorders and the ADA?
Two publications that may be helpful in working through the accommodation process are: The ADA and Psychiatric Disabilities at http://www.eeoc.gov/policy/docs/psych.html and The ADA: Applying Performance and Conduct Standards to Employees with Disabilities at http://www.eeoc.gov/facts/performance-conduct.html.
Accommodating Employees with Personality Disorders
(Note: People with personality disorders may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with personality disorders will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.)
Questions to Consider:
- What limitations is the employee with a personality disorder experiencing?
- How do these limitations affect the employee and the employee's job performance?
- What specific job tasks are problematic as a result of these limitations?
- What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?
- Has the employee with a personality disorder been consulted regarding possible accommodations?
- Once accommodations are in place, would it be useful to meet with the employee with a personality disorder to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?
- Do supervisory personnel and employees need training regarding personality disorders?
Dealing with Emotions:
- Encourage the use of stress management techniques to deal with frustration
- Allow the presence of a support animal
- Allow telephone calls during work hours to doctors and others for needed support
- Allow flexible breaks
- Provide job restructuring to remove or modify tasks that exacerbate symptoms
- Refer to employee assistance program (EAP)
- Refer to counseling and EAP
- Allow telephone calls during work hours to doctors and others for needed support
- Allow the presence of a support animal
- Allow flexible work environment:
- Flexible scheduling
- Modified break schedule
- Leave for counseling
- Work from home/Flexi-place
Interacting with Coworkers:
- Encourage the employee to walk away from frustrating situations and confrontations
- Provide partitions or closed doors to allow for privacy
- Provide job restructuring to reduce or increase face to face interaction
- Provide additional training to encourage appropriate social interaction
- Provide disability awareness training to coworkers and supervisors
- Provide positive praise and reinforcement
- Provide day-to-day guidance and feedback
- Provide written job instructions via email
- Develop clear expectations of responsibilities and the consequences of not meeting performance standards
- Schedule consistent meetings with employee to set goals and review progress
- Allow for open communication
- Establish written long term and short term goals
- Develop strategies to deal with conflict
- Develop a procedure to evaluate the effectiveness of the accommodation
- Provide sensitivity training to coworkers and supervisors
- Do not mandate that employees attend work related social functions
Complying with Behavior and Conduct Rules:
Under the ADA, employers can enforce conduct standards that are job related and consistent with business necessity, but may need to consider what kinds of accommodations may be effective in enabling employees to meet those standards. Because employees with personality disorders may be more likely to have problems getting along with others and following workplace rules, employers may need to address such issues from a conduct standpoint.
For example, an employee with histrionic personality disorder may be overly physical with certain coworkers, an employee with border personality disorder may decide impulsively to leave work in the middle of the day, or an employee with schizoid personality disorder may treat coworkers or customers in a manner that seems rude or mean. In cases such as these, the employer has the right to enforce conduct standards. The following are suggestions to consider concerning how to address the behavior and conduct of an employee with a personality disorder:
- Provide clear expectations concerning behavior and conduct
- Provide additional training to encourage appropriate behavior in social settings
- Provide quick and clear feedback when a conduct problem arises
- Provide concrete examples of what is considered appropriate and inappropriate when a problem arises
For more information concerning performance and conduct issues, please see our publication on the topic at http://askjan.org/topics/condandperf.htm.
Situations and Solutions:
An individual with paranoid personality disorder is working as a financial consultant for a large marketing firm. Due to his condition, he often feels like coworkers and supervisors are looking for ways to hurt or sabotage him. He has been going to therapy and is aware that at least some of his beliefs are not true. He decides to disclose his disability and requests more frequent interactions with the supervisor to insure effective communication, the ability to have a support person present for performance evaluations, and a flexible schedule to allow for continued therapy appointments. The employer agrees to provide the accommodations and the employee is able to remain in his position and continue to work effectively.
An employee with schizoid personality disorder has worked in a call center as a customer service representative for two years. Due to business necessity, the employer restructures the employee's position to include face to face interactions with customers. The employer begins receiving complaints from customers that the employee is acting in a rude and generally unfriendly manner. When the issue is brought up during a performance evaluation, the employee discloses his schizoid personality disorder, and explains that it affects his ability to show appropriate affect. He generally appears unenthused regardless of what is happening. As a result, he may appear to be acting rude or disinterested when interacting with customers in person. The employer reassigns the employee to a position where he can work on the phones exclusively again.
An employee with schizotypal personality disorder just started working as a cashier in a small department store. Within three weeks, the employer receives four comments from customers regarding the employee's behavior, that the employee had begun talking to them about strange things including aliens and various conspiracy theories. The employer meets with the employee to discuss these occurrences, at which point the employee discloses her disability. The employee provides medical documentation that states that the employee will at times have episodes where she will think and talk about things that are not grounded in reality and that while medication can help to prevent such occurrences, they will inevitably occur on an almost daily basis. Because it is an essential function to be able to communicate effectively with customers, and the employee's eccentric behavior is not in compliance with the employer's conduct standards, the employer determines the employee is not qualified for the position. Because the employee wasn't qualified for the position from the point of hire, the employer does not have an obligation to consider reassignment, but does anyway, reassigning the employee to a position as a stock clerk, which requires much less interaction with customers.
An employee with antisocial personality disorder works as a construction worker. One day while at work, the employee tells a coworker he does not like him and that the coworker should watch his back. The coworker reports this to the supervisor who then addresses the employee about the comment. The supervisor asks what the problem is, and the employee responds only by saying he just does not like the coworker. The supervisor tells the employee that if he threatens his coworker again he will be terminated. A week later the employee threatens his coworker again. The supervisor terminates the employee. In response, the employee discloses that he has antisocial personality disorder. The employer has no obligation to rescind the termination because it occurred prior to the employee's disclosure.
An employee with borderline personality disorder works as a hairstylist in a beauty salon. At times, she becomes very upset and leaves work abruptly. The supervisor meets with her regarding these occurrences and the employee discloses her disability and explains that because of her work schedule, she has been unable to attend therapy and psychiatrist appointments, which has resulted in an exacerbation of her symptoms. The employer suggests providing her a consistent schedule, allowing her to keep the early part of the day open for her therapist and doctor appointments. The employer also agrees to allow the employee to take two additional unpaid breaks per shift. The accommodations result in the employee getting the treatment she needs, allowing her to continue working successfully in her position.
An employee with histrionic personality disorder works in a cubicle environment as an insurance claims processor. She is regularly talking and distracting her coworkers, at times talking about very personal issues and having crying fits. At other times the employee will be very physical with coworkers, hugging and talking about how much she loves being around them. The employee's behavior is generally disruptive, and when the supervisor confronts her about this, the employee discloses her condition. The employee provides medical documentation that states that she would benefit from working in a more private space where it is not so easy for her to talk to coworkers and listening to music on earphones while doing work off the phones. The employer is able to provide these accommodations, which prove to be effective.
An employee with narcissistic personality disorder is hired as a project manager for a software development company. The employee tells his subordinates that he will be replacing the "incompetent" president of the company within two years, so they had better respect him. One of his subordinates tells the vice president of the company, who tells the president. The president puts the employee on probation, explaining that the next such conduct violation would result in termination. Three months later, the project manager sends out a memo to everyone on his team outlining his accomplishments and how he deserves the praise of his team members and the company. He ends the memo by signing off as the future president of the company. The memo makes its way to the president who then terminates the employee. The employee then discloses he has a personality disorder. The employer follows through with the termination as there is no obligation to excuse prior conduct violations that occur before the employer is made aware of the condition.
An employee with avoidant personality disorder works as a vocational specialist for a disability insurance company. Originally, the employee's position allowed him to work from home full time. Recently, the company decides to begin transitioning some of its teleworking employees back into the office. The employee discloses his condition and requests he be allowed to continue working from home as an accommodation. The employee provides medical documentation explaining that he experiences intense feelings of inadequacy and discomfort when around others and would not be able to perform at the same level in an office environment as he would at home. As a result, the employer allows the employee to continue working from home.
An employee with obsessive compulsive personality disorder works as an administrative assistant for a physician's office. After being hired, she discloses her condition and requests accommodations in the form of written instructions, checklists, and a private workspace. The employer agrees to the accommodations. A few weeks into the job, the employee tells her supervisor she does not like the documentation system the office is using, and will be making changes as she sees fit. The supervisor explains that will not be tolerated, that she needs to follow their protocol, but the employee follows through with making her own changes. The supervisor takes disciplinary action and tells the employee if she continues to go against the employer's protocol that she could be terminated. The employee responds by writing an e-mail to the supervisor outlining how her way of doing things is better and why the employer should make the changes she is suggesting. The employer insists it will not make the changes and the employee needs to comply. The employee continues to defy the employer's instruction and is terminated.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
EEOC Regulations To Implement the Equal Employment Provisions of the Americans With Disabilities Act, as Amended, 29 C.F.R. § 1630 (2011).
Lenzenweger M. F., Lane M. C., Loranger A.W., & Kessler R.C. (2007). DSM-IV personality disorders in the National Comorbidity Survey Replication. Biological Psychiatry. 15;62(6):553-64.