Detecting the Personality Disorder Client from Hell

10-12% of the US population suffers from a diagnosable personality disorder. Do you have a personality disorder client? An attorney with a personality disorder may one day be your client. Recently, Pat described a frustrating interaction with a “nightmare client” and alluded to the red flags that flew early in the relationship. Often, we only see those red flags after we’ve been burned. A personality disorder client, whether an attorney, defendant or plaintiff who slip under the radar and contact us directly, usually have a personality disorder/ They have a personality disorder of a specific type. While they are not “crazy” or psychotic in the clinical sense, their behaviors can make other people feel that way.

Personality Disorder Client Defined

Personality Disorders involve an ingrained set of disordered traits that are exhibited in consistent behavior over most of a lifetime. These behaviors cause serious difficulties for the person and others, including people who want to help them. The essential features of a personality disorder are

• impairments in functioning – especially interpersonally
• the presence of pathological personality traits such as antagonism, which includes manipulation, deceitfulness and hostility
• disinhibition, which takes in impulsivity, irresponsibility and risk-taking

Many people have some traits of a personality disorder rather than the whole syndrome. Cluster B traits cause the biggest headaches for legal nurse consultants: borderline, narcissistic and antisocial personality traits.

Borderline Personality Disorder

Individuals with Borderline Personality Disorder (BPD) are characterized by a common set of behavior patterns that include

• chronic rage
• reckless and impulsive acts
• a strong tendency to see people and events as all good vs. all bad
• rapid mood reactivity (they love you one day, hate you the next)
• pre-occupation with being misunderstood or disrespected

Such people often try to file frivolous malpractice actions–when they inevitably become disillusioned with their doctors or other helping people after they “proved” themselves unable or unwilling to give them the care they needed.

Borderline Personality Disorder Revealed

Although the diagnosis of Borderline Personality Disorder is more frequently made in women, there are definitely male Borderlines, too. At first, a Borderline (male or female) may appear shy, vulnerable or in need of care. This is the first clue: beware of clients who feel like lost puppies. If you experience an urge to take a client home and feed him, there’s a red flag. But, we’re nurses and like to help people (and we want the work). So, if you can’t stop yourself, then avoid future frustration by making a careful scan for the following reactions and characteristics as you begin to work with him.

In the beginning, you may feel a rapidly growing sense of compassion for whatever painful plight the personality disorder client has gotten himself into, because he portrays himself as the “victim of circumstance.” But listen closely to how he sees himself as a victim. You will begin to hear how no one understands him – except you. Other people have always failed him because of their “insensitivity.” He is always being betrayed, just when he starts trusting people. But there is something “special” about you, because “you really know me.”

The Seductive Personality Disorder Client

It is this intense way he has of bearing down on you emotionally that can feel very seductive. You will feel elevated, honored to work with him – and you will feel that way quickly. He is alternately depressed or anxious, detached and indifferent or vulnerable and hypersensitive. He can swing from elated agitation to mournful gloom at the blink of an eye. Watching the erratic changes in his moods is like tracking the needle on a seismometer at the site of an active volcano.

But after every emotional Vesuvius he pleads for your mercy. And if he has imbedded his guilt-hooks deep enough into your conscientious nature, you will continue to allow the client to manipulate and flout the rules you thought you had agreed to. But, continuing to try to work with this client is a pointless exercise in emotional rescue.

If the client also has a mixture of narcissistic and antisocial traits, ranting and blaming may not stop at the verbal level but may be accompanied by abusive behavior as well.

In part 2 of this blog, I will share strategies you can use as a legal nurse consultant when you encounter a borderline personality disorder client.

Leslie Durr PhD RN PMHCNS-BCprepared this guest post. She is in private practice providing psychotherapy and consultation in Charlottesville, Virginia. She earned her PhD in Nursing systems Administration from Virginia Commonwealth and her M.S. in Nursing from Hunter College of the City University of New York. She is board certified in Child & Adolescent Psychiatric/Mental Health Nursing.

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