The classification of personality disorders as disabilities in the context of work

Some of the first questions inspired by the focal article were simply (a) whether or not personality disorders would classify as disabilities under the ADA (1990, 2008), and (b) how this relates specifically to Title I of the ADA (1990, 2008; equal employment opportunity for individuals with disabilities) regarding these individuals’ abilities to perform essential job functions with or without reasonable accommodations. Our first point presents a potential dilemma, as the ADA (1990, 2008) does not constitute which specific medical conditions should be classified as disabilities but rather lists conditions that must be met to classify one as an individual with a disability. We agree with Melson-Silimon et al. (Reference Melson-Silimon, Harris, Shoenfelt, Miller and Carter2019) that personality disorders likely meet the requirements of disability class membership according to the ADA (1990, 2008): personality disorders likely result in some physical or mental impairment that “substantially limits one or more major life activities” (ADA, 1990, 2008). For instance, an individual with borderline personality disorder may exhibit frequent mood changes, impulsivity, hostility toward others, and periods of depressivity (DSM-V). Thus, these symptoms could easily impact major life activities outlined by the ADA (1990, 2008), including caring for oneself, concentrating, and, most relevant to the current commentary, working. Notably, the alternative model of personality disorders (AMPD) included in Section III of the DSM-5 (APA, 2013), reviewed by Melson-Silimon and colleagues, explicitly includes personality functioning/impairment within this diagnostic model. The AMPD includes a requirement for moderate or greater impairment in personality functioning in two of the four areas: identity, self-direction, empathy, and intimacy (American Psychiatric Association, 2013).

Title I of the ADA (1990, 2008) focuses on equal employment opportunities for individuals with disabilities and applies to both applicants and employees with a disability who are qualified for and can perform the essential functions of the job, with or without reasonable accommodations. This leads us to the question of how many individuals with personality disorders are obtaining employment and thus potentially utilizing Title I of the ADA (1990, 2008). As the focal article by Melson-Silimon et al. (Reference Melson-Silimon, Harris, Shoenfelt, Miller and Carter2019) focused primarily on selection, this specific aspect of the ADA (1990, 2008) was not within the scope of their article but is a point on which we wish to expand. Although research suggests that individuals with personality disorders may experience persistent unemployment (Lenzenweger, Lane, Loranger, & Kessler, Reference Lenzenweger, Lane, Loranger and Kessler2007; Zimmerman, Martinez, Young, Chelminski, & Dalrymple, Reference Zimmerman, Martinez, Young, Chelminski and Dalrymple2012), many do obtain employment, as evidenced by research on vocational functioning of individuals with personality disorders (e.g., Dahl, Lariviere, & Corbiere, Reference Dahl, Lariviere and Corbiere2017; Miller, Lewis, Huxley, Townsend, & Grenyer, Reference Miller, Lewis, Huxley, Townsend and Grenyer2018). Thus, at least some subset of individuals with personality disorders appears to secure employment and therefore may choose to request reasonable accommodations. For instance, an individual with obsessive compulsive disorder (OCD) may be extremely conscientious, allowing him/her to perform detail-oriented tasks. However, for individuals with OCD, this trait likely exhibits a curvilinear relationship with performance: an individual’s extreme levels of conscientiousness may cause him/her to get caught up in the details as they strive for perfection (Carter et al., Reference Carter, Dalal, Boyce, O’Connell, Kung and Delgado2014). Although it appears that some individuals with personality disorders obtain employment, they may face challenges that require certain organizational accommodations. This raises the following question for both applicants/employees and organizations: “What reasonable accommodations are appropriate for individuals with personality disorders?” In the next section, we address how reasonable accommodations for personality disorders might appear in practice.

Work accommodations and personality disorders

Per the EEOC (2010), reasonable accommodations are modifications or adjustments to either the job application process or the work environment that allow a qualified individual with a disability to be considered for a position, provided that they are able to perform the essential functions of the job. Notably, the term reasonable comes into play in that the accommodation(s) must not impose undue hardship on the organization, typically in the form of significant difficulty or expense. This begs the question of whether individuals with personality disorders would request accommodations at work; if so, what types of accommodations would be useful for an individual with a personality disorder; and finally, would they meet the “reasonable” component of the ADA (1990, 2008)? First, there is evidence to suggest that individuals with personality disorders are requesting and using accommodations at work. A review of the National Health Interview Survey from 1994–1995 found that 9.9% of people with a personality disorder reported receiving accommodations (Zwerling et al., Reference Zwerling, Whitten, Sprince, Davis, Wallace, Blanck and Heeringa2003). Regarding the actual accommodations themselves, Dahl et al. (Reference Dahl, Lariviere and Corbiere2017) conducted a qualitative study of individuals with borderline personality disorder. Their interviews suggested that some of the most useful accommodations included being able to take a break when needed to avoid being verbally aggressive, clarity and stability of work expectations, and a flexible work schedule.

Although reasonable accommodations aim to help employees with disabilities in performing their essential job functions, there are also potential barriers/facilitators that may influence the success of such accommodations. A review of workplace accommodations for individuals with disabilities found that some of the strongest barriers/facilitators of the usefulness of workplace accommodations centered around acceptance by their work peers, and specifically their coworkers’ and employers’ attitudes and levels of understanding (or lack of; Nevala, Pehkonen, Koskela, Ruusuvuori, & Anttila, Reference Nevala, Pehkonen, Koskela, Ruusuvuori and Anttila2015). The importance of acceptance from one’s work peers regarding a disability and any reasonable accommodations is likely much more complex than simply receiving a diagnosis and seeking support. In the next section, we discuss the complexities of disclosing a personality disorder in the workplace.

An invisible identity: Disclosure of a personality disorder in the workplace

One area of research that is gaining momentum in the industrial and organizational (I-O) psychology literature is that of invisible stigmatized identities in the workplace (Clair, Beatty, & Maclean, Reference Clair, Beatty and Maclean2005; Ragins, Reference Ragins2008; Sabat et al., Reference Sabat, Lindsey, Membere, Anderson, Ahmad, King and Bolunmez2014). Invisible stigmatized identities are those that are not able to be determined by simply looking at an individual (Clair et al., Reference Clair, Beatty and Maclean2005; Goffman, Reference Goffman1963), such as HIV/AIDS status, sexual orientation, and chronic illness. One subset of invisible stigmatized identities includes some physical and most mental disabilities, such as cancer, diabetes, alcoholism, and mental illness (Ragins, Reference Ragins2008). The diagnosis of a personality disorder would logically fit into this category. When one’s stigmatized identity is not readily visible, the individual must constantly manage the presentation of this identity (Pachankis, Reference Pachankis2007; Ragins, Reference Ragins2008). Disclosure of one’s invisible stigmatized identity is a dynamic process, as the individual can make choices about to whom, how much information, and when he or she may disclose. There can be full disclosure, also called revealing; partial disclosure, called signaling; or no disclosure at all, referred to as concealing or passing (Clair et al., Reference Clair, Beatty and Maclean2005; Herek, Reference Herek, Herek, Jobe and Carney1996; Jones & King, Reference Jones and King2014). Not surprisingly, individuals with concealable or invisible disabilities do not disclose as frequently as individuals with a visible disability (Colella & Stone, Reference Colella, Stone, Dipboye and Colella2005; Hulett, Reference Hulett2017; Santuzzi & Waltz, Reference Santuzzi and Waltz2016). However, concealment can come at a cost. Managing the concealment of one’s stigmatized identity involves high levels of self-regulation, leading to less available resources to devote to the job tasks at hand, and consequently leads to decreased levels of employee engagement (Demerouti, Bakker, Nachreiner, & Schaufeli, Reference Demerouti, Bakker, Nachreiner and Schaufeli2001; Jones & King, Reference Jones and King2014). Aside from negative job-related outcomes from concealment, there are also undesirable psychological outcomes such as anxiety, depression, and lower self-esteem (Quinn & Earnshaw, Reference Quinn and Earnshaw2011; Santuzzi & Waltz, Reference Santuzzi and Waltz2016), as well as work–family conflict (Williamson, Beiler-May, Locklear, & Clark, Reference Williamson, Beiler-May, Locklear and Clark2017).

One reason individuals with invisible disabilities such as a personality disorder might be hesitant to disclose is that it may impact their chance of obtaining a job in the first place. In terms of hiring decisions, meta-analysis suggests there is an overall negative effect of disability on hiring, and that this relationship is stronger for mental disabilities than for physical disabilities, indicating that though it is considered undesirable to hire individuals with disabilities in general, it is somewhat more desirable to hire individuals with a physical disability than a mental disability (Ren, Paetzold, & Colella, Reference Ren, Paetzold and Colella2008). The authors found that type of disability was the strongest moderator they tested, such that mental disabilities were shown to have a more negative effect than physical disabilities on performance expectations and hiring decisions.

To date, there is a lack of research on disclosure of personality disorders in general, and specifically the disclosure of such in the workplace. Although this may be due to the fact that only a percentage of individuals with a personality disorder obtains and sustains employment (Medard, Dubertret, Peretti, Ades, & D’escatha, Reference Medard, Dubertret, Peretti, Ades and D’escatha2010; Skodol et al., Reference Skodol, Gunderson, McGlashan, Dyck, Stout, Bender and Sanislow2002), research on this topic would be fruitful. Indeed, most of the limited research on personality disorders in the workplace focuses on the negative implications for organizations, such as potential leader derailment for those with narcissistic tendencies (Simonet, Tett, Foster, Angelback, & Bartlett, Reference Simonet, Tett, Foster, Angelback and Bartlett2018) or that borderline personality disorder is negatively related to task strategy, ultimately leading to lower task performance (Thompson, Payne, Horner, & Morey, Reference Thompson, Payne, Horner and Morey2012). Thus, a number of questions relating to the experience of applicants and employees with personality disorders remains for future research to address.

Finally, there is the question of whether individuals with a personality disorder perceive themselves to have such a disorder, and how the complex role of one’s own perceptions of their disability serves in the larger process of organizational action (Santuzzi & Waltz, Reference Santuzzi and Waltz2016). Historically, maladaptive personality traits were presumed to be associated with a lack of insight (Westen, Reference Westen1997); however, recent research suggests that individuals are able to accurately report on their own maladaptive traits (Klonsky, Turkheimer, & Oltmanns, Reference Klonsky, Oltmanns and Turkheimer2002; Maples-Keller & Miller, Reference Maples-Keller and Miller2018), indicating the possibility of disclosure may be more relevant than previously perceived. Though an organization has several legal standards requiring protection, accommodation, and advocacy for an employee with a disability, these efforts can only go so far as the employee perceives to have a disability and discloses that disability in the workplace. Organizational efforts to engage this individual as a member of a protected class by expecting disclosure or accommodations meet a dead end when an individual meets the legal definition of having a disability yet does not believe he/she has a disability, or if he/she does perceive him/herself as an individual with a disability but chooses not to disclose. This lends itself to another interesting avenue of research: How does the perception of having (or not having) a personality disorder affect the employability and performance of an individual with a personality disorder?