Healthcare professionals aren’t immune to personality disorders, which can make peer-to-peer and HCP-to-patient relationships challenging.
Physician-specific research suggests that doctors and other HCPs may have experienced an uptick in obsessive-compulsive disorder, and that bullying stemming from narcissistic personality disorder may be an issue in medicine.
Coping with these challenging professional scenarios may require calling in HR or other resources for support.
An estimated 9.1% of American adults have a personality disorder, which the DSM-5 defines as “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture.” If that percentage holds for the US physician population, then there are approximately 84,500 practicing doctors in the US who also have a personality disorder.
That means for the average HCP, there’s a non-trivial chance of working with someone who has obsessive-compulsive personality disorder, narcissistic personality disorder, or borderline personality disorder, among others. Research indicates that there may be some common personality disorders among US physicians.
Obsessive-compulsive disorder (OCD)
COVID-19 made many people more conscious of fomites and pathogens. The resulting fear was perhaps most acute on the frontlines of care, as evidenced by one study.
A 2020 study published in Medicine Science involved 198 healthcare professionals, including doctors, midwives, nurses, technicians, and other staff. The study group worked in COVID-positive settings and the control group did not.
Researchers evaluated study participants for anxiety, depression, and OCD. The group working in COVID-positive settings had significantly higher OCD scale scores, compared with controls (26.6 vs 19.72). Anxiety scores were also higher (13.15 vs 9.63). Moreover, the depression score was nearly double that for controls (14.71 vs 7.49).
“It is essential to monitor and assess the well-being and mental health of the [healthcare workers],” the researchers wrote.
One small study even suggests that in a Spanish hospital, the pandemic may have given rise to a type of OCD called "checking OCD." It is less common, but particularly deleterious for physicians and other HCPs.
Publishing in Psychiatry Research Case Reports, a team of researchers identified the emergence of checking OCD in the doctors. The researchers presented three instances of OCD in doctors that occurred during the pandemic. One was a 55-year-old female urologist, the second was a 36-year-old female pediatrician working in a primary care setting, and the third was a 48-year-old male emergency medicine (EM) physician who worked in an outpatient setting.
In each of these instances, the doctors tended to obsess over the possibility of making fatal medical errors.
For example, the urologist had taken several months of sick leave to avoid the possibility of a fatal mistake. The pediatrician obsessively studied international COVID-19 protocols, reviewed her patients’ medical histories, and called patients’ parents during her down time.
"She neglected other aspects of her life. Most of the time, she studied COVID-19 protocols until she [fell] asleep."
— Author, Psychiatry Research Case Reports
Although her concern at first focused on COVID-19, it later became “general to any potential serious illnesses in children.”
Finally, the EM, feeling that his medical certainty was waning, experienced frequent rumination, and checked medical records at home. He also reported hypochondriac thoughts.
In their conclusion, the researchers pointed out that, prior to the pandemic, there had been only one case of checking OCD among their colleagues.
“The changes to healthcare practice brought about by COVID-19 have resulted in three cases of OCD among physicians in less than a year, which represents a significant increase.”
Granted, these findings represent a small sample size. But they do offer some clues as to how the pandemic may have triggered or exacerbated instances of OCD among physicians, stemming from the radical uncertainty surrounding COVID-19.
Narcissistic personality disorder (NPD)
Narcissistic personality disorder (NPD), which affects up to 5% of the population, is typified by diminished empathy, a pressing desire for admiration, and grandiose tendencies, according to the DSM-5.
Writing on KevinMD in 2019, Leanne Rowe, MD, said that from her experience, narcissism in physicians sometimes manifests in bullying behaviors.
"Fundamentally, a doctor with NPD is arrogant, feels entitled and believes others have a problem."
— Leanne Rowe. MD, KevinMD
Doctors with NPD, she said, go out of their way to let others know about their exceptional clinical acumen or other special traits. According to Dr. Rowe, patients may adulate these doctors for these reasons. Meanwhile, doctors with NPD may disparage other clinicians to their patients, Rowe wrote.
Over time, doctors with NPD can slowly erode collegiality among colleagues with sarcasm, petty criticism, eye-rolls, or stonewalling, Dr. Rowe wrote. Those with more extreme cases may plot character assassinations, lie pathologically, or be abrasively competitive. These doctors can go for the jugular, attacking another physician’s work ethic, honesty, and competence.
Can these doctors change? “Change is also difficult because doctors with NPD usually don’t regard narcissistic traits as negative as they feel superior to other doctors and often say so directly or indirectly,” Dr. Rowe wrote.
Medicine in the 'dark tetrad'
The corrosive nature of NPD in medical practice has support from research. Publishing in the International Journal of Health Planning and Management, researchers described the impact of "dark tetrad" personality traits (narcissism, psychopathy, Machiavellianism, sadism) in Pakistani medical practice.
After evaluating data from 400 doctors, researchers concluded that dark tetrad personality traits increased counterproductive work behavior and breach of psychological contract. The researchers added that political skills had an enhancing effect.
Ultimately, doctors and other healthcare professionals are people, too.
“Physicians, just like the general population, have a wide range of personalities,” said Amanda Zeglis, DO, a practicing psychiatrist and member of the MDLinx advisory board. “These personalities often come to the forefront in a working environment and can create difficulties among colleagues or even with patients.”
Zeglis said that these difficulties are not intractable. Communication and mutual respect can go a long way in creating stable, cohesive, and supportive care environments.
“At times, these difficulties could feel insurmountable, and it may be helpful to reach out for support—either from Human Resources within your organization, from fellow colleagues or peers, or from mental health professionals,” she added.
What this means for you
Doctors and other HCPs may be experiencing OCD at higher rates following the COVID-19 pandemic. NPD, and its associated bullying also exists in medicine. Both of these disorders have implications for patients as well as physicians and their peers. Communication is key in navigating these tricky interpersonal dynamics. HCPs should not be afraid to seek support from their HR departments, colleagues, or mental health professionals.