Criteria for Staff Personality Disorder

Personality Disorders

Staff Personality Disorder 601.83

A pervasive pattern of condescension, degradation of others, and controlling behavior beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

Condescending or degrading use of body language, vocal inflection, and behavior.
Presentation of two or more markedly different personality styles based entirely on context.
Persistent protection of people in positions of power even if such people have done something unethical or illegal.
Employment in one of the "helping professions", or other situations in which a person has or can secure power over others.
Rigidity in application of rules and explanations to other people
Persistent or stereotyped use of euphemisms, jargon, deceptive language, and double standards in language
Persistent use of degradation, ridicule, and violence, either gratuitously or grossly out of proportion to the situation

Diagnostic Features

The essential feature of Staff Personality Disorder is a pervasive pattern of condescension, degradation of others, and controlling behavior that begins by early adulthood and is present in a variety of contexts.

Individuals with Staff Personality Disorder display condescending or degrading body language, vocal inflection, and behavior (Criterion 1). They may use a patronizing "contaminated" smile, a sing-song voice, or the forms of language use described in Criterion 6. This behavior would be considered patronizing when directed at the average individual.

Individuals with Staff Personality Disorder present two or more markedly different personality styles based entirely on context (Criterion 2). For instance, while dealing with "clients", while alone, they may be vicious, punitive, and controlling. When dealing with the general public, they may adopt a saintlike persona. It is not at all uncommon for the antisocial behavior of people with Staff Personality Disorder to go unnoticed, even when that behavior extends to torture or murder.

Individuals with Staff Personality Disorder will persistently protect people in positions of power, even if those people have done something unethical or illegal (Criterion 3). This may consist of putting up a "united front" to clients or to the public. People with this disorder will hide or excuse antisocial behavior in others with the disorder. Hiding may take the form of altering logs and failing to report abuse. Excusing may involve character assassination directed toward victims of mistreatment or abuse, or diminishing their credibility in some other way, while making it seem as if the behavior is the only logical response to certain sorts of people. They will also use these techniques of hiding and making excuses, to justify and rationalize their own behavior.

Individuals with Staff Personality Disorder are often employed in one of the "helping professions", or other situations in which a person has or can secure power over others (Criterion 4). People with this disorder are disproportionately represented among psychiatric technicians, group home workers, home health care aides, social workers, special education teachers, counselors, nurses (especially psychiatric nurses), direct care staff, and institution staff. People with this disorder may also be grammar-school teachers, prison guards, and other professionals in positions of direct power over others. These positions may be either the cause or the result of the disorder.

Individuals with Staff Personality Disorder are rigid when applying rules and explanations to other people (Criterion 5). This, curiously but characteristically, may not extend to others with this disorder. Individuals with this disorder are likely to use a narrow set of rules to understand the behavior of others, particularly clients. They will see most ordinary behavior as manipulative, attention-seeking, or non-compliant. When confronted with something like violence on the part of clients, they will fail to differentiate between malice, self-defense, and frustration at being trapped. This may result in across-the-board application of punishments such as are described in Criterion 7.

Individuals with Staff Personality Disorder may display persistent or stereotyped use of euphemisms, jargon, deceptive language, and double standards in language (Criterion 6). They euphemistically refer to others as special needs, challenged, or consumers. They prefer jargon to ordinary language, and describe the behavior of others using clinical and psychiatric jargon, often loosely adding such jargon into everyday conversation, e.g. saying that someone they dislike has a Borderline Personality Disorder. They use deceptive language, for instance referring to prisons as hospitals and violence as treatment. They use double standards in language, e.g. referring to themselves as getting bored but to clients as going off task. They may apply certain words in a stereotyped fashion, repeating over and over that others are non-compliant, attention-seeking, manipulative, or playing games, without apparent regard to context or motivation.

Individuals with Staff Personality Disorder display persistent use of degradation, ridicule, and violence, either gratuitously or out of proportion to the situation (Criterion 7). Degradation may take the form of degrading language such as "retard" or "psycho", denial or pathologization of the existing identity or roles of others (for instance telling someone that thinking he is a writer is a delusion of grandeur), treating people like children, or assigning humiliating tasks. More advanced forms of degradation involve using elaborate methods to thoroughly confuse a person's sense of reality or self on all levels. Ridicule might include laughing at the aspirations or humiliation of clients, or laughingly dismissing their communication or behavior. Violence includes physical or sexual assault, mechanical restraints, chemical restraints, and solitary confinement. These things may be undertaken gratuitously, on a whim, as a result of boredom or frustration. They may be out of proportion to the situation, such as restraining someone for making eye contact with staff. These things are often justified using the means described in Criterion 3.

Associated Features and Disorders

Individuals with Staff Personality Disorder may have a tendency to take care of people who don't need taking care of, or imposing their idea of care onto other people regardless of context or other people's wishes. They may have a tendency to rationalize their own behavior in terms of helping others and be apparently unable to see their victims as fully human. They can be highly manipulative, especially to those they regard as inferior. Staff Personality Disorder may be associated with Stockholm syndrome and complex post-traumatic stress disorder in individuals who have been subjected to abuse by people with the disorder. Thus, a significant minority of people who are in institutional situations may develop features of this disorder or the full-blown disorder. Staff Personality Disorder is sometimes seen in the prodromal stages of developing full-fledged Psychiatry Disorder. Non-disabled children who participate in "Circle of Friends" and other helping-based friendship programs are more likely than other children to develop Staff Personality Disorder by adulthood, as are children who have been raised to be caretakers to disabled siblings or parents. People who go into the "helping professions" or who work in institutions are at high risk of developing Staff Personality Disorder, even if they have shown no signs of it in the past.

Specific Culture, Age, and Gender Features

The pattern of behavior seen in Staff Personality Disorder has been identified in many settings around the world, but is especially common on the top end of unequal power situations. Children imitating adults may transiently show signs that seem to point to Staff Personality Disorder where none is present. In the past, it seemed that Staff Personality Disorder was more prevalent in females, but it is now accepted that due to cultural pressures, it can present differently in males and females.

Prevalence

The prevalence of Staff Personality Disorder is estimated to be about 5% of the general population, about 80% among individuals who work in outpatient settings, about 95% among individuals who work in inpatient settings and other total institutions, and about 20% among inpatients and other people who experience prolonged abuse at the hands of people with Staff Personality Disorder.

Course

While there is considerable variability in the onset of Staff Personality Disorder, there is almost no variability once it becomes entrenched in a person's identity. The most common pattern is that a person seeks a job in any of a number of "helping professions" and is gradually molded into the behavior patterns that typify Staff Personality Disorder. There is a window of opportunity in acclimation to these behavior patterns, in which a person may still have the insight to quit their job or resist further indoctrination. Once these behaviors become entrenched, they are self-justifying and rarely respond to reason or therapy. This is enhanced by the fact that many people with Staff Personality Disorder spend a lot of time socializing with other people with Staff Personality Disorder. A minority of individuals, when presented with the evidence of the harm they have caused to others with their behavior, truly become cured of Staff Personality Disorder, although literature indicates this requires constant vigilance to avoid falling into their old behavior patterns. Some people with Staff Personality Disorder acquire a disabling condition or another mental disorder and recover after learning what it is like to be subjected to the behavior of people with Staff Personality Disorder, but others will maintain their staff identity even within the inmate role.

Familial Pattern

Staff Personality Disorder is about five times more common among first-degree biological relatives of those with the disorder than in the general population. There is also an increased familial risk for Psychiatry Disorder.

Differential Diagnosis

Staff Personality Disorder often co-occurs with Psychiatry Disorder, and when criteria for both are met, both should be diagnosed. In instances where it is related to the development of post-traumatic stress disorder or other trauma-related disorders, it should be diagnosed in addition to those disorders with a notation that they are connected.

Other Personality Disorders may be confused with Staff Personality Disorder because they have certain features in common. It is, therefore, important to distinguish among these disorders based on differences in their characteristic features. However, if an individual has personality features that meet criteria for one or more Personality Disorders in addition to Staff Personality Disorder, all can be diagnosed. Although Histrionic Personality Disorder can also be characterized by manipulative behavior, Staff Personality Disorder is distinguished by condescension. Paranoid ideas or illusions may be present in both Staff Personality Disorder and Schizotypal Personality Disorder, but in Staff Personality Disorder these ideas are limited to concerns about the behavior of those under the person's control (often inmates). Although Paranoid Personality Disorder and Narcissistic Personality Disorder may also be characterized by an angry reaction to minor stimuli, the reactions in Staff Personality Disorder have to do with specific situations related to the staff role and distinguish these disorders from Staff Personality Disorder. Although Antisocial Personality Disorder, Borderline Personality Disorder and Staff Personality Disorder are al lcharacterized by manipulative behavior, individuals with Antisocial Personality Disorder are manipulative to gain profit, power, or some other material gratification, the goal in Borderline Personality Disorder is directed more toward gaining the concern of caretakers, and the goal in Staff Personality Disorder is to maintain control over a specific person or group of people. Also, while individuals with Antisocial Personality Disorder rarely show remorse for their antisocial behavior, individuals with Staff Personality Disorder make heavy use of specific rationalizations to justify their behavior to their conscience. However, some people with Antisocial Personality Disorder may have co-morbid Staff Personality Disorder and both should be diagnosed in that case. Personality Disorder can further be distinguished from other personality disorders by the typical pattern of protecting others with the disorder and persistent use of euphemisms and jargon to describe one's actions.

Staff Personality Disorder must be distinguished from Personality Change Due to a General Institutionalized Condition, in which traits emerge solely in the institutional environment due to the direct effects of people with Staff Personality Disorder on an inmate's behavior.

It also must be distinguished from Factitious Staff Syndrome, in which a person without Staff Personality Disorder masquerades as a person with Staff Personality Disorder in order to assume the staff role and effect change for the better for those under the power of people with Staff Personality Disorder. Factitious Staff Syndrome does not qualify as a mental disorder, but individuals practising it unwarily may develop Staff Personality Disorder.

Links Related to Staff Personality Disorder and this article

My Contaminated Smile — describes and dissects the condescension prevalent in Staff Personality Disorder
Mourning Has Broken — the touching story of one man's recovery from Staff Personality Disorder
The Language of Us and Them — a poem illustrating some of the double standards used by people with Staff Personality Disorder
Barney's Harmonica — the story behind "The Language of Us and Them"
Hell-Bent on Helping: Benevolence, Friendship, and the Politics of Help — in-depth discussion of one possible etiology of Staff Personality Disorder
Conversation on Institutions — a conversation/interview with a woman who practised Factitious Staff Syndrome for the benefit of others
The Stockholm Syndrome — one possible etiology of Staff Personality Disorder

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Degradation may take the form of degrading language such as "retard" or "psycho", denial or pathologization of the existing identity or roles of others (for instance telling someone that thinking he is a writer is a delusion of grandeur), treating people like children, or assigning humiliating tasks. More advanced forms of degradation involve using elaborate methods to thoroughly confuse a person's sense of reality or self on all levels. Ridicule might include laughing at the aspirations or humiliation of clients, or laughingly dismissing their communication or behavior. Violence includes physical or sexual assault, mechanical restraints, chemical restraints, and solitary confinement. These things may be undertaken gratuitously, on a whim, as a result of boredom or frustration. They may be out of proportion to the situation, such as restraining someone for making eye contact with staff.