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Charlie Sheen and the High Conflict Personality?

By March 3, 2011

This week as I was searching for news on borderline personality disorder (BPD), I found this article on Charlie Sheen in the Huffington Post. While the piece is tagged as an article about borderline personality disorder, it is attempting to draw parallels between Charlie Sheen's behavior and a "high conflict personality" pattern.

I had never heard of "high conflict personality" before (it is not a DSM-IV diagnostic category), but the symptoms listed in the article sound very much like the features of BPD (i.e., unable to accept or heal from a loss, strong negative emotionality) and narcissistic personality disorder (NPD;† i.e., difficulty empathizing, blaming others). There is a great deal of comorbidity (co-occurrence) of NPD and BPD-- I wonder if this "high conflict personality" construct is merely a description of individuals who have both disorders.


Comments
March 4, 2011 at 11:15 pm
(1) RedRover says:

I suspect you’re right. “High Conflict Personality” appears to be a label designed by professionals outside the mental health field. Seems it’s just a catch-all designation, that includes behaviors also associated with clinically recognized personality disorders. I suspect the term “High Conflict Personality” developed so that non mental health professionals could recognize pathological behaviors, without making clinical diagnoses.

At least these issues are being discussed. It’s tragic that we’ve not had public discourse about personality disorders.

March 7, 2011 at 1:00 pm
(2) Randi Kreger says:

The term high conflict personality was put forward by Bill Eddy of HighConflictInstitute.com. He is both a licensed therapist in CA, an attorney and mediator. He is the author of Splitting: Protecting Yourself When Divorcing a Borderline or Narcissist and many other books.

The author of the HuffPo article does give Bill credit. But you can find much more in his books.

As the author Stop Walking on Eggshells, which has to do with borderline disorder, I have evolved in my thinking about the current Cluster B complex of BPD, NPD, histronic, paranoid and antisocial PDs and concluded that there can be so much comorbidity (co-occuring diagnoses) that it’s very hard to tell which combo you’re dealing with.

Right now there is no real agreement about personality disorders as the American Psychiatric Association is debating about how to define and organize the terms in the DSM-5 (which is supposed to be out in 2013 but-who-knows.) So frankly, I think right now this issues is very much in flux.

Were I to write SWOE again, I would use the HCP construct. I am working on a new book now with Bill and am going to be using that concept.

March 7, 2011 at 8:08 pm
(3) bpd says:

Hi Randi,

It’s not that I have a problem with the concept, but I just did a search of the research literature and the term “high conflict personality” does not appear in a single article in the whole of the psychology literature. Perhaps Mr. Eddy is on to something with this construct, but without any kind of empirical validation I am skeptical. There is a great deal of comorbidity between the personality disorders, but coming up with new, unvalidated labels will not help this problem– moving toward more dimensional diagnosis (as has been proposed for DSM-V) will.

Kristalyn

March 7, 2011 at 3:36 pm
(4) Non in therapy says:

Thanks to both of you for all your insights!!! I have come a long way! Can’t wait to read the new book and DSM V.

For me, I am undoing the internalizations of the high conflict person’s messages. I think I got it now! I like the way you discussed how to diffuse arguments with a BPD, Randi! Wow, that could be used for anyone with arguments.

Bascially, not taking things personally is the answer and responding in a neutral way resounding part of the person’s judgments, but with a way to hold one’s own personal power and not giving it away.

I have to admit I admire anyone in this business!!! I don’t like being on this level with my mind set. I am all into watching my ego, waiting and looking at me, fogiving and letting go. This stuff takes so much mental effort. I guess I short out in motivation with high conflict people. God bless you forever!

With love,
Non glad to detached with Love

March 8, 2011 at 5:16 am
(5) bunny says:

It’s been explained to me that People with BPD have extra empath. So I am confused as how BPD and NPD can be comorbid?

March 8, 2011 at 8:34 pm
(6) Amy says:

Thanks for the informative piece Dr. Salters-Pedneault and thank you for sticking with the facts! I will continue getting my medical advice from NAMI, NIMH, DSM, et al, rather than that of a professional writer and one (1) therapist/attorney’s concept. If the DSM changed everytime someone had a novel idea, we as patients and families of patients would be doomed. This week BPD is Charlie Sheen; a few months ago, Darth Vader was the face of BPD.

March 9, 2011 at 6:44 am
(7) Bobby says:

The symptoms Charlie is displaying is in no doubt Narcissistic (301.81) but he touches on other criteria for Borderline and possible others. This High Conflict PD is something new to me so I would have to see it researched before buying into it. The other explanation is that Charlie is acting and knows how to manipulate the audience into thinking he is mentally ill to a severe state. He has been a top actor for many years.

March 12, 2011 at 4:33 pm
(8) Babs says:

Since there are overlapping traits and behaviors amongst the four Cluster B personality disorders and they are grouped together because they are the dramatic, emotional or erratic pds, why not just use that term instead of “co-morbid” or “high-conflict pd” or whatever?

Referring to an individual as “someone with Cluster B pd” seems simpler and more straightforward to me, plus it relates to the current DSM-IV classifications.

And regarding the DSM-IV, my philosophy is: if it ain’t broke, don’t fix it. I think all the traits and behaviors referred to as Cluster B traits and behaviors are valid, whether they are organized as separate disorders or as a scale or rating of severity, the traits and behaviors exist, they are negative, and they toxic and damaging to the person displaying them and to those around them (particularly to the vulnerable minor children of such individuals.)

I am concerned that the DSM committee seems to want to entirely eliminate many traits and behaviors that define narcissistic pd (such as lack of empathy) and histrionic pd (acting out sexually to get attention) and the inappropriate and extreme anger of bpd. How can those negative, toxic, destructive traits/behaviors not be considered emotionally disordered?

I hope that eventually all the existing diagnostic traits/behaviors plus some of the ones that have already been eliminated (like passive-aggressive behaviors) are included in a huge menu of negative behaviors, to be checked-marked and rated for frequency and intensity, to arrive at a highly individual diagnosis for each patient of “Personality Disorder with a, c, e, f, j, k, m, n, o, p, x, and z traits”

Babs

March 12, 2011 at 4:51 pm
(9) Babs says:

@ bunny:
“Itís been explained to me that People with BPD have extra empathy. So I am confused as how BPD and NPD can be comorbid?”

I think you might have misunderstood the explanation. There is a difference between being sensitive (or even extra-sensitive) and being empathetic.

In this context, sensitivity is caring about one’s own feelings, and empathy is caring about others’ feelings.

Those with borderline pd are extra-sensitive / hyper-sensitive about their own feelings.

Bpds have “no emotional skin”, so even a slightly unpleasant situation or slightly irritating remark is perceived by the person with bpd as horribly unpleasant, or unbearably irritating. Hence the “walking on eggshells” around them, to avoid triggering their hyper-sensitive reactions.

Empathy is the ability or willingness to care about another person’s feelings. Someone who lacks empathy can’t or won’t try to cheer up a sad friend who just lost her pet, or give congratulations to a happy friend who just got engaged, etc. The person who lacks empathy just doesn’t care. Or their brain has a “hole” in it where normal human empathy is supposed to be, and they lack the capacity to care.

So, that is how a person can have both borderline pd and narcissistic pd at the same time. A person can be hyper-sensitive to perceived criticism of herself, AND show no concern or empathy for other people’s feelings… both at the same time.

Babs

March 21, 2011 at 12:58 pm
(10) Randi Kreger says:

One thing I forgot to say in my original comment is that according to Bill, the high conflict personality may have one or more cluster B disorders, usually a combo of BPD/NPD, but also possible comorbid antisocial and histrionic (and paranoid to a lesser extent).

To Kristalyn:

I think it’s a good idea for clinicians to determine if clinical studies back something up; I know that is a huge issue. Here are my responses to your comments:

1) HCP is simply a term for someone with comorbidity in the cluster B personality disorder arena. The research shows that comorbidity is high within cluster B: in fact, there is SO much comorbidity that the APA is proposing trait ranking (such as a 1 for low narcissism and a 5 for very narcissistic).

In other words, the HCP ALREADY EXISTS: the only thing new is the term. Different researchers come up with different terms all the time (eg the BPD “as if” personality) and there is always much disagreement. Nothing new there.

When it comes to terms and labels, clinicians try to avoid being judgmental. The term “HCP” is about as non-judgmental as you can get when describing someone with severe psychopathology.

I think if there were a scientific term in use that means the same thing, Bill would use it. But there isn’t anything anyone can agree on.

2) Bill’s purpose is not to put “HCP” into scientific usage, but help people understand what they are dealing with. In the same vein, some of the terms I use in my books are not meant to be scientific–they are attempts to communicate something in shorthand in a way that everyone can understand. (And, btw, they succeed in doing so, whether or not people happen to like them).

March 21, 2011 at 6:33 pm
(11) Randi Kreger says:

I asked Bill Eddy to comment, since he originated the term, and this is what he said:
………………………………………….

As more people learn about HCPs, itís important for them to understand it is not intended to ever be a diagnosis Ė but rather a warning sign to be careful in how you manage your relationships.

Most of us recognize that there are people with a lot of conflict as part of their personalities. Many of them appear to have personality disorders (a mental health diagnosis in the DSM-IV) OR just some ďtraitsĒ (NOT a mental health diagnosis in the DSM-IV).

So when people ask me if HCPs have a mental disorder, I say that I donít know and I donít need to know. If they show a lot of high-conflict behaviors (all-or-nothing thinking, unmanaged emotions and extreme behaviors), then I know that I need to use methods that work best with HCPs, such as:

1) showing a lot of EAR (Empathy, Attention and Respect); and
2) focusing them on tasks and not on emotions; and
3) having a healthy skepticism about what they say; and
4) setting clear boundaries and appropriate consequences.

Anyone can use these methods when you think you are dealing with an HCP. You donít need to make a diagnosis Ė and you shouldnít.

Bill

March 22, 2011 at 9:11 pm
(12) Amy says:

The term is not in the current DSM and there are no plans for inclusion. Randi, why don’t you stick with selling books and let the professionals handle the diagnostics? Your input would be more appropriate in a blog about some of the groups you advocate for on your website such as “The Psycho Ex Wife”.

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