A person with a High Conflict Personality (HCP) usually has an underlying personality disorder, generally viewed as one linked to the “dramatic, emotional or erratic” cluster (Cluster B) that includes antisocial, borderline, narcissistic and histrionic personality disorders. Personality issues are pervasive, which are longstanding patterns of behavior and experience that adversely affect a person’s interrelationships with others and ability to function effectively in the world. People with HCP do not necessarily fall neatly into one of these recognized categories. Instead, they can demonstrate symptoms from one or more of the Cluster B diagnostic categories, and they may by exclusion fit into the category of “Personality disorder not otherwise specified.”
HOW IS HIGH CONFLICT PERSONALITY TREATED?
In most cases, psychotherapy is the treatment of choice for HCP, whether in an individual or group setting. Since HCP clients have been helped by both psycho-dynamic and cognitive-behavioral treatment modalities, therapists have several tools at their disposal. One in particular, dialectical behavioral therapy (DBT), a method of psychotherapy originally developed to treat Borderline Personality Disorder, has been effective for clients with HCP, as the two disorders have many characteristics in common. While medication may not be the treatment of first resort, it can be appropriate for some clients, especially for those who may be suffering from other psychological issues, especially mood disorders, in addition to a HCP.
WHAT CAUSES HIGH CONFLICT PERSONALITY?
Like many psychiatric disorders, specific causes of HCP have not been clearly identified. In general, research has demonstrated an association between personality disorders and abuse or neglect early in life. There are many theoretical constructs that attempt to explain the circumstances that give rise to one disorder or another, but definitive causes are generally elusive. If nothing else, it is fair to say that there is no demonstrable link between these disorders and any genetic or physiological condition, although temperament may play a role in their development. It is believed that HCP is related to an insecure or disrupted attachment in childhood. Accordingly, the symptoms of HCP can clearly be exacerbated by situations like divorce or relationship difficulties (that are filled with conflict even for people without HCP).
WHAT ARE THE SYMPTOMS OF HIGH CONFLICT PERSONALITY?
HCP, given its overlap with the antisocial, borderline, narcissistic and histrionic personality disorders, may be more of a descriptive term than a specific diagnosis. People with HCP tend to have several things in common. They initiate and receive reward from conflict with others, and they are usually at the center of whatever conflict is occurring. They appear to treat conflict as normal and expected in their interactions, to a point at which conflict becomes a defining aspect of relationships. They are adept at escalating conflict and at blaming others. At the same time, they have great difficulty seeing things through the eyes of others and they are extremely reluctant to take responsibility in their lives or to accept blame when things go wrong. They are often referred to as “chronic blamers.” They tend to be emotional, aggressive, mistrustful and controlling. They easily see themselves as victims, and they are extremely resistant to acknowledging that they may have contributed, in even the smallest way, to making a situation difficult. For people with HCP, the world appears in black and white. Others are either with them or against them. They have little or no insight into their own behavior, and they are easily threatened by interpretations of behaviors that do not comport with their own worldview. Splitting is an important concept among persons with high conflict personalities. The people around them are perceived as all good (over-idealized) or all bad (devalued). Someone who has “split” off a family member or friend may refuse contact with that person and may speak very negatively about them.
FREQUENTLY ASKED QUESTIONS ABOUT HIGH CONFLICT PERSONALITY WHAT IS THE PROGNOSIS FOR HCP?
Clients with HCP are not naturally insightful. They can react with hostility to therapeutic intervention, often interpreting the therapist’s efforts as an attack. These qualities can make treatment difficult, but a trained therapist who understands HCP can work through these difficulties using specific techniques. Change may be gradual, but clients with HCP can ultimately adopt more effective ways of living. For persons more on the narcissistic spectrum, initiating therapy may be difficult to impossible. Forming a deep relationship with a therapist is also difficult for them.
ARE FAMILY AND FRIENDS INCLUDED IN TREATMENT PLANS?
Many of the symptoms of HCP are most pronounced in interactions with those closest to the client, so these relationships are especially important to effective treatment. The involvement of family and friends in treatment can be enormously helpful for all parties, encouraging them to understand the behaviors at issue and to adopt new, more productive ways of interacting.
Thom Kessler, LMFT, RAS
Marriage & Family Therapist and Registered Addiction Specialist