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Part V: Impaired Managers

Part V: Impaired Managers

I’m Not at My Best

Many people unnecessarily suffer under a burden of treatable psychiatric problems that significantly impair their performance. Failure to recognize and treat common problems such as attention deficit hyperactivity disorder (ADHD), anxiety disorders, depression, emotional trauma, burnout, and alcohol or drug abuse costs businesses billions of dollars a year in lost productivity. Unfortunately, most of the time, the nature of the problem and the relative ease with which it can be ameliorated is not recognized.

These problems are also important because they can markedly exacerbate, or even mimic, the various personality disorders discussed in Parts I through V. When this is the case, treating the problem can lead to marked improvement in the toxic behavior. When people with narcissistic personality traits become depressed or anxious they become even less capable than they usually are to respond to others feelings. Moreover, they become desperate in their attempts to reinforce their fragile self-esteem, and so their toxic behavior increases. When rigid individuals become anxious or depressed their fear of chaos increases and their desire to be in control increases. Moreover, their cluelessness increases further impairing their ability to treat others considerately. Frantic and volatile managers, when anxious or depressed, become even more frantic and volatile than usual.

There are a number of reasons that the problems are missed. First, rather than realizing that anxiety, depression, or ADHD are making it hard for the person to function, people assume that there are personality traits leading to the aggression, rigidity, disorganization, impulsivity, and poor motivation that they see. Many therapists, and even many psychiatrists miss the treatable anxiety/depression/ADHD problem underlying what appear to be problematic personality traits. Many people burdened by these problems fail to go for assessment or treatment because they feel that there is a stigma attached to seeing a psychiatrist. In reality, their superiors, subordinates, coworkers, and families would rather they have treatment and function well than continue to be stressed and not be at their best. People also assume that the problems will somehow go away on their own. Sometimes they do ease in time on their own. They also sometimes get worse. Meanwhile a great deal of unnecessary suffering occurs. Many fail to go for treatment because they, and even their medical doctors, do not realize that there is a treatable psychiatric problem. People become used to a certain level of anxiety or depression and think that it is normal or inevitable. They do not realize that they could feel and perform much better. They also do not realize the toll that the anxiety and depression take on their physical health, relationships, and productivity.

ADHD, anxiety, PTSD, depression, burnout, and substance abuse share many symptoms. They all impair concentration, induce anxiety, impair the person’s ability to enjoy things, and cause irritability. The relative intensity of the different symptoms varies across the different problems. Fortunately, the medication for anxiety and depressive symptoms is the same, so that even if the exact diagnosis is unclear, the treatment is clear.

Table V-1. Overlapping Symptoms of Various Types of Impairment
 Distractibility, Poor ConcentrationHyper/AnxiousLoss of EnjoymentIrritability
Alcohol Abuse++++++ if detoxifying++++++

Part V Overview

The section begins with a discussion of attention deficit hyperactivity disorder (ADHD). The distractibility, disorganization, and impulsiveness that result from ADHD can significantly impair work function and can give the impression of self-centeredness. The problem is generally fairly responsive to medication, increased awareness of the problem, and mild adjustments in work environment. The next two chapters cover anxiety disorders and depression. Both anxiety and depression not only cause significant discomfort and impair work ability, but their presence generally exacerbates any existing personality problems. Both can often be ameliorated or completely controlled by medication and cognitive behavior therapy. Posttraumatic stress disorder (PTSD) has prominent anxiety and depressive symptoms. It can also give a presentation similar to ADHD. Burnout resembles depression and arises from experiencing high levels of stress. Bipolar disorder entails a combination of depression and manic/hypomanic episodes. During a hypomanic episode, a manager, as a result of grandiose feelings and a collapse of judgment, can make disastrous business decisions that cost the company considerable damage and expense. Alcohol and drug abuse are, unfortunately, very common. They impair judgment and functioning, and can cause problems with anxiety and depression.

  • Chapter 22—ADHD: Distracted, Disorganized, Impulsive

  • Chapter 23—Anxiety: Nervous, Frightened, Worried, Preoccupied

  • Chapter 24—Depression: Pessimistic, Exhausted, Irritable, Unhappy

  • Chapter 25—Posttraumatic Stress Disorder: I Can’t Believe This Happened and I Can’t Stop Thinking About It

  • Chapter 26—Burnout: Used Up

  • Chapter 27—Bipolar Disorder: Invincible to Depressed and Back

  • Chapter 28—Alcohol and Drug Abuse: Only the Bottle Takes Away My Stress

Further Reading

R. Lubit, C. Kellner, B. Ladds, & S. Eth. Five-Minute Psychiatric Consult. Lippincott Williams & Wilkins, 2004.



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