Personality Disorder

Transcription

1 9/12/2016 Personality Disorder David G. Mirich, PhD Testimony by Dr. Robert Elliot and accepted by Judge Pope "A personality disorder is a psychological condition manifested by a consistent or long-lasting pattern of dysfunctional behavior that impairs personal, social, or work functioning. The condition is severe enough to repeatedly have been manifested by overt acts." 1

2 Generic Diagnostic Criteria Lasting pattern of behavior and inner experience. Markedly deviates from norms. Manifested in at least two areas: Affect. Cognition (how they perceive and interpret self and others in events). Impulse control. Interpersonal functioning. Generic Diagnostic Criteria Pattern fixed and affects personal and social situations. Causes clinically important distress or impairs work, social, or personal functioning. Root in adolescence or young adulthood. Not explained by another mental disorder, general medical condition, or use of substance. 2

3 FAA Criteria FAR : No established medical history or clinical diagnosis of: A personality disorder that is severe enough to have repeatedly manifested itself by overt acts. Captain John Captain John was referred for a fitness for duty re-evaluation after having been found to be unfit for duty one year prior by a neuropsychologist. Airman was repeatedly having problems in interpersonal relationships in his employment and was having difficulty taking responsibility. The previous evaluator was concerned about the airman s elevated level of suspiciousness and failure to take responsibility. He recommended counseling as well as cognitive rehabilitation. 3

4 Precipitants Captain John was convinced that airlines officials, as well as FO s and flight attendants were conspiring against him. He was continually writing complaints and making reports to his Chief Pilot about these claims. He demanded that action be taken against these individuals and when confronted about his behavior which led to distrust and confrontations with others, he would not accept any other point of view but his own. Additionally, he was often abrasive with passengers which led to complaints against him. He had training failures Captain John Regarding Captain John s employment problems, a year prior the psychiatrist stated that evaluated him stated, This is a narcissistic position which does not allow for the wider view necessary in a leadership position which one has as a pilot. Captain John attended one therapy session. The psychologist commented that he appeared unable to fully avail himself for supportive psychotherapy because he was not capable of the type of honest self-appraisal needed to engage in the work. Also, he was not taking responsibility for strained relations with crew and was still blaming his coworkers for a hostile work environment (ostensibly because he was a strike-breaker 20 years prior). 4

5 Captain John He attended two sessions of cognitive rehabilitation. The treatment provider stated, He did not follow our normal protocol for doing the therapy as I only saw him on two occasions. Normally I see my pilot patients every two to three weeks over a three to four month period. I felt he was rushing his re-evaluation. MMPI-II Validity Indices VRIN and TRIN were considered to be valid. The S (Superlative Self-Presentation) elevation suggests moderate defensiveness. Score on the Fb (F-back) validity scale suggests Consider faking good. L (Lie) validity scale suggests a valid profile, yet notes that the patient may have Little or no insight into own motivations, and Little awareness of consequences to others of their behavior. K (Correction) validity scale suggests moderate defensiveness as well as noting possible denial, intolerant and un-insightful. They lack self insight and self understanding. 5

6 MCMI-III His results show a Fake Good performance. In order to try to obtain valid results, he was asked to look through his answers again and honestly disclose true information. This proved to be difficult for him as he only went back through about half of the test before stating that he had already told enough truth on his first attempt and discontinued the test. Elevations were found on the Narcissism and Schizoid scales. MCMI-III Critical Items Endorsed 10. What few feelings I seem to have I rarely show to the outside world 24. I began to feel like a failure some years ago 27. When I have a choice, I prefer to do things alone 30. Lately, I have begun to feel like smashing things 48. A long time ago, I decided it s best to have little to do with people 92. I m alone most of the time and I prefer it that way 96. People have said in the past that I became too interested and too excited about too many things 99. In social groups I am almost always very self-conscious and tense 167. I take great care to keep my life a private matter so no one can take advantage of me 6

7 Evidence Supporting Personality Disorder MCMI-III resulted in elevations on the Narcissism and Schizoid scales MMPI-2 results indicated that he has the profile of an individual who engages in denial, is intolerant and un-insightful, has a lack of openness, and according to the manual, not much to work with in therapy. The treating psychologist stated that he found persistent defensiveness and suspiciousness. He spent a lot of time telling me about how unfairly he has been treated. He believes management and several pilots are out to get him. He denied he was at fault. He has difficulty seeing how his behavior affects others. Usually engages in justification for his behavior and blaming others. He seems to have little interest in or expectation of acting in cooperation with others. Evidence Supporting Personality Disorder The Neurocog. Rehab. Specialist said Although I found John to be a likable person, once I got to know him, I can see that his personality might lead to difficulties with people who do not know him well. He seems a bit needy and also demanding. The Chief Pilot had documented that Captain John had anger issues, multiple complaints from passengers and had more FO s who would not fly with him than any other Captain. He had been grounded for two years by the time of the reevaluation. The psychiatrist independently diagnosed Captain John with a Personality Disorder. 7

8 Mild Impairment on Cognitive Testing Low scores from previous testing persisted in follow-up testing: (Category Test, TPT Memorization and Localization). Additionally, he had scores below ATP norms in the area of visual memory (CVMT), Trial 2 on the PASAT,) verbal learning (CVLT), executive functioning (COWAT and Trails B), and speed of reasoning (Trails A). The criteria that informs my decision to recommend or not recommend a return to duty: Does the pilot s attitudes and actions cause the potential for a dangerous situation to develop? (Aggressive narcissism, blaming, minimizing, fails to accept responsibility). Is the pilot unable to develop the necessary introspection and accurate self-appraisal necessary to get along with flight crew and passengers? (Extremely close-minded, always has to be right, is overly defended and seems to get enjoyment from arguing). Does the person deny the need for change? Has the pilot rejected therapy to resolve issues that have been pointed out or has been treatment-resistive? Did the pilot have a negative attitude in regards to working on him or herself? Is there a lack of evidence of meaningful change? 8

9 My Conclusion In my opinion, Captain John is not fit for duty at this time based upon evidence of disqualifying neurocognitive disorder and evidence of a personality disorder which render him unsuitable for active flight status. 9