Why are people with Personality Disorder so manipulative?

Those with personality disorder are manipulative.  This is a fact.  At least, you would think it was a fact if you heard it as many times as I have coming from the mouths of people in the caring professions.  Whenever I’m doing training on personality disorder, there is rarely a session where this fact isn’t voiced at some point.  When it does come out, it isn’t spoken in a timid, tentative way, but with the full throated confidence of someone speaking a truth universally acknowledged.  It is a fact as certain as death and taxes, and because people are so assured that it is a fact, the presence of a service user with a diagnosis of personality disorder in the room does nothing to encourage them to censor their views.

I’m going to spend some time thinking about manipulation, what we might mean by it and whether this is another way of interpreting behaviour in a way that might help carers keep caring.

 Most definitions of manipulation use the terms like clever, skilful or artful, implying a conscious use of talent on behalf of the manipulator. Based on this definition, we all manipulate the people in our lives in that we consciously try to get them to do what we want.  Being good manipulators, we hope to do this while keeping people liking us.  This is the skill.  It is not the forcing of our will onto others but being able influence people while keeping them on our side.  The problem that people with personality disorders have is that they are awful manipulators. Very often in my life women who are older than me tend to mother me.  If I look a bit flustered or helpless, they will frequently step in and do things for me that I’m perfectly capable of doing myself.  At the end of it, we all tend to like each other a bit more.  I’m in their debt and they feel they’ve been useful.  You can argue that this is a skilful bit of interaction, but based on the definition above, you could also argue that I’m manipulating people.  Let’s contrast this with me walking into the office and shouting “If someone doesn’t give me a lift into town, I’m going to fucking kill myself and it will be your fault.”  I have no doubt that the people in the office would indeed take me into town.  Whether they would ever want anything to do with me in the future is another matter.  Again, lets have a think about what might be the actions of a skilful arch manipulator, and what might be someone with really ineffective ways of getting their needs met.  A good manipulator gets what they want and people like them.  A bad manipulator gets what they want and people resent them.

It wasn’t a million years ago that I shared the ‘personality disorder = arch manipulator’ view. I used to work in a team where at least once a week a man would phone to tell us he was suicidal.  What followed would invariably be a 30 minute phone call where I desperately tried to get him to tell me he would be ok.  He rarely did.  Every suggestion of what to do had already been tried.  Every option had been explored and found wanting.  It said on his careplan to phone when he was suicidal and here he was phoning.  Now what was I going to do about it?  The answer was always nothing particularly useful.  While I was being berated for my incompetence I tended to feel powerless, useless and for someone who came to work to make people better, pretty bad at my job.  It would be fair to say that I hated the way he ‘made’ me feel and I know that many of my responses on the phone were far more about me trying to ‘win’ than they were about trying to provide care.  Because he had phoned weekly for years, I knew the actual risk of him committing suicide was pretty static and that the phone calls didn’t reflect a significant change.  In my head this guy was sat at home planning different ways that he could torture me.  I saw him rejoicing in my discomfort, raising his fist in the air (as I did) when he felt he’d refuted an argument and hanging up the phone after a particularly vitriolic exchange happy with a job well done.  My team were very helpful in supporting me with my view of him and we would have many conversations that built up a picture of someone whose sole pleasure in life was my misery.

It’s hard to be particularly caring to someone who at best, I wished would leave me alone.  Because I took the majority of his phone calls, I sought out some supervision to help me manage what I viewed as a cruel individual.  The supervision was not an enjoyable experience as rather than help me to manage a trouble maker, the supervisor started pulling apart the foundations of the power crazed manipulator I had built up.  He asked me what the service user was looking for when he called and what in his life might explain the way he interacted the way he did.  He got me to see how unhelpful the picture I had of the client was and even worse, how I might be exacerbating and maintaining some of the very things that did my head in.  That was the first time that everything I thought I knew about personality disorder had been challenged and now I reflect on it, the first step towards me choosing this area for my career.

The point of the above is that I can sympathise with the view that people with personality disorder are manipulators and it’s a view that I’ve held myself.  Now let’s try a different way of looking at things.

Within DBT (Linehan 1993) manipulation would be viewed as poor interpersonal effectiveness.  Most of us come from a background that helped us to be effective.  We know how to get our needs met while keeping people on our side.  We know that when we raise the intensity of our communication by being more assertive or even hostile and rude, we run the risk of damaging the relationship with that person.  We generally know that if we need help someone will do something and that we can say no to requests that are unreasonable.  People with personality disorder haven’t come from the same background and as a result, they don’t have the same skill set as the average person in the street.  They might have come from a background where your needs were only met if you screamed blue murder.  They might have come from a background where people modelled that threats and violence were the only way to get people to do what you want.  They might have only been cared for when they were physically hurt or they might never have been taught to put their feelings into words.  They might….and on and on.  The gist of this is that we will see peoples past relationships in their present ones if we look for them.  If we look hard enough, we can see how people have been taught to interact the way we do.  If we’re being brutally honest with ourselves we might see how what we do keeps some of these problems going.  If we only spend time with people when they’re in crisis, if we only increase input when they self harm or we reduce our contact as soon as they’re ‘doing well’,  we can be playing a big part in keeping some of the more difficult to manage behaviours going.

It might also be worth thinking about splitting, where people with personality disorder ‘play staff off against each other’ and form special relationships with particular carers.  Splitting in teams certainly happens but I wonder if us staff ignore the part we play.  Instead we blame the client and think of them as an evil puppet master, pulling strings that ‘make’ us act.    Now I come from a background that taught me I was loved and valued.  Despite this I tend to gravitate towards people I perceive as warm, friendly and interested in me.  People with personality disorder have the same tendency.  When in a frightening place it makes sense for them to particularly attach to staff who show the most warmth or have some characteristic that feels safe.  It makes more sense to strengthen that relationship by giving gifts, telling secrets and ‘being good’ for them.  Those staff care.  They need to be hung on to.  The relationship can also be strengthened by distancing yourself from people who are more cold, apathetic, hostile or just different.  By being difficult for the ‘other’ ones or only working with the special ones the special relationship is emphasised . This isn’t a cold, calculated endeavour to cause chaos, but a natural response from someone whose early experience of carers was different to our own.  In The Ailment, Tom Main (1957) gives the example of a baby crying in a room full of people.  They will compete to sooth it and some will succeed.  In an innocent way the baby evokes some rivalries in the people around it.  It might become distressed by these rivalries and might even make them worse in the quest for comfort.  While the baby hasn’t caused the rivalry (or split), its behaviour which draws in some while pushing away other inflames them.  The baby (fairly understandably) is pretty poor at managing the people around him but he does the best with what he has.  The split isn’t his fault. 

We can also think about personality disorder as a difficulty in managing strong emotions.  Often people with personality disorder were never taught to manage their emotions, they had people in their lives who modelled ineffective ways of coping or they learned that only intense expressions were effective.  When on the receiving end of these powerful emotional communications it’s important to remember how well we are able to think when we are at our most frightened and angry.  When working with those who have been taught that the world is out to hurt them or those who are terrified at the prospect of being left alone, it is understandable that strong emotional responses will be a part of many of our interactions.  When angry or afraid we all want to manage the immediate threat and pay less attention to what happens in the long term.  If we can view people as feeling threatened or terrified, if we can understand why they might do all they can to achieve a short term goal again, it is harder to keep that picture of a skilful arch manipulator. 

We started with a picture of people with personality disorders as calculating master manipulators.  We’re now at a place where we might see that some behaviours are exaggerated natural responses while others are the product of poor interpersonal skills.  We might substitute the idea of people intentionally causing chaos with people doing the best they can with what they’ve got.  Holding this in mind is essential for keeping some care in the caring professions.  It is nigh on impossible to care for someone who you think is deliberately trying to hurt you simply for the pleasure it will give them.  If we can ask ourselves why the client communicates in this way and find an explanation in their past then we can keep empathy.  While we have empathy, we can show compassion.

We live and work in busy times.  There is little time to search peoples records for clues from their past.  Action is valued, reflection looks a lot like doing nothing.  We do little good for our clientele when we act without empathy and yet the pressure to act on what is in front of us is immense.  Perhaps next time we feel that pressure to act we might do it with a person who has missed out on some of the skills we have in mind.  We can notice the sense that we’re being manipulated and wonder what that might mean in the context of an unskilful person trying to get their needs met.  It doesn’t mean that our actions will be different but it might mean we might communicate in a more caring way.

We all manipulate.  People with personality disorder are just particularly bad at it. 

Keir is a Lead Therapist in an NHS Specialist Service and provides training, consultation and therapy around complex mental health problems through beamconsultancy.co.uk

Linehan, M. M. (1993). Cognitive Behavioral Treatmentof Borderline Personality Disorder. New York: Guilford Press.

Main TF. The Ailment. Br J Med Psychol. 1957; 30:129-45.

 

As ever, all of the above is just an idea to play with.  Don’t take it as fact.  Other ideas are available...

 

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34 thoughts on “Why are people with Personality Disorder so manipulative?

  1. This is going to fly in the direction of as many mental health professionals as I can get it too especially my crisis team. Too often I encounter these attitudes from professionals when all I’m doing is asking for help when that’s what they’ve told me to do. Thank you for writing this.

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      1. Oh for sure it will upset quite a few I expect. I found it hard to read having been on the receiving end of similar attitudes. I got a lot of flak for one of my posts and needed to take cover for a while. I’ve been incensed at how I’ve been treated over the years and try v hard (with some staff on side too) to dispel the myths of PD’s

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    1. Thank you Judy. I suppose its worth saying its not all professionals and even then, attitudes are based on not being able to understand rather than people being deliberately mean.

      I’m glad you liked it and really appreciate the feedback, Keir.

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  2. Thank you for such a thought provoking article. It made me pause and think, and will definitely challenge mine and my colleagues attitudes more often. I recognise the bit about action valued more than reflection, yet only through reflection I would argue can we start to appreciate where someone is coming from. Three years in Forensic mental health and I can count number of team reflections on one hand.

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    1. Gosh I’m late replying to this. I suppose it gives m the chance to ask how the challenging got on. It’s hard to get time to reflect but the first step is to let people know you value it. You can be the change!
      Thanks you so much for taking the time to comment. It is so appreciated.

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  3. Brilliant post. I’m a student mental health nurse, one of those who had a view of people with personality disorder as “manipulator”. Certainly this view is shared among many mental health professionals I have worked. This blog Was so helpful in challenging my views about them and I hope I can translate this to my practice

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    1. I was talking to someone today about the value of shouting into the echo chamber that is twitter and only hearing people who agree with you. I really appreciate you taking the time to let me know how this impacted on you. Now you have to pick up the torch and spread the light. Thank you ☺

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  4. Fantastic & thank you for offering a different perspective of manipulation. When well I teach staff about self-harm & suicide; I offer a flippant example of manipulation to hopefully help staff understand that we all at times manipulate (usually along lines of I have will go home after teaching today, sit on sofa [should just add I live with chronic pain & poor mobility] & tell my husband how much I love him, any chance of a coffee or bottle of Stella!) to get our needs met, it’s what as human beings we have evolved to do. As you can imagine staff can offer relate to this example. I want to encourage staff to move away from the manipulative label, take a step back, what is really happening in that persons life, either now, in the past or possibly fear for the future.
    The sad thing is I’m not well at present & am ODing worse than I have for many, many years. Yesterday I was told “it’s your choice …”

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    1. Thanks for you kind words Sam. I try to get staff to move away from that label too. It’s good that most want to and can see a more empathic way of interpreting things. Let’s keep challenging. Thanks for taking the time to comment. ☺

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  5. The article implies a PD is all learnt behaviour, having a grown up daughter with a PD and most of her manipulative presentation was their from early onset and I’m 100% sure inherited from her absent father, who had the same traits. I do feel for some sufferers there is a generic heritage.
    Interesting read, thank you 😊

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    1. Thanks for commenting Mandy. There’s an argument to be made that our personality is made up of biological, social and psychological elements and which each having more or less influence than others in different individuals. I suppose those in the behaviourist camp would argue that ways of interacting only develop in a particular way if they’re working. It’s all very complex. Glad you found it interesting 🙂

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  6. Hi Kier.
    I wish different pd diagnoses were not lumped together when people talk about them. Someone with an inate psychopathic thinking style has different needs to an individual with borderline pd, who benefits from a therapist helping them to identify and use better emotional coping strategies. They both may use manipulation but for different reasons. I have found the pd label used by certain staff to justify their own lack of compassion, and to justify not meeting a patient’s needs in a timely way. Compassionate staff tend to ask why a person is distressed or being demanding, not to use it as a reason not to help them. Culture is so important in mental health settings and strong compassionate leadership of the service. Compassion, or lack of it, is learned as new staff join and model the staff around them. There can be one culture during office hours – but another during nights and weekends and an OT can’t help this. Training (and lots of it) is so important in helping people to be more understanding. Maybe also changing the name BPD… It sounds so much worse than it is.

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    1. Thanks for commenting Anthea. You’re not going to like ICD 11. That gets rid of the classifications and just rates people on severity. I agree with pretty much all you said but I think the organisation can also influence how compassionate we are. If we have time to be useful to people then we can be, if people are just units to be processed then it’s harder to keep the empathy…Thanks for reading 🙂

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  7. Nearly 20 years ago i worked in a homeless hostel with 30 residents staying for up to a year, with wide and varying needs. One client with a ‘personality disorder’ was ‘the most difficult one’ – she would threaten suicide or ‘kick off’ 3 to 4 times a week causing big issues for other staff and clients. As her key worker i offered to spend a 1-2-1 session with her 3 times a week, regardless of whether there was an incident and she agreed- Just me and her in a room talking for an hour three times a week (this was before such key work sessions became common like they are today). I got to know and like her very much during this time- i had previously found her irritating and manipulative like the rest of the staff. We met like this for several weeks, sometimes she would tell me really difficult and awful memories, othertimes we would just chat about what she was watching on TV- after a month it was noticable the number of hostel ‘incidents’ recorded about her had dropped dramatically. I counted them up one day & estimated my 3 hrs spent with her per week was reducing at least 6 hours of ‘incident’ time. However in our next team meeting other staff and management decided i was spending too much time and ‘rewarding’ her previous ‘bad’ behaviour- so after a couple of months i was told to stop. Guess what happened… yep her ‘incidents’ hit the roof and she felt really let down by me. I left shortly after but always remember that experience. As a young, unqualified support worker i never challenged the decision (even though i thought it was the wrong one) and often wondered what became of her after i left. Thanks for publishing this- it makes sense of that experience for me and is a good reminder of how important professional compassion is when working with people in crisis.

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    1. It is so rude of me to leave it this long before replying! Services can be so fixated on being right they can loose all sense of what they are there for. To improve outcomes to people or enforce rules. It’s difficult to work in an environment where people can’t think, especially if you’re capable of reflection yourself.
      I hope you’re holding onto your compassion, and thank you for taking the time to share your experience.

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  8. Hi Keir, great post! Loved reading it. Can I push you to go a bit further with it though? I think there is only a couple of things missing from your post. At no point do you make it clear that 1) none of what us BPDs do that could be considered in any way ‘manipulative’ (whether we are good at it or not) is actually consciously done 2) plenty of people with mood disorders can be considered manipulative (it’s not just a label that can apply to PDs) and 3) what about treating clients as individuals rather than just walking diagnoses?

    People forget that severe emotional neglect/abuse is often a component of BPD. Part of that is not only calling a child names, but trying to get the child to shut down emotionally. I was told repeatedly ‘crying is manipulation… stop it, it won’t work, I won’t give you what you want’ all I wanted was a hug because I’d grazed my knee or something. It is stuff like that. Demonising of emotion. When not dealt with in a healthy way, when kids are not shown how to handle big emotions, later, when the emotions get too much, they get out of hand. After a lifetime of living in an emotional pressure cooker, it explodes. The intensity of emotion blinds any conscious, rational thought so in the moment, no, we are not thinking about how we can get you to do what we want. We feel abandoned for whatever reason, our emotions go haywire, the pressure cooker explodes and we self-harm or attempt suicide because we cannot cope. Without any hope you will not abandon us. It’s not manipulative (whether we are bad or good at it is irrelevant), it’s just an inability to cope with emotions we cannot handle. Often I feel like people who label me as manipulative are asking ME to be self-aware but actually missing that deep inside them is something that I’ve rubbed up the wrong way. When I began to see that when people called me manipulative they were actually saying ‘you want something I don’t want to give you’ I began to see it a little differently. It is less about what I want and more about what they DON’T WANT TO GIVE ME. So that begs the question…. why don’t they? Does my pain resonate with them? Are they afraid of emotion themselves? Are their emotional boundaries not strong enough and if they are professionals, is it their problem for taking on more than they should have? IF your emotional boundaries are secure, you have the right help and support (supervision, therapy for yourself maybe and a loving group of friends and family), the right experience and qualifications and you take good care of yourself… then actually the chances of labelling clients negatively is less. I’m constantly surprised that my therapist can handle me. She allows me to contact her between sessions, she tells me she genuinely cares and likes me and thinks about me between sessions. I thought that meant she was going to burn out and blame me. She told me ‘no! That’s why I have good emotional boundaries, good support structures and I take good care of myself. I cannot pour effectively from an empty cup’

    Also, the incident you described with the guy who kept ringing to say he felt suicidal then telling you he’d tried all your suggestions… that could also be depression. The number of people with depression who also do that is high as well. Using their illness like a blanket they don’t want to give up… that could count for any number of mood disorders, not just PDs. Only the other day, I met one woman with depression who had recently decided to come off her drugs ‘oh I feel awful’ she said. I empathised. ‘the drugs just don’t work’ she said, I validated and empathised ‘therapy just doesn’t work either’ she said. ‘I’ve tried everything’. When I asked more questions, turned out she’d tried 1 drug and 1 therapist using 1 model of therapy. When I said ‘there are lots of kinds of drugs, don’t give up, you might not have found the right one and there’s hundreds of models of therapy, again you might not have found the one that works’ ‘oh no, it’s me… I cannot be cured, thank you for trying though’. She had depression, not BPD.

    Obviously, not all people with depression are like that. Not all people with BPD are how I suggested either and not all therapists are like mine nor are all OTs like you. Even though we carry a label… that is not all there is to our personalities. We are not just diagnoses. We behave, think and feel differently to each other because we are (bizarre concept I know) unique individuals. Diagnoses are a lazy man’s way of understanding someone. Like all labels; black, white, Christian, Muslim, gay, straight, man, woman etc… if we know someone’s ‘label’ we can quickly make assumptions about what they are like (stereotypes) and assess their ‘danger’ to us (psychology 101). How about… not doing that and taking each individual case as they are and treating them as such?

    Bit radical of me, I know and I apologise if your blog in other places has already dealt with the issues I raised and you already agree with me wholeheartedly (I’d be surprised if you didn’t, judging by your open and non-judgemental attitude displayed on Twitter and in this post). I just wanted to add a BPD perspective to the mix.

    All we want, all any human really wants, is to be appreciated and validated for who we uniquely are. Forget labels, look to the individual for the definition of themselves.

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    1. Sorry for taking so long to reply. To address your 1st point, I hope I make it clear that EVERYONE manipulates people. That’s how we get people to meet our needs and keep liking us. We all do it, but people who tend to have a BPD label aren’t particularly good at it, based on their early learning and (often traumatic) experiences.
      2- You’re right, anyone can have a relationship with staff where they perceive the person as manipulative, but regardless of the diagnosis, if it happens too often someone will stroke their chin and suggest BPD might be a better label.
      3- If I was writing this now I’d use “people labelled with PD” rather than focusing on the diagnosis.

      Thank you so much for letting me know your thoughts and encouraging me to write more. If you ever fancied writing a response id happily publish it. Thanks again,

      Keir

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  9. Loved your article! Your depth of understanding is awesome to see in writing. Unbeknownst to me I married (now divorced 2 years after 20 year marriage) a lady that was diagnosed with a PD during our marriage counseling near the end of our marriage. I began to understand what/why things happened as they had. Only after I began to understand could I go from anger to forgiveness. Her particular love/zeal of manipulation is still frightening to me. Her ability to long term plan to meet her amazingly selfish needs is the most frightening in hindsight. Having someone you’ve loved 20+ years basically stand over you and laugh (and gathering her flying monkeys around to laugh too) as you’re lying on the floor in pieces it’s hard to understand at that moment but in the end it can help understand what they must have experienced as a child. To understand misdirected anger and revenge is helpful but it still hurts like hell. Weird, or maybe not at all, how the abused becomes the abuser. The cycle continues.

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