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Problems on the Job Might Look Like Mental Illness: When an Occupational Problem is Not Psychopathology

Stephen M. Raffle, M.D.

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By Stephen M. Raffle, M.D.

There are distinctions to be drawn when evaluating individuals for occupational problems, psychopathology, disability, creation of a hostile work environment, workplace stress, retaliation, discrimination, risk of violence, and fitness for duty.

The current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) is more than 900 pages long and describes in detail most of the psychiatric disorders which exist and their characteristics. It describes psychopathology, which is to say psychiatric malfunctioning. The DSM also categorizes “other conditions or problems which may be the focus of clinical attention,” but which is not the result of a mental disorder, or the individual has a mental disorder but it is unrelated to the problem, or the individual has a mental disorder that is related to the problem but the problem is sufficiently severe to warrant independent clinical attention.

One of the “other conditions” is Occupational Problem (DSM-IV-TR 62.2). I have evaluated employees who have been identified by their company as having an “Occupational Problem” because the person isn’t working well with others. The question to be answered for the employer is whether or not the occupational conflict / controversy / difference of opinion / “disability” / stress is due to psychopathology. Sometimes there is no diagnosable psychiatric disorder causing the workplace problem but personality traits (not considered pathology) exist in the person which are contributing to the problems. For example, the person may have paranoid personality traits which do not fulfill the diagnostic criteria for a Paranoid Personality Disorder but nevertheless cause the person to misperceive and unconscientiously (unintentionally) distort verbal and non-verbal communications between him and others. He may feel belittled, persecuted, stressed, anxious, or mistrustful, but not to the level of diagnosable pathology. This creates interpersonal difficulty which then becomes the performance problem of an employee not following instructions from others, not getting along with others, creating a disharmonious – not hostile – work environment, and doing the job he was hired for. The dispute, though framed as workplace dysfunction, becomes an “Occupational Problem” not due to psychopathology, because no underlying diagnosable psychopathology exists. The resolution of the problem becomes administrative/managerial and not medical.

Workplace maladaptive behaviors are not considered to be intrinsically psychopathological because maladaptive workplace behavior in and of itself doesn’t define a specific psychiatric condition, i.e. psychopathology, as described in the various DMS diagnostic categories. The legal implication of the maladaptive occupational behaviors is that the employee’s workplace problems are not causing a disability, as described by the Americans with Disabilities Act (ADA), because psychopathology is absent, and therefore the employer is not required to provide reasonable accommodation.

Once a diagnosis of Occupational Problem (DSM 62.2) is made, questions of whether or not, and to what extent, the employer investigates complaints about the employee’s workplace performance, and takes administrative action, is not a medical matter, and is beyond medical/psychiatric expertise.

DISCLAIMER: The information provided on this website does not constitute legal or medical advice. Readers should consult with their own legal counsel or physician for the most current information and to obtain professional legal advice or medical advice before acting on any of the information presented.

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