Thursday, April 7, 2011

HCP is Not a Diagnosis

For over a decade I have been writing and teaching about HCPs (“High Conflict Personalities” or “High Conflict People”) in legal disputes and other settings, including workplace, healthcare, education, neighborhood and family disputes.  Several recent conversations and emails indicate that I need to clarify that I never intended HCP to be used as a diagnosis when I coined this term.

A diagnosis is a term typically applied to assessing a medical problem or mental disorder, so that the proper treatment can be used by the proper professional for the patient with the problem. For example, the DSM (Diagnostic and Statistical Manual) of the American Psychiatric Association lists depression, anxiety, schizophrenia, substance dependence, and narcissistic and borderline personality disorders among its many mental health diagnoses. Based on such a diagnosis, doctors and therapists apply certain treatments, including medications, individual psychotherapy and group therapies.

Some people have wondered if I intended HCP to be a new diagnostic category in the DSM-V, which is expected to be published in 2013. Definitely not. My intention in coining the term “HCP” was to assist ordinary people in managing their professional and/or personal relationships with possible HCPs, not treating the individual as a patient.

I initially wrote about this subject for people in family law disputes, who included lawyers, judges, mediators, counselors and ordinary people dealing with the divorce themselves (and their relatives, friends, etc.) My intention was to make this information accessible to anyone who needed it if they suspected someone might be an HCP. Tips for managing HCPs can be used with anyone, whether or not they are an HCP.

I recommend having a “Private Working Theory” that someone may be an HCP. You don’t tell the person and you don’t assume you are right. You simply focus on key methods to help in managing your relationship, such as paying more attention to: 1) connecting or bonding with the person with empathy, attention and respect; 2) structuring the relationship around tasks rather than reacting to emotions; 3) reality testing so that you don’t necessarily believe everything you are told, but also don’t assume the person is lying because they may honestly believe inaccurate information; and 4) educating about consequences, as HCPs are often caught up in the moment and can’t see the risks ahead.

Of course, the HCP concept is closely related to the issues and methods of dealing with people with personality disorders, which is a DSM diagnosis. But only mental health professionals can diagnosis and treat personality disorders. While the committee currently revising the DSM is planning to change the way diagnoses are made for personality disorders, it won’t have any effect on dealing with possible HCPs – because this is not a diagnosis. It’s a description of high-conflict patterns of behavior.

Lastly, news reports indicate that labeling someone as having a personality disorder is the latest insult. This is very sad and unhelpful, as people with personality disorders have a serious problem and the people around them are often in great distress. As people with personality disorders increase in our society, some will be HCPs – but many HCPs do not have personality disorders (some may have milder traits) and would not qualify for any diagnosis in the DSM.

It’s better to learn about the predictable behavior patterns of HCPs and ways to respond constructively in your professional or personal relationships. If you think someone is an HCP, use this information as a Private Working Theory and focus on changing your own behavior, not theirs. 

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