It seems like we face manipulative people on a daily basis and everywhere we go, whether we are at home or work or online. While it is probable not that often, the occasional encounters can be so stressful that people will avoid all kinds of situations just to avoid manipulative people or worse, become manipulative to try to survive by "fighting fire with fire". Thankfully there is a better way. In psychiatry, we have dealt with some of the most manipulative people on the planet for over a hundred years. This is lecture distills the wisdom of psychiatry on surviving manipulative people into an understandable and useable format for the lay person. Starting with an overview of the official DSM 5 personality disorders as a foundation, I cover the common manipulative strategies and defenses. Then I move to the ultimate manipulators, Borderlines. I deconstruct the strategies and techniques they use to control others and then teach you judo like moves that protect you and even discourage them from trying to manipulate you. I've given this lecture and associated workshop to dozens of audiences in the service industry and helping professions, from teachers to nurses to social workers to health care providers. It is so popular that I am often invited back to repeat the lecture and workshop year after year. You can contact me through www.scottcarrollmd.com to schedule this invaluable training for your team or conference.

1. How to Survive Manipulative People
Scott Carroll, MD
Ayni Neuroscience Institute
www.scottcarrollmd.com

2. Personality Disorders vs Traits
• Personality disorders are enduring, inflexible,
maladaptive patterns of behavior and relating to
others that cause significant dysfunction.
• Personality traits are repetitive patterns that are
not constantly present or may be suppressed when
necessary and do not cause significant
dysfunction.

3. Personality Disorder Clusters
• Cluster A - “Weird” - strange, bizarre, eccentric
• Cluster B - “Wild” - impulsive, dramatic,
aggressive, self-destructive
• Cluster C - “Wimpy”- anxious, rigid, ineffective

4. Cluster A Personality Disorders
• Schizoid - “loner”, lacks desire for social contact,
usually avoids relationships and social interaction
• Schizotypal - “eccentric”, odd with magical
thinking, attribute events to illogical causes,
family members of schizophrenics
• Paranoid - “conspiracy addicts”, wonder if
FBI/CIA follow them, distrusts others, especially
authority figures (police, doctors, lawyers, etc.)

5. Cluster B Personality Disorders
• Histrionic - “actress”, very dramatic, overly
emotional, frequently exaggerates, wants reaction
• Narcissistic - “name dropper”, arrogant, critical,
condescending to staff, will only talk to the doctor
• Borderline - “Marilyn Monroe”, fears being alone,
intense relationships, idealizes/devalues, recurrent
suicide attempts/ideation, dissociates/psychosis
• Antisocial - “career criminal”, disregards rights of
others, lies/cons/threatens others to meet goals

6. Cluster C Personality Disorders
• Dependent - requires presence of the person they
are dependent on to feel safe/happy or to make
decisions, otherwise they are ineffective
• Avoidant - extreme low self-esteem and fear of
criticism or embarrassment, avoids other people
• Obsessive-Compulsive - “perfectionist”, rigid,
legalistic, inflexible, obsessed with lists and
schedules, may hoard, not the same as OCD

7. Common Manipulation Strategies
• Regression - may regress both mentally (magical
thinking) and emotionally, clear limits/directions
• Situational depression - extreme shame/guilt, even
suicidal thoughts, needs strong support/hosp
• Transference - may idealize or devalue (both) you
or anyone else, be aware and don’t get sucked in
• Counter-Transference – your unconscious reaction
to them; may cause excessive sympathy or anger;
also desires to rescue or punish; awareness is key

8. More Common Strategies
• Hysteria - intense emotion to “engage” you or feel
“seen”, acknowledge distress, but don’t fix
• Splitting - idealizes provider, devalues staff or
vice versa, may flip-flop, manipulator not aware,
good team communication usually prevents this
• Boundaries - must be communicated in advance,
be flexible within those limits
• Self-care - essential, have realistic expectations,
care for your self before trying to help others

9. How Manipulators Control You
• They seek resolution of internal chaos, by creating
chaos around them, may lie/act incompetent
• Their goal is to control you with pathological
displays of power to induce you to fail or look
“incompetence”
• They use “illicit currency” (threats, complaints,
refusal, etc.) to emotionally engage/manipulate
• Avoiding such pathological relationships may
limit their self-harm and can even help them

10. Judo Techniques for Self Defense
• Incompetence - They’re going to prove you are
anyway, so present yourself that way early
• Benign Neutrality – be concerned about their well
being, but “Zen” about whether they like or hate you
• Specific techniques - slowing down, use silence,
acknowledge distress, use paradoxical statements.
• Be honest, neutral, non-reactive listeners to promote
their competence and avoid destructive interactions

11. Final Exam
A client is banging her head on your desk, screaming
you are incompetent and that she is going to
destroy you.
A. Beg her to stop
B. Call security to remove her
C. Personally wrestle her to the ground
D. Go get a cup of coffee and check your email
E. Patiently wait for her to stop, then continue