Screening Patients, Part 3: Those Who Neglect Themselves

This is Part 3 of a multi-part post series on various types of potential new patients to screen for, the characteristics of these types, and the importance of screening for them, if for no other reason than to have prior notice regarding what you (as a doctor) could be facing when working with them.

In the previous post, I explored three of the personality disorders that are likely to cause the most significant upheaval and stress in one’s practice.  Originally, I was going to include these next two situations in that post, but then thought the better of it.  Truthfully, these two personality types should get their own post because these are not personality disorders, per se.  These people are generally not mentally ill–that is, unless they also have something else going on neurologically/psychologically.

The reason I screen for these two situations at all is because these folks are burning the candle at both ends, and because they’re often caring for someone else (or have the type of personality that puts others before themselves), they may not have the time, energy, or self-worth to see a care plan through to completion.  This is not true for ALL codependent or martyr-type people of course; just those for whom it IS true.  Some people do quite well, riding a competent balancing act between other people (or another person) and themselves.  However, others don’t, and in their energy expenditure on someone/everyone else, they frequently lose themselves in the milieu.


This profile is a little tougher of a judgment call, and in truth, I’m far, far more likely to accept these people into the office as patients.  They don’t tend to present the same high-voltage risks and hazards to the office as the three other personality disorders discussed in the previous post.

In fact, I’m not even sure codependency itself is a personality disorder.  I don’t think it is.

However, in my experience, I’ve found it helpful to know in advance whether or not a potential new patient fits the codependent profile.  This is because it is indeed a personality type and it will indeed play a huge role in their personality.

Although the experience of working with a codependent person is far less stressful and far less volatile (read: potentially devastating) than getting tangled up with the three personality types discussed in the previous post, I still think it’s important to be aware of any signs of codependency.

Codependency is when a person has been involved in a one-sided, dysfunctional relationship where one person is tasked with meeting all of their emotional needs and, quite possibly, providing the codependent person with their very sense of self.

Much like BPD and one of the narcissism subtypes, the codependent person can–and usually does–have very low self-esteem.  Similar to BPD, there can be a lack of boundaries that might present as clinginess or overstepping, taking too many liberties with your “urgent”/”off-hours” phone line, etc.

Like BPD and narcissism, codependent people can be a little on the slippery, unreliable side.  The motive here, however, tends to be much more of a people-pleasing agenda, as opposed to fluffing themselves up or attempting to project/portray an image of something they’re not.  The codependent simply wants to be likable and to avoid rocking the boat, and they will often attempt to avoid confrontation at all costs.

In my experience, the codependent person, like anyone else (including those I’ve described already) does tend to have legitimate physical or physiological issues; however, although I’m not a huge fan of the concept of “psychosomatic illness”, if there’s one particular group with the highest tendency toward psychosomatic issues, it’s this group (and the next one–the martyr personality type, but we’ll cover that further below).

The other person in the codependent’s relationship, the one on whom the codependent person relies for their self-esteem and personal sustenance is the single biggest factor in the codependent patient’s healing.  And a huge part of their healing, if their improvement is to be sustained long-term, is going to have to be dealing with the codependency itself.  Recovery is possible, but it’s probably going to be over our heads, unless we’re specialists in that specific area.

Although the term “codependency” originally referred to the non-addicted person in a relationship with someone who is an addict (i.e., the “dependent” person), the term has come to take on a broader meaning to describe the basic personality type involved.  The other person need not even be an addict of any kind.

So, I look quite carefully at both people–the codependent and the person with whom they’re involved.  What is the codependent person truly looking for?  Often, it’s acceptance, affection, acknowledgement, or love from the other person, who may or may not be distant, aloof, cold, unloving, or absent.  The other person might be “normal” or healthy in every discernible way; the codependent may simply be extremely emotionally needy or have a poor self-esteem.

Everything the codependent patient does, every move they make, will likely hinge somehow on the person with whom they’re involved.

We actually had a fairly mentally unstable elderly lady (I won’t give details here; suffice it to say that we did not reach that conclusion lightly; we observed extensively and correlated the firsthand perception among multiple doctors and staff members in our office) who, to make a long story short, upon her husband agreeing to the whole kit and caboodle of care that she was after (and genuinely needed), promptly and suddenly backed out, with no explanation given whatsoever.

Upon comparing notes among office members, we surmised, theoretically at least, that this person was simply after her husband’s agreement; that his go-ahead was the signal of love or acknowledgement that she was ultimately looking for.  We found ourselves in the undesirable position of having been “tricked” into thinking she actually wanted to resolve her symptoms and their underlying causes and having to process a massive refund.

So, I screen thoroughly for this personality type, but whether or not I accept them into our program or refer them out to a more appropriate provider depends entirely on the individual circumstances and many factors.

More information on Codependency can be found here.

Martyrdom (aka “The Martyr”):

This personality type can be closely related to the Codependent type in that there can be plenty of overlap between the profiles of traits, but that’s not always the case.

A codependent person may indeed also be a martyr, especially if the codependent person assumes (or is thrust into) a caretaking role (or at least perceives themselves to fill such a role).

The focus here, however, is indeed on caretaking.  In our experience, most of the people who have assumed caretaking roles of any kind do tend to display at least some of the characteristics of martyrdom to at least some degree.  The specifics and intensity of the traits displayed can vary quite a bit, though.

Martyrdom is when someone has assumed a caretaking role, but without proper healthy boundaries.  Often, there’s a legitimate reason for the “lack” of boundaries; the person under “the martyr’s” care might be someone extremely close to them in a very dire situation, such as an aging parent who might be terminally ill or permanently disabled.

The “flavor” of martyrdom varies, however.  Some people in caretaking roles are indeed greatly affected by the situation and its circumstances.  Others are less so, but may put on an act, in the interest of drawing attention to oneself or gaining sympathy.  And then there are multiple midpoints in between.

Each “flavor” of martyrdom presents its own specific challenge to a healthcare provider.  The more genuine ones might be so significantly impacted (emotionally, physically, time-wise, financially, etc) that they’re literally burning the candle at both ends and running on fumes.  They may be under so much stress that they simply won’t be able to make any progress, for stress will hamper and delay the healing/resolution of their own health issues.  No matter what you throw at them (supplements, adjusting, food plans, etc), you’re unlikely to see any benefit or progress made until the stressor is gone (either the loved one recovers and no longer needs care, or they pass away, etc).

Those who run themselves down (either voluntarily or not) and expend such a significant portion of their time, emotional investment, energy, or even finances for the benefit of others are likely putting themselves dead last and will not (either by choice or may actually be unable to) take care of themselves, which can present an obvious hurdle to your attempt to render care.

The less-genuine, more “for show” martyr also presents a challenge to utilizing your care, but for different reasons.  Here the issues is not likely to be stress, but rather, attention-seeking, which I will elaborate further on in a future installment of this post series.  Suffice it to say that those who excessively seek undue attention tend to have personality issues and other kinks in their emotions/thought processes that pose an obstacle to making improvement.  These may or may not be the folks who tend to lament that they’re not getting any better; sometimes they are and sometimes they’re not (this point will likely get its own post as well, whether in this post series or as a standalone post).

Those who are ultimately seeking attention will attempt to satisfy that need in multiple ways–whatever works.  For a while, their attention-getting vehicle will be the fact that they’re taking care of someone; after that, they’ll attempt to grab that attention in some other way, one of the most common of which involves lamenting about their physical symptoms and/or health issues.  This desire for attention can become so powerful that some people become “married to their disease, disorder, condition”, etc.  Their health issues can be 100% genuine, but they may resist (often subconsciously) advancing along the path of recovery because they (again, usually subconsciously) realize that their attention-grabbing “excuse” might evaporate.  They often (here again, subconsciously) decide (and I’ve personally had this happen, many times) to sabotage or derail their progress in favor of hanging onto the sympathy and attention they glean from those around them.

More information on Martyrdom and the specific game-playing behavior can be found here.

The specific “attention-seeking” personality will be fleshed out in greater detail in the next installment of this series, because it deserves its own specific mention.  It would not be entirely fair to lump the attention-seekers with ulterior motives in with those who truly care for others more than themselves; attention-seeking is an entirely different animal, so it will be covered as such.  Stay tuned!


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