The walk-in medical clinic was about to close for the day when Susan Biali got a call from one of her longtime patients. Could the doctor please hang in a bit longer? The caller was feeling very ill and needed to see her immediately. An exhausted Biali extended her already burdensome day and waited for the patient to arrive. Some time later, the woman sauntered in; she was perfectly fine. She just needed a prescription refill.

"She totally lied to me," the Vancouver doctor recalls. "Afterwards, I was so upset that the degree of my reaction troubled me. I'm a general physician with some training in . Yet I couldn't put my finger on exactly why I was so bothered. I thought it was a flaw in myself."

Eventually, she identified what set her off: "You think you're in an innocuous situation—a typical doctor-patient encounter. But the woman took complete advantage of my compassion. Then, not only wouldn't she acknowledge the lie, but she looked at me blankly and demanded, 'Can't you just move on and give me my prescription?' She made me feel that I was the problem."

Ever wonder how an encounter goes so quickly awry? Doubt your own perceptions? Feel thrown totally off balance by another person? Find yourself acting crazy when you're really a very nice person? Manipulation comes in many forms: There are whiners. There are bullies. There are the short-fused. Not to forget the highly judgmental. Or the out-and-out . But they often have one thing in common: Their MO is to provoke, then make you feel you have no reason to react—and it's all your fault to begin with! Feeling deeply discounted, even totally powerless, while having to jettison the original aim of an interaction is a distressing double whammy of —and a cardinal sign you're dealing with a difficult person. No, it's not you. It's them. And it's the emotional equivalent of being mowed down by a hit-and-run driver.

It doesn't take a sociopath; anyone can be difficult in a heartbeat. "To a great extent, the problem is in the eye of the beholder," says Topeka, Kansas, psychologist Harriet Lerner, author of the now-classic Dance of Anger and the just-released Relationship Rules. "We all come into relationships with hot-button issues from our own past. For one person what's difficult might be dealing with someone who's judgmental. For another it might be a person who treats you as if you're invisible." That said, she adds that there are certain qualities that make people persistently hard to handle—hair-trigger defensiveness that obliterates the ability to listen, meanness, and a sense of worthlessness that leads people to bulk up by putting down others, just to name a few.

Experience motivates most of us to avoid or minimize interacting with such people. But sometimes that problem person is a , a boss, a coworker. Even your mother. And managing the relationship by distancing yourself or it off altogether is impossible or undesirable. The goal, in such cases, is to prepare in advance for an encounter, knowing it will take a special effort to hold onto your own sense of self, and to stay calm.

Although it is typically disturbing to be in the presence of such people, remaining composed in the face of unreasonableness helps you figure out exactly what species of difficulty you're dealing with. Therein lies your advantage. It allows you to predict the specific emotional trap being set for you, which is your passport to getting your own power back.

In the Hothouse at Home vs. Tough at Work

In dealing with a difficult person, the setting is everything.

Handling difficult people at work is not quite the same as coping with problem people in family life. The goal is to get the work done, and that requires great caution and considerable strategizing. "It's not like a , where the dailiness of living will allow you to repair a lot of interactions gone wrong," Lerner observes.

In a marriage, she says, it's often advisable to exit a conversation. Of course, there are a variety of ways to do that. A common one is to scream "I hate you" and slam a door behind you. Better, she advises, to say something like: "I love you, I want to be here for you, I want to hear your criticisms, but I cannot listen when you throw them at me rat-a-tat-tat. I need you to approach me with respect. So let's set up a 15-minute meeting after breakfast and start over." The difference is clarifying a loving position versus escalating things further.

The Hostile

Telltale signs: High, sometimes explosive, reactivity. Frequently disagreeable. Cynical. Mistrustful. Does not like to be wrong.

Where you'll find them: Corner offices. The Internet, often under the cloak of anonymity.

Call in the wild: "I am going to come and burn the f**king house down."

Notable Sightings: Mel Gibson. Mike Tyson. Naomi Campbell. Chris Brown. Russell Crowe. Courtney Love.

People very low on the dimension of typically express themselves with irritability, hostility, and noncooperativeness. They have a short fuse and are commonly cynical and mistrustful. They are not able to look at themselves, and they are hyperquick to blame. Placating others is not a skill in their repertoire, nor do they endorse such a possibility. The trouble is their responses run to the intense side, and their reactivity and intensity breed more of the same in those who must deal with them, says Lerner. And so, not only are these people angry but you may be suddenly on the receiving end of criticism that feels extremely unfair. The hostile person will not be thinking clearly and is probably not taking in anything you say. "It takes a great deal of emotional maturity to deal with someone who is very intense and angry," she notes. "The reactivity is contagious and you are likely to get reactive yourself."

One common manifestation of hostility, especially in the workplace, is the boss. Such people misuse power. They humiliate you in front of others. They are verbally abusive. They overcontrol and micromanage. They don't just differ with you, they do so contemptuously and lob unfair criticism at you. If bullies are technically competent at the jobs they do, they feel immune to . As a result, there tend to be high rates of turnover among their underlings. In performance-oriented companies, getting rid of bullies may not be high on the agenda, no matter how much damage they do. Like bully kids, bully bosses do not see themselves accurately. They often view themselves as better than others, and they are not sensitive to the feelings of staffers. They misuse power to deliberately hurt those of lesser status.

It is possible, and often necessary, to confront a bully directly. But do so calmly and professionally, and never in public; this is an activity for behind closed doors. The bully will never back down in front of an audience. You must declare the bully's behavior unacceptable, specify exactly what behaviors are at issue—"You may not demean me in front of my staff or others"—and instruct the bully, succinctly, on how you wish to be treated. "I need you to support me in the presence of others. Any issues you have with my work we can discuss civilly in private."

An all-too-common variant of hostility is , in which the hostility is covert, expressed in nonobvious, underhanded ways—dragging one's heels on a project, failing to respond to a meaningful request. It's often difficult to pin down the hostility, but the effects are usually clear—your and are sabotaged. A colleague briefs you on events but leaves out critical information you need for getting your job done. Your spouse belittles you in front of others—and then insists he was "just kidding" as you seethe with rage and .

Sarcasm is a common tool of passive . And frustration is a common response: You may find yourself getting upset and angry but can't be entirely sure it is justified. Over time, it becomes difficult if not impossible to trust anything offered by a passive-aggressive person.

The Rejection-Sensitive

Telltale signs: Constantly scanning for slights real and imagined. All slights deemed intentional. Becoming unglued at the hint of disapproval. In extremis, (primarily by males).

Where you'll find them: Your inbox (most likely in an email demanding to know why you failed to respond to a note, overture, etc.). Backstage. Poetry readings. Call in the wild: "Are you annoyed with me for some reason?"

Notable sightings: Marilyn Monroe. Princess Diana. Michael Cartier. Liza Minnelli.

With a hair-trigger reaction to any indication that you don't like them or, in fact, disagree with them or didn't do what they asked, the rejection-sensitive walk around with what seems like a perpetual chip on their shoulder. They interpret everything through the lens "You somehow disrespect or dislike me." That's difficult, says Duke University psychologist Mark Leary, because you have to walk on eggshells around them and make sure that everything you say or do doesn't push the imaginary button where they feel they're being devalued by you.

Threats lurk everywhere for these people, who are constantly scanning their environment for signs of being excluded. You didn't call or send an email right away because you were bogged down in deadlines, and then your eldest was sent home sick from school? The resulting drop in self-esteem experienced by the rejection-sensitive begets an overwrought response to slights real and imagined—all of which are presumed intentional.

They will dredge up evidence, citing lapses in your actions that defy . The irony is that, over time, the irritability, negativity, and self-doubt of the rejection-sensitive do in fact drive others to avoid them. And the rejection-sensitive don't act irrationally only in response to perceived slights; they expect rejection and anticipate it, and react automatically when reflective and strategic behavior would be in their better interests.

Rejection or the expectation of it makes them hostile. Their reactive aggression is more likely to manifest in passive rather than overt aggression, although stalking behavior is a form of aggression thought to result from rejection-sensitivity.

Unfortunately, the rejection-sensitive are present in increasing numbers. Many observers find that the psychological fragility that underlies rejection-sensitivity is on the rise. Common mood disorders such as are typically accompanied by hypersensitivity to rejection, and a whole generation of overpraised children, preoccupied with evaluation, has grown up and brought its overtuned rejection radar into the workplace as well as into personal relationships.

of rejection tends to paralyze the afflicted. In the workplace, it can keep people from taking on new tasks or new assignments of any kind; instead they offer a host of irrational explanations for why each new project or new hire is a bad idea. Such a colleague may be unwilling to ask for needed help or direction for fear of rejection—and then fault you for not providing it. Competitive environments bring out the worst in them.

The Neurotic

Telltale signs: . . Obstructionism. Naysaying. Shooting down the ideas of others.

Where you'll find them: Online medical chat rooms. Political blogs. Doctors' offices.

Call in the wild: "Yes, but..."

Notable Sightings: Larry David. Woody Allen. Harold Camping. Chicken Little.

What you might experience as a minor frustration is, for the neurotic, a hopeless difficulty. is typically displayed as unhappiness, anxiety, and ease of emotional arousal. "These people don't realize they're being difficult," says Leary. "But they quickly get on other people's nerves. They are demanding, and they worry about everything. They think they're only trying to be helpful and not creating problems."

What makes them especially difficult in work environments, he explains, is that they tend to be obstructionists. "They're so worried about something going wrong that they disagree with others' ideas. They are naysayers." And in dredging up so much negativity, they stir up residual doubts in others and erode in novel ideas and projects.

A hallmark of this type of difficult person is a pessimistic thinking style, a concern with "what's going to go wrong next in my life?" Although these people are innocently difficult, says Leary, it's still hard to deal with them because they are always going to say "Yes, but..." They'll find the cloud in any silver lining, discourage you from taking that solo cross-country trip or starting a new business.

It's futile to talk naysayers out of their misery. They are often immune to outside influence. The best you can aim for is to understand their perspective without endorsing it: "My experience has been totally different," for example.

The basic challenge in dealing with difficult people of any stripe is to remain a calm presence in a highly charged emotional field. "You have to get your own reactivity down, even if it means deep-breathing to calm yourself," says Harriet Lerner. "That enables you to listen well and understand what the other person is saying, and to respond with clarity, rather than participate in a downward-spiraling conversation." There's a temptation to write someone off as a difficult person. Resist it. "Once you label someone as impossible, you are likely to miss all the good points the person might be making," Lerner observes.

The Egoist

Telltale signs: Own interests come first, last, and always. Takes everything personally. Unable to compromise, ever. Insists on being seen as right by everyone.

Where you'll find them: Reality TV shows. Congress. Art school.

Call in the wild: "It's my way or the highway."

Notable sightings: . Kanye West. Chris Christie. Paris Hilton.

Our culture devalues stoicism and rewards overreacting to every little thing, especially on reality TV.

This is a group of people—Leary sees their numbers increasing—whose ego is far too involved in anything that happens. As a result they take everything personally. What makes them difficult is their fierce demands coupled with their inability to compromise. They frequently "lose it." Mention a problem to them and they immediately assume you are blaming them. "On top of the tangible problem, they add a layer of symbolism that makes everything about them," says Leary. "They live their life according to the symbolic meaning as opposed to solving the problem."

Leary argues that both egoic and egocentric individuals view the world through a self-centered lens, but the egoic are especially inclined to respond strongly when their desires are not satisfied. (Egotism, by contrast, refers to an inflated sense of one's positive qualities.)

Leary, who has long identified problems of the self, says, "This type hit me when I saw Congress discussing the debt ceiling. There was so much posturing—'I have to show everybody I'm right'—rather than movement toward solving the problem." The egoic person is convinced his ideas are 100 percent right—and must be seen as right. Further, he feels entitled to have things happen his way. "A person who is convinced his perspectives, beliefs, and values are right cannot tolerate any conciliatory conversations. It's 'my way or no way.' " is not the only home of the egoic. "These people wreck relationships, work, even societies," observes Leary.

There are times, he adds, when anyone can be egoic. "Something pushes a button and we get ego-involved and lose perspective." But with the truly egoic, such a response is independent of the stimulus.

With his Duke colleagues, Leary is currently investigating individual differences in how egoic and hyperegoic people tend to act. "The more egoic, the more difficult a person becomes."

It's thoroughly natural for people to put their own interests first, Leary observes. No animal can survive unless it does. "People have always been egoic about personal well-being," he explains. Today, however, he sees egoicism on the rise because many traditional restraints on behavior have been removed.

"It used to be that anger was viewed as a character defect. People now fly off the handle at the slightest provocation when others disagree with them. We no longer value the stoicism by which we tried to keep anger in check." Leary thinks reality TV shows of the past decade have helped breed egoicism "because they are based on people overreacting to things that have no or minor consequences for them."

7 Ways to Defuse a Difficult Encounter

Having learned the hard way, Vancouver physician (and PT blogger) Susan Biali offers concrete steps for dealing with unreasonable person.

Minimize time with problem people. Keep interactions as short as possible. Keep it logical. Communications should be fact-based with minimal details. Don't try to connect and reason with difficult people. Their response will often only make you more upset. Focus on them in conversation. One way to avoid being the target of demeaning comments, manipulation, or having your words twisted is to say as little as possible. They are a far safer subject of conversation than you are. Give up the dream that they will one day be the person you wish them to be. There are people in our lives who have moments when they seem to be the parent/partner/spouse/friend/whatever we've always wanted. Yet they end up disappointing or hurting us. Accepting the person as is can be a remarkable relief. Avoid topics that get you into trouble. Before any interaction with a difficult person, mentally review the topics that invite attack and make an effort to avoid them. If your in-laws always demean your choice of , change the topic immediately if they ask how your work is going. Don't try to get them to see your point of view. Don't try to explain yourself or get them to empathize with you.They won't. And you'll just feel worse for trying. Create a distraction. Play with a pet if there is one handy. Plan the interaction around some kind of recreational activity or entertainment. Or get the other person to do something that absorbs their (taking it off you). Just don't use as your distraction of choice. It will only make you more likely to say or do something that will set you up as a target or make you feel bad later.

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