Personality disorders: understanding and managing the difficult patient in neurology practice

This article provides a background for understanding and managing maladaptive personality traits and personality disorders in neurology practice. These characteristics are commonplace in neurology patients and may cause diagnostic confusion, increased functional impairment, and complications in the doctor-patient relationship. Maladaptive personality traits and personality disorders may precede neurological illness, may contribute to circumstances that lead to neurological injury, and may be caused by neurological illness, or some combination of these factors. Maladaptive personality traits associated with key neurological illnesses are reviewed, as are the major personality disorders, maladaptive defense mechanisms, countertransference reactions, and how these combine to contribute to difficulty in patient management. Finally, basic clinical management strategies are suggested.