Difficult Patient Behaviors in the Hospital Setting: A Narrative Review

In the inpatient medical setting, difficult patient behaviors can complicate care delivery. When difficult behaviors are present, patients may experience worsened outcomes, and medical providers may experience distress. Most recommendations for such behaviors in the literature focus on outpatient care or inpatient psychiatric settings; recommendations for inpatient medical settings are limited. While difficult behaviors are commonly associated with personality disorders, patients without AQ6personality disorders may also exhibit these behaviors when acutely stressed, such as when they are experiencing a medical illness. Common difficult behaviors include splitting, acting out, avoidance, boundary crossing, false compliance, and dependence. Increased recognition of difficult behaviors, understanding of why these behaviors occur, and familiarity with potential management techniques may improve patient outcomes and reduce clinician distress. We provide a narrative review of these challenging behaviors, discuss potential underlying causes, and provide management recommendations.