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Personality disorders among difficult patients
1Department of Family Practice, University of California at San Francisco/Fresno Medical Education Program, USA.
Objective:
To determine the association between "difficult" patient status and personality disorder.
Design:
A survey using the Diagnostic Interview for Personality Disorders.
Participants:
Twenty-one patients nominated by 9 family medicine providers who subjectively experienced their care as difficult and 22 control subjects systematically selected from the same practices.
Main Outcome Measure:
The presence of personality disorder measured by the Diagnostic Interview for Personality Disorders.
Results:
Personality disorders were more prevalent among the difficult patients: 7 of 21 difficult patients and 1 of 22 control subjects had at least 1 personality disorder (P = .02). Five of 7 difficult patients had dependent personality disorder. None of the providers realized that the difficult patients had personality disorders.
Conclusions:
Unrecognized personality disorder can make difficult provider-patient relationships more likely. Dependent personality disorder may be especially difficult. Improved physician awareness of personality disorders may lead to more effective understanding and treatment of some difficult patients.