Personality disorders among difficult patients.

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.