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.