The Difficult Patient

Some patients may present quite a challenge for the health care team-from the receptionist to the social worker to the nurse and to the physician. An understanding of personality disorders can be helpful for the provider working with a complicated or "difficult" patient. Borderline personality disorder is relatively common in patients presenting with a complicated medical and psychosocial picture. Recognizing borderline personality disorder allows providers to better tailor treatment goals and expectations, manage personal reactions, set effective boundaries, and avoid potential confrontations with the difficult patient. Using a clinical case vignette, this article discusses the prevalence, etiology, diagnosis, and management of borderline personality disorder in the obstetrical and gynecological patient.