Psychological medicine

Managing the ‘difficult’ patient

Jeffrey Streimer



Patterns of persistent abnormal illness behaviour and associated abnormal treatment behaviour arising from personality disorders lead to poorer treatment outcomes and to risks for both patient and doctor.

Article Extract

‘Difficult’ people

Most of us can be difficult at times and often in life we struggle with difficulties we encounter in others. Many, if not most, of our normal patients struggle personally or interpersonally throughout life and they may share or visit aspects of their struggle on us. Those with personality disorders involve us in more complex ways.

For about 10% of the general population and 20% of GPs’ patient population, these personality problems are recurrent and unchanging, leading to limited or poor adaptation in social, interpersonal or occupational life. Almost always these manifestations burst into the open as a crisis. Something has tripped an emotional ‘land mine’ and its effects become apparent because of emerging disrupted feelings, thoughts or actions.