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Semin Neurol 2009; 29(3): 266-271
DOI: 10.1055/s-0029-1223880
© Thieme Medical Publishers

Personality Disorders: Understanding and Managing the Difficult Patient in Neurology Practice

Stephen J. Ferrando1 , Uchenwa Okoli1
  • 1Department of Psychiatry, New York–Presbyterian Hospital, Weill Cornell Medical College, New York, New York
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Publication History

Publication Date:
23 June 2009 (online)

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ABSTRACT

This article provides a background for understanding and managing maladaptive personality traits and personality disorders in neurology practice. These characteristics are commonplace in neurology patients and may cause diagnostic confusion, increased functional impairment, and complications in the doctor-patient relationship. Maladaptive personality traits and personality disorders may precede neurological illness, may contribute to circumstances that lead to neurological injury, and may be caused by neurological illness, or some combination of these factors. Maladaptive personality traits associated with key neurological illnesses are reviewed, as are the major personality disorders, maladaptive defense mechanisms, countertransference reactions, and how these combine to contribute to difficulty in patient management. Finally, basic clinical management strategies are suggested.

KEYWORDS

Personality disorders - maladaptive personality traits - defense mechanisms - “difficult patients”

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Stephen J FerrandoM.D. 

Professor of Clinical Psychiatry and Public Health, New York–Presbyterian Hospital

525 E. 68th Street, Box 181, New York, NY 10065

Email: sjferran@med.cornell.edu

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