Personality disorders and the “difficult” dermatology patient: Maximizing patient satisfaction

Personality disorders (PDs) are stable and enduring patterns of thought, feeling, and behavior that deviate from one's cultural norms and cause impairment in functionality. Patients with PDs are commonly encountered in the dermatologic setting and can be perceived by providers as “difficult.” Given that PDs are chronic, rigid, and frustrating to deal with, it is important to be skillful in the approach to such patients, especially in the era of the value-based reimbursement system, in which patient satisfaction is crucial for reimbursement. This contribution discusses four PDs most commonly encountered in the dermatology setting: Borderline, histrionic, obsessive-compulsive, and narcissistic. Although the details regarding the approach to patients for each PD differ as discussed, once a PD is identified, there are few key management strategies that can be helpful in minimizing conflict and enhancing outcomes. In patients with PD, the presenting skin complaint is often a secondary problem, as there may be an underlying psychologic issue (somatization). Understanding the underlying psychologic aspect of the patients' dermatologic complaints and adapting behaviors to the patients' needs are fundamental for maximizing patient satisfaction.