The Difficult Chronic Pain Patient:A Case of Borderline Personality Disorder?

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Executive SummaryAs the primary care physician is often the main physician involved in management of patients with chronic pain, the presence of borderline personality disorder (BPD) complicates the therapy.The average prevalence rate of BPD in patients with various types of chronic pain syndromes is 30%, a rate that is 4.5 times the prevalence rate for BPD found in the general population.BPD in Cluster B group consists of personality dysfunc tions characterized with dramatic, emotional and erratic features and is unique because these individuals have inherent difficulties with self-regulation (i.e., an inability to regulate core behaviors related to self-management).As an alternative to DSM diagnosis for non-psychiatrists, there are a number of self-reported assessment measures that can be useful to yield a reasonably accurate diagnosis of BPD.Although the long-term treatment outcome of patients with chronic pain and BPD is empirically unknown, generally they are less likely to experience the resolution of pain symptoms and will be more likely to seek disability.

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