The Disordered Personality

So aside from my last post which was inspired by a writing prompt, the proverbial writer’s block hasn’t  lifted.

Normally, the ideas for posts come easily to me, but lately, not so much.  My day job is as interesting as ever, and my kids continue to make me laugh, so there should be plenty to talk about right?  Right.

Problem is, is that my day job has been incredibly draining the last few weeks.  It would seem that all the “crazies” have come back to roost.  It’s the term I lovingly call those patients who suck the life out of a doctor.  There’s another, more appropriate term – the personality disorder patient.  I’m not talking about the Type A or Type B personality traits we all know.  I am talking about the deeply troubled individuals who fall into what the Diagnostic and Statistical Manual for Mental Disorders calls Personality Disorders.

There are six specific personality disorder types:

  • antisocial (the scary dude who has no conscience – think Paul Bernardo)
  • avoidant (the opposite of the dude above, the guy who is meek, shy and afraid to be around others)
  • borderline (the woman with chaotic emotions, unstable relationships, and who makes those around her feel like they are always walking on eggshells)
  • narcissitic (the guy who knows he’s God’s gift to women, and has little capacity for compassion)
  • obsessive-compulsive (the guy who has to have everything in his life be perfect, regardless of what anyone else thinks)
  • schizotypal (the really odd guy who makes everyone around him a little bit nervous)

Dealing with the patient who has a personality disorder is extremely difficult.  As a family doctor, the most common type I see in the office is the borderline patient.  It’s exhausting because on any given visit, I might be her best friend or her worst enemy.  Sometimes I can get a sense of what the visit will be like based on her behaviour in the waiting room.  And other times, she’ll turn on me like a dime and it’s game-over.  Sometimes months will go by and I won’t hear a word from her; other times, she’s in my office on a weekly basis.  It’s definitely a roller-coaster ride.

Lately she’s been in my office on a weekly basis, sometimes twice a week, always in crisis, always on the verge of suicide, always needing help.  She’s never made an attempt on her life, she always scoffs at (what I think are) my helpful suggestions, and she is highly, highly dramatic.  She spends the amount talking at me, asking a series of rhetorical questions yet expecting some miraculous answer.  I can’t tell you how exhausting it is to sit through.

We are taught in medical school that these kinds of patients require boundaries.  Set time for appointments, don’t go past the allotted time; warn the patient they have 5 minutes left, etc.  If the patient arrives early for their appointment, make them wait, do not accommodate them.  If you do it once, they will always expect it.   My patient is unravelling before my very eyes and I feel powerless to help her.  How do you help someone who so desperately can’t help themselves?  How do you change 20, 30, 40 years of behaviour?

I wonder what Barney would say if he were borderline?

2 thoughts on “The Disordered Personality

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