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The Challenge of Significantly Distressed Chronic Pain Patient

Have you known that the efforts and challenge to restore a significantly disturbed chronic pain patient to his/her normal lifestyles can be extremely difficult?

Medical world through the psychological part of a pain management program is able to treat the anxiety and depression that are frequently found in chronic pain patients, but to treat the harshly characterologically-distressed chronic pain patient would be another issue.

The “dramatic” personality syndrome, or often referred as “Cluster B’s” inside the DSM-IV (American Psychiatric Association, 1994) could be the most difficult pain to deal with in an interdisciplinary setting.

“Cluster B’s” usually include:

  • Antisocial personality
  • Borderline personality
  • Histrionic personality
  • Narcissistic personality

The chronic pain patients with personality disorder syndrome cannot change easily due to their “ego-syntonic” symptoms.

Antisocial Personality Disorder
According to American Psychiatric Association, the Antisocial Personality Disorder is signed by a “pervasive pattern of disrespect for, and defilement of, the rights of others”.

Deceitfulness also reported as the highest prognostic value for antisocial personality (Links, 1996).

Borderline Personality Disorder
Although less dangerous than the patients with Antisocial Personality Disorder, The Borderline Personality Disorder is feared by most mental health practitioners.

The patients with Borderline Personality Disorder have the following behaviors and characteristics (American Psychiatric Association, 1994):

  • Instability and/or insecurity of interpersonal relationships
  • Problems in self-image and affects
  • Marked impulsivity

Histrionic Personality Disorder
Almost similar with borderline personality disorder, the patients with Histrionic Personality Disorder have the following behaviors and characteristics (American Psychiatric Association, 1994):

  • Attention seeking behavior
  • Pervasive emotionality
  • Excessive emotionality

As an example of attention-seeking behavior, patients with Histrionic Personality Disorder are likely to complaint and exaggerate their health problems.

Narcissistic Personality Disorder
Patients with Narcissistic Personality Disorder have the following behaviors and characteristics (American Psychiatric Association, 1994):

  • Need for admiration
  • Lack of empathy
  • Pervasive pattern of grandiosity

Chronic pain patients with Narcissistic Personality Disorder believe that they are special and always look for entitlement.

In the next article, we will write further about the challenge of significantly distressed chronic pain patient.

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