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Pediatric Subspecialty Psychiatry page 25 of 57
11. An 18-year-old white female is considered a difficult patient. She is hostile and exceedingly demanding, often requests specific medications, and once asked you to bring her back a souvenir from your vacation. She seems accident-prone and has frequently gotten into minor trouble as a teenager. She has multiple somatic complaints and has been diagnosed as having chronic fatigue syndrome by another physician.
Of the following, the most likely diagnosis is:
A) chronic mononucleosis.
B) dysthymia.
C) depression.
D) borderline personality disorder.
E) antisocial personality disorder.
ANSWER: D
Of the conditions listed, borderline personality disorder is the most likely diagnosis in this patient. One diagnostic hallmark of this disorder is a history of self-destructive behavior, often manifesting itself as accident proneness. The behavior frequently dates to adolescence. These patients may demand prompt solutions to problems and may pressure the physician to prescribe mediation. Complicated or incomplete recovery from organic or functional illness may occur. Patients with borderline personality disorder may consciously or unconsciously invent vague, undiagnosable illnesses, such as chronic viral infection or chronic pain.
Ref: Sansone RA, Sansone LA: Borderline personality disorder: Office diagnosis and management. Am Fam Physician 1991; 44 (1): 194-198. 2) American Psychiatric Association, 1994, pp 650-654.
