Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Absolute Chaos

After a lumbar fusion on a patient who had been briefly employed for his company, the patient was initially deeply appreciative of the surgeon….perhaps overly appreciative. Then, following surgery, he became suddenly and abruptly hostile, demanding, and began drug seeking, making accusations of malpractice and asked for a change of provider to a questionable surgeon.

Dr. Adams Replies: There is a disorder upon which we have previously touched. It presents itself as follows:

a. More common among injured workers than the general public

b. Characterized by an unstable sense of identity illustrated by frequent and sometimes radical changes in occupation

c. Accompanied by intense-unstable relationships and often frequent divorces

d. A history of reckless acts varying from shoplifting to DUI, spousal abuse, and impulsive spending while already in debt

e. Common pattern of substance abuse and misuse of prescribed narcotics

f. Rapid change from idealized affection for another person and sudden rejection and hostility toward them

g. Paranoid suspicion of being mistreated, misunderstood and unsupportive

h. Frantic attempts within a relationship to avoid abandonment, only to then leave and disparage the relationship

i. Destroying a situation just prior to achievement of a goal (Eg. Quitting treatment just prior to release, leaving school prior to graduation_)

j. Chronic feelings of emptiness

k. Inappropriate intense anger to the point of rage

l. Recurrent major depressive episodes and suicidal attempts

m. Early death from reckless and self-destructive behaviors

75% of these patients are female. There appears to be a genetic pattern for the behavior, and those with this disorder in mother and/or father are five times as likely to themselves develop this disorder during the first 18 years of life.

Approximately half of those diagnosed with a Personality Disorder have this specific personality disorder.

It is common among injured workers since they place themselves at risk and early school termination forces them into high risk professions. They may often fire their attorneys equally as impulsively.

We are, of course, talking about Borderline Personality Disorder. Such patients are driven by their own chaotic moods, contradictory beliefs and impulsive behaviors.

If you treat an injured worker who appears to overly endorse you, appears to unrealistically praise you, but who has a brief recent employment history and a _colorful_ past including arrests and substance abuse (or a family with these characteristics), you likely are treating/managing a patient with this disorder.

It is neither caused by, nor made worse by, an injury. It is opportunistic in that the injury becomes a place where the chaotic moods and actions can be expressed and justified by the patient.

If you suspect it, have it confirmed, and then take the recommendations regarding the setting of boundaries.

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