Treating the untreatables: identifying the somaticizing borderline patient.

Both medical and psychiatric services have long been challenged by patients with either clear psychosomatic disease or disease complicated by functional elements. Not only are these patients unresponsive to the usual medical management, but they seem to derive little benefit from the usual psychotherapeutic approach. This paper is intended as an examination of this group of difficult patients for the purpose of: 1. creating a suggestive profile to aid in the identification of such patients; 2. anticipating some of the difficulties experienced by clinicians and institutions responsible for their care; and 3. formulating a framework for understanding the basic difficulty experienced by some of these patients as an expression of borderline personality phenomena.