Physicians in all branches of medicine are frequently confronted by confusing and bizarre symptoms presented by borderline psychotic patients. These patients, while not overtly psychotic, present many manifestations of profound personality disorder. Such patients often present to the physician complaints referable to known organic illness. For many reasons, an early diagnosis of the patient''s severe emotional illness is desirable. Characteristic manifestations of such illnesses are enumerated and illustrated with case examples. Principles of management of this type of patient within the structure of general medical and surgical practice are outlined.