Borderline Personality Disorder in Late Life

Rosowsky, Erlene; Gurian, Bennett S.

doi:10.1017/s1041610291000509

Cited by 28 publications

(18 citation statements)

References 17 publications

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“…The relative lack of cluster B diagnoses has also been reported by other authors, and may be a function of sample size, diagnostic instrument or increased age. It has been postulated that, in the case of borderline personality disorder, the core symptomatology may undergo a 'transmutation' with age, and our current diagnostic instruments may be insensitive to the clinical diagnosis in the elderly (28). Clinical observation has also led to the speculation that there may be a decrease in the 'labile or immature' character disorders with age (29-3 1).…”

Section: Discussionmentioning

confidence: 99%

Personality disorder and the Temperament and Character Inventory in the elderly

Casey

Joyce

1999

Acta Psychiatr Scand

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Section: Discussionmentioning

confidence: 99%

Personality disorder and the Temperament and Character Inventory in the elderly

Casey

Joyce

1999

Acta Psychiatr Scand

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“…1 Since that time, clinicians and researchers who work with older adults have recommended that DSM criteria should be used cautiously with this age group. 2,3 These advocates noted that approximately 25% of DSM criteria contain poor face validity for use with older adults. …”

Section: Introductionmentioning

confidence: 99%

Overdiagnosis and Underdiagnosis of Personality Disorders in Older Adults

Balsis

Woods

Gleason

et al. 2007

The American Journal of Geriatric Psychiatry

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Objective-Recent evidence suggests that some of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition personality disorder (PD) criteria contain measurement bias across age groups. Specifically, this research showed that younger and older adults were differentially likely to endorse certain PD criteria, even when both groups were statistically matched using mechanisms of item response theory (IRT) for degree of PD pathology. For the analyses presented here, the authors used data from a large epidemiological study (N=43,093), the National Epidemiologic Survey on Alcohol and Related Conditions, to examine the influence of this item-level measurement bias for reaching accurate algorithmic PD diagnoses of older adults.Methods-Joint probability analyses were used to determine the net effect of the item-level bias on the possible over-or underdiagnosis of six PDs in older adults.Results-When older adults were compared to younger adults at equivalent levels of PD pathology, they were more likely to receive diagnoses of obsessive-compulsive and schizoid PDs. In contrast, they were less likely to receive diagnoses of avoidant and dependent PDs. Younger and older adults were equally likely to receive diagnoses of histrionic and paranoid PDs. Of the seven PDs assessed in this dataset, only these six lend themselves to this type of analysis; antisocial PD differs because a diagnosis depends upon the presence of conduct disorder.Conclusion-These findings raise concerns regarding the interpretation of existing older adult PD prevalence data. KeywordsAge bias; item response theory; personality disorder Concern over possible age bias in Diagnostic and Statistical Manual of Mental Disorders (DSM) personality disorder (PD) criteria dates back to the publication of DSM-III. 1 Since that time, clinicians and researchers who work with older adults have recommended that DSM criteria should be used cautiously with this age group. 2,3 These advocates noted that approximately 25% of DSM criteria contain poor face validity for use with older adults. HHS Public AccessAuthor manuscript Author Manuscript Author Manuscript Author Manuscript Author ManuscriptThey pointed out, for example, that the criterion for avoidant PD ("avoids occupational activities that involve significant interpersonal contact …") may not be useful for the assessment of PD pathology in an older, retired person. 3 Although convincing arguments have been made about the limited face validity for many of the PD criteria, 3,4 only recently has there been empirical support for these arguments. 1 In a recent empirical study, 1 item response theory (IRT) analyses of a large public dataset indicated that approximately 29% of DSM-IV criteria were endorsed at different rates by younger and older adults when controlling for level of PD pathology. In other words, younger and older adults with the same amount of pathology endorsed specific items at different rates. This suggests that the items measure PD pathology differently across these age groups, a...

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“…At this juncture, the data are insufficient to warrant a firm conclusion about whether these and other personality traits and disorders play a central role in suicide across the second half of life. The relative underinvestigation of personality in samples of older suicides may be attributable to culturally biased beliefs that personality processes are less relevant to the understanding of late-life disorders (Casey & Schrodt, 1989), the possibility that the DSM-111-R criteria set for personality disorders are inappropriate for the elderly (Rosowsky & Gurian, 1991;Sadavoy & Fogel, 1992), or because there really is no link between personality and elderly suicide.…”

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confidence: 99%

Openness to Experience and Completed Suicide Across the Second Half of Life

Duberstein

1995

Int. Psychogeriatr.

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Personality data gathered in a psychological autopsy study indicate that completed suicides obtain higher neuroticism scores than age- and gender-matched controls. Older suicide victims obtained lower openness to experience (OTE) scores than both younger suicide victims and normal controls. Although the role of neuroticism and negative affect in psychopathology has been discussed extensively, OTE has been accurded relatively little attention in the psychiatric literature. The apparent role of OTE in completed suicide warrants its closer examination. In this article, I offer the testable hypotheses that persons low in OTE are at risk for taking their own lives because their affective dampening, cognitive certainty, diminished behavioral repertoire, and rigidly defined self-concept have decreased their capacity to adapt to the expectable age-associated changes in role, health, and function that accumulate over time. Concrete thinking and excessive focus on proximal, low-level goals place them at risk for descending into states of suicidal meaninglessness in times of stress or crisis. This state of awareness increases the desirability of suicide as an action oriented solution to the stressors of aging. Other lines of investigation are suggested. These include research on OTE in attempted suicide; OTE and the neurobiology of suicidal behavior; OTE and gender differences in suicidal behavior; and clinical intervention designed to increase the degree to which one is open to experience.

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Borderline Personality Disorder in Late Life

Cited by 28 publications

References 17 publications

Personality disorder and the Temperament and Character Inventory in the elderly

Personality disorder and the Temperament and Character Inventory in the elderly

Overdiagnosis and Underdiagnosis of Personality Disorders in Older Adults

Openness to Experience and Completed Suicide Across the Second Half of Life

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