Many of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV; American Psychiatric Association, 1994) personality disorder (PD) diagnostic criteria focus on a younger social and occupational context. The absence of age-appropriate criteria for older adults forces researchers and clinicians to draw conclusions based on existing criteria, which are likely inadequate. To explore which DSM-IV PD criteria contain age group measurement bias, the authors report 2 analyses of data on nearly 37,000 participants, ages 18-98 years, taken from a public data set that includes 7 of the 10 PDs (antisocial, avoidant, dependent, histrionic, obsessive-compulsive, paranoid, and schizoid). The 1st analysis revealed that older age groups tend to endorse fewer PD criteria than younger age groups. The 2nd analysis revealed that 29% of the criteria contain measurement bias. Although the latent variable structure for each PD was quite similar across younger and older age groups, some individual criteria were differentially endorsed by younger and older adults with equivalent PD pathology. The presence of measurement bias for these criteria raises questions concerning the assessment of PDs in older adults and the interpretation of existing data. Keywords age bias; aging; item response theory; personality disorders; prevalence At least six studies have compared the prevalence of personality disorders (PDs) in younger and older adults Casey & Schrodt, 1989;Fogel & Westlake, 1990;Kenan et al., 2000;Mezzich, Fabrega, Coffman, & Glavin, 1987;Molinari, Ames, & Essa, 1994; see also Abrams & Horowitz, 1999). One study found that the prevalence of PDs in community-dwelling younger adults was just under 18%, whereas for a similar sample of older adults the prevalence was approximately 13% . Four of the studies revealed a similar negative trend in clinical samples (Casey & Schrodt, 1989;Fogel & Westlake, 1990;Kenan et al., 2000;Mezzich et al., 1987). In a cross-sectional study of psychiatric inpatients, for example, 76% of younger adults were diagnosed with PDs, whereas only 55% of older adults were similarly diagnosed (Kenan et al., 2000). Although the remaining study found that the prevalence of PDs for younger and older adults in clinical
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Author Manuscriptsettings was similar at approximately 50% , the overall trend suggests that younger adults are diagnosed with PDs more frequently than older adults. 1 The reasons for this trend are unclear. Some researchers have suggested that the higher prevalence rates of PDs reported for younger adults as compared with older adults indicate that PDs mellow or soften with age (Kenan et al., 2000;Paris, 2003). This hypothesis finds support in longitudinal data, which indicate that PD features decline with age (e.g., Lenzenweger, Johnson, & Willett, 2004). Other studies have found that although specific symptoms disappear with increasing age, significant problems remain (Moffitt, Caspi, Harrington, & ...