Missed diagnosis: The emerging crisis of borderline personality disorder in older people

Beatson, Josephine; Broadbear, Jillian Helen; Sivakumaran, Hemalatha; George, Kuruvilla; Kotler, Eli; Moss, Francine; Rao, Sathya

doi:10.1177/0004867416640100

Cited by 37 publications

(51 citation statements)

References 44 publications

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“…With the rise in the elderly population, there will be greater numbers of people struggling with personality disorders, resulting in an increased burden of the disorder on health services (Beatson 2016). The situation is not entirely grim; a number of older people with personality disorders show more effective coping than their younger counterparts, indicating that experience and wisdom acquired with age may result in healthier coping responses in spite of potentially greater exposure to losses and stressors (Coolidge 2000).…”

Section: Discussionmentioning

confidence: 99%

“…A personality disorder should be a differential diagnosis in an older patient with depression who fails to respond to treatment, including psychotherapy. Although infrequent, suicide attempts by elderly people with personality disorders tend to be life-threatening (Beatson 2016). When anxiety is a prominent feature in an elderly person it may be a strong pathognomonic sign for the presence of a personality disorder such as the schizotypal, dependent, avoidant, obsessive-compulsive or schizoid type (Coolidge 2000).…”

Section: Personality Disorders and Mood Disorders In Later Lifementioning

confidence: 99%

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Personality disorders in later life: epidemiology, presentation and management

Bangash

2020

BJPsych advances

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SUMMARYDespite the enormous amount of literature on medical care of older people, personality disorders in late life have been given little attention. Clinicians tend not to assign this diagnosis to older adults in view of limited research into, and therefore limited awareness of, this topic. This article aims to promote better understanding of this subject in view of the growing population of older people and hence an expected increase in the number of personality disorder cases.

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Section: Discussionmentioning

confidence: 99%

Section: Personality Disorders and Mood Disorders In Later Lifementioning

confidence: 99%

Personality disorders in later life: epidemiology, presentation and management

Bangash

2020

BJPsych advances

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“…Case studies and clinical experience suggest that features of BPD can be exacerbated in old age due to contextual changes, even causing a growing prevalence of BPD in residential care and psychiatric facilities for the elderly [ 55 – 58 ]. Poor interpersonal functioning has caused many old BPD patients to be estranged from their family and former friends, and when they become dependent for care, this might re-trigger insecure attachment style issues and fears of abandonment [ 55 ]. BPD symptoms, together with trait neuroticism, appeared unique predictors of greater suicidal ideation in older adults, over other personality disorders and normal-range personality traits [ 59 ].…”

Section: Waxing and Waning Course Of Bpd From Childhood To Old Agementioning

confidence: 99%

A Life Span Perspective on Borderline Personality Disorder

Videler

Hutsebaut

Schulkens

et al. 2019

Curr Psychiatry Rep

131

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Purpose of Review To provide an update of a life span perspective on borderline personality disorder (BPD). We address the life span course of BPD, and discuss possible implications for assessment, treatment, and research. Recent Findings BPD first manifests itself in adolescence and can be distinguished reliably from normal adolescent development. The course of BPD from adolescence to late life is characterized by a symptomatic switch from affective dysregulation, impulsivity, and suicidality to maladaptive interpersonal functioning and enduring functional impairments, with subsequent remission and relapse. Dimensional models of BPD appear more age neutral and more useful across the entire life span. There is a need for age-specific interventions across the life span. Summary BPD symptoms and impairments tend to wax and wane from adolescence up to old age, and presentation depends on contextual factors. Our understanding of the onset and early course of BPD is growing, but knowledge of BPD in late life is limited. Although the categorical criteria of DSM allow for reliable diagnosis of BPD in adolescence, dimensional models appear both more age neutral, and useful up to late life. To account for the fluctuating expression of BPD, and to guide development and selection of treatment across the life span, a clinical staging model for BPD holds promise.

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“…Recognising the need for early diagnosis and intervention, the Australian National Health and Medical Research Council (NHMRC) clinical practice guideline for the management of BPD has recommended that BPD be diagnosed from the age of 12 (20). Some recent reports have noted that BPD symptoms can persist beyond 65 years of age or manifest for the first time in later life (21).…”

Section: Editorialmentioning

confidence: 99%