Personality disorders in late life

Abstract

There is growing empiric evidence to suggest that a large number of elderly patients who have chronic depression frequently have comorbid personality disorders as well. In addition, contrary to commonly held clinical beliefs, a recent meta-analysis suggests that rates of personality disorders among older adults are essentially equivalent to that of younger groups. Although understudied, personality-disordered elderly patients have been shown to be less responsive to mental health interventions, and personality dysfunction may be one of the most relevant factors to account for when examining late-life depression remission and relapse. The paper considers briefly the notion of personality and personality disorders in late-life, examines prevalence rates including a recent meta-analysis, explores relevant issues associated with treatment, and discusses new developments in treatment.

Personality disorders in the elderly: a flagging field of inquiry

“…Several other reviews published within the past decade have made similar observations about the dearth of research in geriatric personality disorders and the reasons for it; to revive the field, these authors have advocated the use of dimensional assessments (Agronin and Maletta, 2000;Morse and Lynch, 2000) and the creation of age-sensitive diagnostic criteria (Agronin and Maletta, 2000). We acknowledge the advantages of dimensional assessments in characterizing the subsyndromal and NOS disorders in the elderly, but in view of the challenges and uncertain benefits which validating new entities would entail, we favor continuing the use of standard nosology for the present.…”

“…However, these observations were cross-sectional and epidemiological, and did not address whether individuals experience personality change as they age. In addition, age-related changes in behavior may not necessarily reflect shifts in personality (Morse and Lynch, 2000).…”

“…Assessments using the five-factor model may be more resistant to state effects than clinical personality disorder diagnoses (Costa and McCrae, 1992). Self-report of Axis II symptoms in the elderly may also be limited by cognitive deficits, lack of insight, and social stigma (Morse and Lynch, 2000).…”

The Relationship Between Borderline Personality Disorder and Major Depression in Later Life: Acute Versus Temperamental Symptoms

“…High rates of co-occurrence between borderline personality disorder and major depression have been reported, and some findings indicate that rates of co-occurrence are just as high in older adults as in younger adults. 2 Unfortunately, a satisfying empirical explanation for the link between these two disorders has not been established.…”

Conversion pseudodementia in older people: a descriptive case series

“…Hospitalisation or institutionalisation can lead to feelings of abandonment, depression and rage and a further retreat into pseudodementia and dependency. Recent work on personality disorder in later life has suggested that borderline and emotionally unstable personality traits (ICD 10, 1992) can be unmasked in later life by cumulative losses after a period of relative quiescence in middle age (Reich et al, 1988;Rosowsky and Gurian, 1991;Abrams and Horowitz, 1999;Morse and Lynch, 2000;Hepple, 2004). The presentation of borderline and other 'dramatic cluster' (including narcissistic and histrionic) traits in later life can be modified in comparison with younger adults, with less overt self-harm and more passivedependent behaviours and somatisation.…”