Personality Disorders in Older Adults: Emerging Research Issues

Abstract

Empirical research focusing on personality disorders (PDs) among older adults is mainly limited to studies on psychometric properties of age-specific personality tests, the age neutrality of specific items/scales, and validation of personality inventories for older adults. We identified only two treatment studies-one on dialectical behavior therapy and one on schema therapy-both with promising results among older patients despite small and heterogeneous populations. More rigorous studies incorporating age-specific adaptations are needed. Furthermore, in contrast to increasing numbers of psychometric studies, the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 pays little attention to the characteristics of older adults with PDs. Moreover, the constructs "personality change due to another medical condition" and "late-onset personality disorder" warrant further research among older adults. These needs will become even more pressing given the aging society worldwide.

Screening for personality disorders in geriatric medicine outpatients

“…The past decades interest in research of PDs is growing both in adulthood and adolescence samples. However, psychometric research on PDs concerning older adults is still limited [1].…”

“…In geriatric medicine, older adults with multi-morbidity are treated for a variety of somatic, psychogeriatric, functional and social complaints. Research has shown that the presence of a personality disorder (PD) is a highly frequent complicating factor in both psychiatric and somatic health care [1]. The life style of patients with PDs, their lack of compliance, limited support system and conflicts with caregivers/professionals can complicate the treatment of somatic disorders in geriatric medicine.…”

Psychotherapeutic Treatment Levels for Personality Disorders in Older Adults

“…Treatment of personality disorders (PDs) in older adults is a highly underexplored topic (Van Alphen, Derksen, Sadavoy, & Rosowsky, 2012;Van Alphen et al, 2015). The number of publications on this subject is scant.…”

“…CBT has been proven efficacious for the treatment of depression and anxiety disorders (Gould, Coulson, & Howard, 2012a;2012b;Laidlaw & Thompson, 2014;Pinquart, Duberstein, & Lyness, 2007;Scogin & Shah, 2012) in older adults. Furthermore, case studies and empirical reviews indicate that cognitive behavioral therapy (CBT) and schema therapy (ST) are applicable for the treatment of PDs in later life (Bizzini, 1998;Dick & Gallagher-Thompson, 1995;James, 2003James, , 2008Van Alphen, 2010;Van Alphen et al, 2015).…”

“…There was agreement that features of the gerontological perspective on treatment of PDs are particularly loss experiences, which are often prominent in the life of older adults. Moreover, as people with PDs age, as a consequence of their history of lifelong maladaptive coping, they have more trouble than older adults with a healthy coping repertoire, facing age-related loss experiences, such as loss of health (related to the beliefs about-and the consequences of-somatic ailments), loss of significant others, and loss of autonomy (Knight, 2004;Segal, Coolidge, & Rosowsky, 2006;Van Alphen et al, 2015). Besides the loss experiences, there are the cohort beliefs, the sociocultural context, and changes in role investment.…”