The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition alternative model for personality disorders offers a two-part definition of personality pathology, separating personality functioning from traits. The Level of Personality Functioning Scale (LPFS) from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition alternative model for personality disorders encapsulates the personality functioning criterion, and several methods have been used to assess it. Previous interview rating methods have overlapped with an assessment of personality traits and symptoms, biasing the assessment of functioning, and recently developed self-report instruments rely on the participant’s awareness of their personality pathology. The purpose of the current analyses was to examine the reliability and validity of LPFS ratings based on open-ended, nondiagnostic interviews. The sample consisted of 162 community-dwelling, older adult participants from the St. Louis Personality and Aging Network. Undergraduate students rated video recordings of Life Story Interviews, using a 12-item version of the LPFS. One-way random, average measures intraclass correlation coefficient for the total LPFS was .80. A principal components analysis indicated that a single underlying dimension could characterize the LPFS. Component scores derived from this analysis demonstrated theoretically consistent associations with both normal-range and maladaptive personality traits. The component scores also contributed small but significant variance to the prediction of personality disorder symptoms, health, and functional outcomes over and above personality traits. These findings support the reliability and validity of the LPFS as assessed using Life Story Interviews and suggest that personality functioning ratings may have utility in predicting clinically relevant outcomes.

Research shows moderate agreement between different sources of information when assessing personality disorders (PDs) in older adults. The differences between measurement methods appear to be not only the result of measurement error, but also an indication that each source holds nonredundant information relevant to PD diagnosis. The current article examines three sources of diagnostic information (self-report, informant report, and clinical interview) and the utility of these instruments in predicting important outcomes in older adulthood. We analyzed data from 1,630 adults between the ages of 55 and 64 years participating in a longitudinal study of later life. PD symptomatology was assessed using multiple methods, which were then used to predict health, marital satisfaction, and cognitive decline. All three sources contributed significantly to the prediction of these outcomes, with important implications for the assessment of older adults in research and clinical settings.

Borderline personality disorder (BPD) is associated with negative physical health outcomes. Clinical case studies suggest that employment status may buffer against the negative effects of BPD on physical health. The goal of the current study was to examine the interaction between BPD features and employment status in predicting subjective perceptions of physical health. We hypothesized that employment status would moderate the relationship between BPD features and physical health, such that individuals who are employed would exhibit a weaker negative relationship between BPD features and self- and informant ratings of physical health. We investigated this question using data from a community sample of 1,630 middle-aged to older adults participating in the St. Louis Personality and Aging Network, an ongoing study of personality, health, and aging. Results indicated that employment status and BPD features were significant predictors of both self- and informant ratings of physical health. Confirming our hypothesis, the interaction term contributed to a significant increase in the proportion of explained variance, suggesting that employment is associated with a weaker negative relationship between BPD features and physical health. These findings highlight the importance of examining occupational functioning in the long-term course of BPD and offer avenues for further research into moderators of the relationship between BPD features and physical health. (PsycINFO Database Record

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Methodological advances enable the latest research on personality pathology in later life to turn toward understanding the role personality pathology plays in age-related outcomes. Despite indications that some features of personality disorders fade in later life, a prevalence rate of approximately 10 percent has been established for adults aged 50 or older. Personality disorder features have been linked to suicidal ideation, poorer physical health, and cognitive decline in later life. Given these associations, the literature on treatment of personality disorders in this age group is surprisingly scant. Future research needs to address this lack in order to provide guidelines for the use of the DSM-5 Alternative Model for Personality Disorders with older adults.