Personality Disorders in the Elderly

Abstract

<p>Personality disorders in the elderly have received relatively little attention, yet they may seriously complicate the course and treatment of other psychiatric disorders and adversely affect quality of life. Patients with personality disorders have longstanding difficulties in multiple aspects of functioning, notably in managing interpersonal relationships, maintaining a stable sense of self, and tolerating strong emotions. Consequently, elderly patients with personality disorders may be more vulnerable to the stresses associated with aging than their same-aged peers. They may also present with additional needs, but, paradoxically, they have greater difficulty in accepting or making use of available resources. This article summarizes studies of geriatric personality disorders and clinical approaches to problems of the aging personality.</p> <h4>ABOUT THE AUTHORS</h4> <p>Robert C. Abrams, MD; and Chaim E. Bromberg, PhD, are with the Department of Psychiatry, Weill Medical College of Cornell University, New York, NY.</p> <p>Address correspondence to: Robert C. Abrams, MD, Box 140, 525 E. 68th Street, New York, NY, 10021.</p> <p>The authors would like to acknowledge the American Philanthropic Foundation and the Reynolds Foundation.</p> <p>The authors disclosed no relevant financial relationships.</p> <h4>EDUCATIONAL OBJECTIVES</h4> <ol> <li>List common problems in assessing older adults for <cite>Diagnostic and Statistical Manual of Mental Disorders</cite>, fourth edition (DSM-IV) personality disorders.</li> <li>Describe the relationships between depressive and personality disorders in older adults.</li> <li>Identify ways in which personality disorders in elderly patients can be diagnosed and managed in general medical settings.</li> </ol>

Personality Disorders in Late Life

“…Assessing PDs in older adults is complicated by multiple factors of aging that cause functional impairment, including shifts in physiology, lifestyle, and environment (Abrams & Bromberg, 2007). Existing diagnostic criteria fail to take these variables into account and therefore lack face validity for older adults.…”

“…On the other hand, an older individual’s decreased independence may exacerbate the dysfunction caused by these traits. Abrams and Bromberg (2007) describe the older patient with Cluster A personality symptomatology as a chronic recluse, a self-neglector, and an iconoclast who may not encounter major difficulties until age-related disability compels them to depend on societal or institutional supports (Abrams & Bromberg, 2007).…”

Personality disorders in later life: epidemiology, presentation and management

“…An assessment depends on acquiring an accurate lifetime history. This can present its own challenges when the reports of patients and informants are influenced by cognitive impairment and stigma attached to socially undesirable behaviours (Abrams 2007). Clinicians can experience difficulty in distinguishing between long-standing personality dysfunction and recent reactive personality changes (Agronin 2000).…”

“…The rules and procedures of the mental health setting, expectations regarding the speed of replying to non-emergency telephone calls and other limits should be explained at the initiation of the clinician-patient relationship. Patients should understand that rules apply to all patients and should be seen not as a punishment but for the patients' protection (Abrams 2007).…”