Impact of self-reported cognitive dysfunction on the alternative model of personality disorders among older adults

Abstract

Objectives: The Alternative Model of Personality Disorders (AMPD) is a classification system for personality disorders (PDs) proposed in Section III of DSM-5. The AMPD contains two diagnostic constructs: personality functioning and pathological personality traits. Previous research has suggested that the model performed differently among older adults than younger adults (e.g., more generalized patterns). However, explanations for this difference in performance remain unclear. This study examined how self-reported cognitive dysfunction (a common complaint among older adults) impacts the AMPD’s two constructs among a later life sample. Method Older adults (N = 202) completed the Levels of Personality Functioning Scale-Self-Report, Personality Inventory for DSM-5, and Coolidge Axis II Inventory with its six self-report cognitive dysfunction scales. Results Results suggested high correlational overlap between subjective cognitive problems with personality functioning and pathological personality, as measured by the AMPD. Hierarchical regressions revealed that subjective measures of executive functions, perceptual motor, and language difficulties were most strongly related to the AMPD’s constructs. Results are discussed in the context of prior research on objective cognitive impairment among individuals with PDs. Conclusion The degree of overlap found within the current older adult sample suggested an age-related problem or potential age-bias, with older adults being at-risk of (a) having their subjective cognitive problems being incorrectly interpreted as personality pathology under the AMPD or (b) having personality pathology being overlooked under the AMPD, with symptoms instead attributed to subjective cognitive issues. This study suggested that subjective cognitive dysfunction may be one mechanism that contributes to differential performance of the AMPD among older adults.