Personality Disorders In Older Adults Research Articles

Personality Disorders in the Elderly

<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>

An item response theory analysis of DSM-IV personality disorder criteria across younger and older age groups.

Many of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV; American Psychiatric Association, 1994) personality disorder (PD) diagnostic criteria focus on a younger social and occupational context. The absence of age-appropriate criteria for older adults forces researchers and clinicians to draw conclusions based on existing criteria, which are likely inadequate. To explore which DSM-IV PD criteria contain age group measurement bias, the authors report 2 analyses of data on nearly 37,000 participants, ages 18-98 years, taken from a public data set that includes 7 of the 10 PDs (antisocial, avoidant, dependent, histrionic, obsessive-compulsive, paranoid, and schizoid). The 1st analysis revealed that older age groups tend to endorse fewer PD criteria than younger age groups. The 2nd analysis revealed that 29% of the criteria contain measurement bias. Although the latent variable structure for each PD was quite similar across younger and older age groups, some individual criteria were differentially endorsed by younger and older adults with equivalent PD pathology. The presence of measurement bias for these criteria raises questions concerning the assessment of PDs in older adults and the interpretation of existing data.

Treatment of older adults with co‐morbid personality disorder and depression: a dialectical behavior therapy approach

The treatment of personality disorders in older adults, particularly those co-morbid with other Axis I disorders (e.g., Major Depressive Disorder), is an understudied clinical phenomenon. It has also been demonstrated that personality disorders in older adults complicate treatment of other psychopathology, as well as result in heightened interpersonal disturbance and emotional distress. Two studies utilizing standard Dialectical Behavior Therapy (DBT) to treat depression and personality disorders in older adults are reviewed. Study 1 examined 34 chronically depressed individuals aged 60 and older who were randomly assigned to receive 28 weeks of antidepressant medication plus clinical management, either alone (MED) or with the addition of DBT skills-training and scheduled telephone coaching sessions (MED + DBT). Study 2 had two phases of treatment: Phase I: 8-week open-trial of antidepressant medication (n = 65); Phase II: 24-week randomized trial of DBT + MED versus MED alone for those who prospectively failed to respond to the Phase I medication trial (n = 37). Study 1 demonstrated that 71% of MED + DBT patients were in remission at post-treatment, in contrast to 47% of MED patients. This became a significant difference at the 6-month follow-up; where 75% of MED + DBT-D patients were in remission compared with only 31% of MED patients. Study 2 showed that after 8 weeks of treatment with antidepressant medication alone (Phase 1) only 14% of the sample had at least a 50% reduction in HAM-D scores. Phase II results showed on average, the DBT + MED group reached depression remission by the post-group assessment and maintained these gains while the MED group did not reach remission, until the follow-up assessment. Results demonstrated superiority of DBT + MED compared to MED alone on Interpersonal Sensitivity and Interpersonal Aggression at post-treatment and 6-month follow-up. Results from these two treatment development studies indicate that applying standard DBT for the treatment of co-morbid MDD or MDD + PD in older adults is feasible, acceptable, and has clinical promise. Modifications to standard DBT and an overview of a new treatment manual for this population are summarized.

A preliminary study of the diagnostic accuracy of the Gerontological Personality disorders Scale (GPS)

There is still a lack of diagnostic instruments that are specifically developed to diagnose personality disorders in the elderly. To develop a reliable and valid screening instrument to assess personality disorders in older adults. The draft version of the screening instrument (52 items) consists of two sections: one for patients and one for informants. The diagnostic accuracy of the instrument has been assessed in the Netherlands in 159 elderly patients in an ambulatory department of geriatric psychiatry and 96 informants. In the patient section, sixteen items had a reasonable score for both sensitivity and specificity (approximately 70%). The internal consistency was moderate for habitual behavior (HAB; 7 items) and good for biographical information (BIO; 9 items). The test and retest reliability was moderate for HAB and excellent for BIO. The informant section, on the other hand, had a low score for sensitivity (45%) and a good score for specificity (78%). A specific instrument has been developed to diagnose personality disorders in older adults. However, further research is necessary to improve the diagnostic accuracy of the Gerontological Personality disorders Scale (GPS).

Personality Disorders in Older Adults: Emerging Issues in Diagnosis and Treatment

Personality Disorders in Older Adults: Emerging Issues in Diagnosis and Treatment

Personality Disorders in Older Adults: Emerging Issues in Diagnosis and Treatment Erlene Rosowsky, Robert C. Abrams, and Richard Zweig (Eds.). Mahwah, NJ: Lawrence Erlbaum, 1999, 312 pp., price not stated.

Personality Disorders in Older Adults: Emerging Issues in Diagnosis and Treatment Erlene Rosowsky, Robert C. Abrams, and Richard Zweig (Eds.). Mahwah, NJ: Lawrence Erlbaum, 1999, 312 pp., price not stated.

Personality Disorders in Older Adults

Personality Disorders in Older Adults

EPIDEMIOLOGY OF PERSONALITY DISORDERS IN LATE LIFE

Early anecdotal reports and community epidemiologic studies on the prevalence of personality disorders in late life indicate that although these disorders exist in late life, prevalence is lower than in younger adults. More recent empirical studies have also indicated that the prevalence of personality disorders in older adults is lower than in young adults, although both cohorts demonstrate a similar variance in rates across treatment settings. Inpatient and outpatient psychiatric samples reveal prevalence rates four- to fivefold greater than community samples across all ages It is not clear, however, whether the findings of a decline in the rates of personality disorder in late life represent a true age effect, or rather reflect methodologic flaws that fail to take into account geriatric variants in the presentation of personality disorder. Future DSM classification for personality disorders may need to utilize more age-neutral diagnostic criteria in order to increase the validity of studies that attempt to measure the prevalence of personality disorders across age cohorts.

Diagnosis and Assessment of Personality Disorders in Older Adults: A Critical Review

Personality disorders in older adults only recently were identified as significant clinical problems, with little empirical attention having been directed to this diagnostic classification. In light of the burgeoning population of older adults, clinicians and researchers are now beginning to recognize the importance of evaluating specific diagnostic and assessment strategies for such personality-disordered older adults. From our critical review of the extant literature, it is apparent that personality disorders traditionally have been underdiagnosed in older adults. Moreover, some of the diagnostic criteria in use appear to be inadequate for this population. In addition, failure to recognize the moderating impact of a characterological component to Axis I symptom presentation in older individuals may result in faulty treatment decision making. Appropriateness and utility of measures for evaluating personality disturbances in older adults are discussed, and comparisons between instruments are provided. Considerably more investigation in this area is warranted, and suggestions for future empirical work are outlined.