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Personality Disorders in Older Adults: Emerging Research Issues

  • Personality Disorders (C Schmahl, Section Editor)
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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.

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References

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  1. American Psychiatric Association. Diagnostical and statistical manual of mental disorders. 5th ed. Washington: American Psychiatric Publishing; 2013.

    Book  Google Scholar 

  2. Oltmanns TF, Balsis S. Personality disorders in later life: questions about the measurement, course, and impact of disorders. Annu Rev Clin Psychol. 2011;7:321–49. Review which explores the benefits of considering older adults in the study of personality disorders.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Agronin ME, Maletta G. Personality disorders in late life. Understanding and overcoming the gap in research. Am J Geriatr Psychiatr. 2000;8(1):4–18.

    Article  CAS  Google Scholar 

  4. Segal DL, Coolidge FL, Rosowsky E. Personality disorders and older adults: diagnosis, assessment and treatment. New Jersey: John Wiley & Sons Inc; 2006.

    Google Scholar 

  5. Van Alphen SPJ, Derksen JJ, Sadavoy JJ, Rosowsky EE. Features and challenges of personality disorders in late life. Aging Ment Health. 2012;16(7):805–10.

    Article  PubMed  Google Scholar 

  6. Schuster JP, Hoertel N, Le Strat Y, Manetti A, Limoson F. Personality disorders in older adults: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Am J Geriatr Psychiatr. 2013;21(8):757–68.

    Article  Google Scholar 

  7. Balsis S, Gleason ME, Woods CM, Oltmanns TF. An item response theory analysis of DSM-IV personality disorder criteria across younger and older age groups. Psychol Aging. 2007;22(1):171–85.

    Article  PubMed  Google Scholar 

  8. Balsis S, Woods CM, Gleason ME, Oltmanns TF. Over and underdiagnosis of personality disorders in older adults. Am J of Geriatr Psychiatr. 2007;15(9):742–53.

    Article  Google Scholar 

  9. Debast I, Rossi G, Van Alphen SPJ, Pauwels E, Cleas L, Dierckx E, et al. Age-neutrality of dichotomously and dimensionally measured DSM-5 Section II personality disorder criteria. (submitted).

  10. Black DW, Baumgard CH, Bell SE. A 16- to 45-year follow-up of 71 men with antisocial personality disorder. Compr Psychiatry. 1995;36(2):130–40.

    Article  CAS  PubMed  Google Scholar 

  11. Van Alphen SPJ, Engelen GJJA, Kuin Y, Hoijtink HJA, Derksen JJL. A preliminary study of the diagnostic accuracy of the Gerontological Personality disorders Scale (GPS). Int J Geriatr Psychiatr. 2006;21(9):862–8.

    Article  Google Scholar 

  12. Van Alphen SPJ, Nijhuis PEP, Oei TI. Antisocial personality disorder in older adults. A qualitative study of Dutch forensic psychiatrists and forensic psychologists. Int J Geriatr Psychiatr. 2007;22(8):813–5.

    Article  Google Scholar 

  13. Van Alphen SPJ, Bolwerk N, Videler AC, Tummers JHA, Van Royen RJJ, Barendse HPJ, et al. Age related aspects and clinical implementations of diagnosis and treatment of personality disorders in older adults. Clin Gerontol. 2012;1:27–41.

    Article  Google Scholar 

  14. Rossi G, Van den Broek J, Dierckx E, Segal D, Van Alphen SJP. Personality assessment among older adults: the value of personality questionnaires unraveled. Aging Ment Health. 2014;24:1–5. One of the first studies on the age neutrality of test items and the implications. DTF analysis investigates the aggregated effect of all DIF to determine whether the scale can still be used to compare the scores of younger and older adults.

    Google Scholar 

  15. Costa PT, McCrae RR. Revised NEO Personality Inventory (NEO-PI-R) and the Five Factor Inventory (NEO-FFI): Professional manual. Odessa: Psychological Assessment Resources Inc; 1992.

    Google Scholar 

  16. Costa Jr PT, McCrae RR. NEO Inventories professional manual for NEO-PI-3, NEO FFI-3 & NEO-PI-R. Odessa: Psychological Assessment Resources; 2010.

    Google Scholar 

  17. Mooi B, Comijs HC, De Fruyt F, De Ridder D, Hoekstra HA, Beekman AT. A NEO-PI-R short form for older adults. Int J Methods Psychiatr Res. 2011;20(3):135–44.

    PubMed  Google Scholar 

  18. Van den Broeck J, Rossi G, De Clercq B, Dierckx E, Bastiaansen L. Validation of the FFM PD count technique for screening personality pathology in later middle-aged and older adults. Aging Ment Health. 2013;17(2):180–8.

    Article  PubMed  Google Scholar 

  19. Barendse HPJ, Thissen AJC, Rossi G, Oei TI, Van Alphen SPJ. Psychometric properties of an informant personality questionnaire (the HAP) in a sample of older adults in the Netherlands and Belgium. Aging Ment Health. 2013;17(5):623–9.

    Article  CAS  PubMed  Google Scholar 

  20. Schotte C, De Doncker D. ADP-IV Questionnaire. University Hospital Antwerp: 1994.

  21. Miller JD, Maples J, Few LR, Morse JQ, Yaggi KE, Pilkonis PA. Using clinician-rated five-factor model data to score the DSM-IV personality disorders. J Pers Assess. 2010;92(4):296–305.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Young JE, Brown G. Cognitive therapy for personality disorders: a schema-focused approach. Sarasota: Professional Resource Press; 1994.

    Google Scholar 

  23. Krueger RF, Derringer J, Markon KE, Watson D, Skodol AE. Initial construction of a maladaptive personality trait model and inventory for DSM-5. Psychol Med. 2012;42(9):1879–90.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Debast I, Van Alphen SPJ, Rossi G, Tummers JHA, Bolwerk N, Derksen JLL, et al. Personality traits and personality disorders in late middle and old age: do they remain stable? A literature review (in press).

  25. Pauwels E, Claes L, Dierckx E, Debast I, Van Alphen SPJ, Rossi G, et al. Age neutrality of the young schema questionnaire in patients with a substance use disorder. Int Psychogeriatr. 2014;3:1–10.

    Google Scholar 

  26. Van den Broeck J, Rossi G, Dierickx E, De Clercq B. Potential age bias in the NEO-PI-R: differential item functioning in older versus younger adults. J Psychopathol Behav Assess. 2012;3:361–9.

    Article  Google Scholar 

  27. Van den Broeck J, Bastiaansen L, Rossi G, Dierckx E, De Clercq B. Age neutrality of the traits facets proposed for personality disorders in DSM-5: A DIFAS analysis of the PID-5. J Psychopathol Behav Assess. 2013;35:487–94.

    Article  Google Scholar 

  28. Rosenbluth M, Macqueen G, McIntyre RS, Beaulieu S, Schaffer A, Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force. The CANMAT task force recommendations for the management of patients with mood disorders and comorbid personality disorders. Ann Clin Psychiatr. 2012;24(1):56–68.

    Google Scholar 

  29. Newton-Howes G, Tyrer P, Johnson T. Personality disorder and the outcome of depression: meta-analysis of published studies. Br J Psychiatry. 2006;188:13–20.

    Article  PubMed  Google Scholar 

  30. Newton-Howes G, Tyrer P, Johnson T, Mulder R, Kool S, Dekker J, et al. Influence of personality on the outcome of treatment in depression: systematic review and meta-analysis. J Pers Disord. 2014;28(4):577–93. The most recent meta-analysis in this field concludes that a personality disorder comorbid to a depressive disorder more than doubles the odds of a poor outcome in depression treatment as compared to those with no personality disorder.

    Article  PubMed  Google Scholar 

  31. Morse JQ, Pilkonis PA, Houck PR, Frank E, Reynolds 3rd CF. Impact of cluster C personality disorders on outcomes of acute and maintenance treatment in late-life depression. Am J Geriatr Psychiatr. 2005;13(9):808–14.

    Article  Google Scholar 

  32. Lynch TR, Morse JQ, Mendelson T, Robins CJ. Dialectical behavior therapy for depressed older adults: a randomized pilot study. Am J Geriatr Psychiatr. 2003;11(1):33–45.

    Article  Google Scholar 

  33. Kindynis S, Burlacu S, Louville P, Limosin F. Effect of schema-focused therapy on depression, anxiety and maladaptive cognitive schemas in the elderly. Encéphale. 2013;39(6):393–400.

    Article  CAS  PubMed  Google Scholar 

  34. Lynch TR, Cheavens JS, Cukrowitz KC, Thorp SR, Bronner L, Beyer J. Treatment of adults with co-morbid personality disorder and depression: a dialectical behaviour therapy approach. Int J Geriatr Psychiatr. 2007;22(2):131–43.

    Article  Google Scholar 

  35. Videler AC, Rossi G, Schoevaars MH, Van der Feltz-Cornelis CM, Van Alphen SPJ. Effects of schema group therapy in older outpatients: a proof of concept study. Int Psychogeriatr. 2014;26(10):1709–17. The second treatment study conducted on ST evaluated short-term schema group therapy. It demonstrates a reduction in symptoms mediated by a change in dysfunctional schemas, which supports the effectiveness of ST for older adults.

    Article  CAS  PubMed  Google Scholar 

  36. First MB, Gibbon M, Spitzer RL, Williams JBW, Benjamin LS. Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Washington: American Psychiatric Press Inc; 1997.

    Google Scholar 

  37. Van Alphen SPJ, Tummers JHA, Derksen JJL. Reaction to ‘Treatment of older adults with co-morbid personality disorder and depression: a dialectical behavior therapy approach’. Int J Geriatr Psychiatr. 2007;22(7):702–3.

    Article  Google Scholar 

  38. Van Vreeswijk MF, Spinhoven P, Eurelings-Bontekoe EHM, Broersen J. Changes in symptom severity, schemas and modes in heterogeneous psychiatric patient groups following short-term schema cognitive behavioural group therapy: a naturalistic pre-treatment and post-treatment design in an outpatient clinic. Clin Psychol Psychother. 2014;21(1):29–38.

    Article  PubMed  Google Scholar 

  39. American Psychiatric Association. Diagnostical and statistical manual of mental disorders. 4th ed. Washington: American Psychiatric Publishing; 1994.

    Google Scholar 

  40. Widiger TA, Trull TJ. Plate tectonics in the classification of personality disorder: shifting to a dimensional model. Am Psychol. 2007;62(2):71–83.

    Article  PubMed  Google Scholar 

  41. Verheul R. Personality disorder proposal for DMS-5: a heroic and innovative but nevertheless fundamentally flawed attempt to improve DSM-IV. Clin Psychol Psychother. 2012;19(5):369–71.

    Article  PubMed  Google Scholar 

  42. Livesley WJ. Disorder in the proposed DSM-5 classification of personality disorders. Clin Psychol Psychother. 2012;19(5):364–8.

    Article  PubMed  Google Scholar 

  43. Van den Broeck J, Rossi G, De Clercq B, Hofmans J. Hierarchical structure of maladaptive personality traits in older adults: joint factor analysis of the PID-5 and the DAPP-BQ. J Pers Disord. 2014;28:198–211.

    Article  PubMed  Google Scholar 

  44. Van Alphen SPJ, Rossi G, Segal DL, Rosowsky E. Issues regarding the proposed DSM-5 personality disorders in geriatric psychology and psychiatry. Int Psychogeriatr. 2013;25(1):1–5.

    Article  PubMed  Google Scholar 

  45. Tyrer P. The classification of personality disorders in ICD-11: implications for forensic psychiatry. Crim Behav Ment Health. 2013;23(1):1–5.

    Article  PubMed  Google Scholar 

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Conflict of Interest

S. P. J. van Alphen, S. D. M. van Dijk, A. C. Videler, G. Rossi, E. Dierckx, F. Bouckaert, and R. C. Oude Voshaar declare that they have no conflict of interest.

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Correspondence to S. P. J. van Alphen.

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This article is part of the Topical Collection on Personality Disorders

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van Alphen, S.P.J., van Dijk, S.D.M., Videler, A.C. et al. Personality Disorders in Older Adults: Emerging Research Issues. Curr Psychiatry Rep 17, 538 (2015). https://doi.org/10.1007/s11920-014-0538-9

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