Personality disorders in the elderly: a flagging field of inquiry

Department of Psychiatry, Cornell University, Итак, New York, United States
International Journal of Geriatric Psychiatry (Impact Factor: 3.09). 11/2006; 21(11):1013-7. DOI: 10.1002/gps.1614
Source: PubMed
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    ABSTRACT: Stability is thought to be one of the major distinguishing features between personality disorders (PDs) and other forms of psychopathology. The development of more reliable PD assessments and the implementation of four major longitudinal studies on PD stability have provided critical data with which to evaluate the stability of PD features. Results from these and other studies reveal significant complexity in the interpretation of PD stability because of several issues that can impact stability estimates. Such estimates will vary as a function of the type of constructs being assessed, the type of stability being considered, the modality and reliability of the assessments being used, and the impacts of sampling. In this article, longitudinal research on PD stability is reviewed in the context of these issues. It is concluded that no single answer can be given to the question, "How stable are PDs?" and that future research and classification need to consider carefully and account for the complexity of this question. Expected final online publication date for the Annual Review of Clinical Psychology Volume 9 is March 26, 2013. Please see for revised estimates.
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    ABSTRACT: Geriatric researchers and clinicians often have to deal with a lack of valid personality measures for older age groups (e.g., Mroczek, Hurt, & Berman, 1999; Zweig 2008), which hampers a reliable assessment of personality in later life. An age-neutral measurement system is one of the basic conditions for an accurate personality assessment across the lifespan, both longitudinally and cross-sectionally. In the present study, we empirically investigate the age-neutrality of one of the most widely used personality measures (i.e., the NEO PI-R (Costa & McCrae, 1992)), by examining potential Differential Item Functioning (DIF). Overall, results indicate that the vast majority (92.9 % at domain-level and 95 % at facet-level) of the NEO PI-R items was similarly endorsed by younger and older age groups with the same position on the personality trait of interest, corroborating the NEO PI-R’s age neutrality. However, Differential Test Functioning (DTF) analyses revealed large DTF for Extraversion, and facet A6 (Tender-Mindedness). Results are discussed in terms of their implications for using the current format of the NEO PI-R in older aged samples.
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    ABSTRACT: To investigate age-related diagnostic and therapeutic aspects of personality disorders in later life (≥ 60 years) and implications in clinical practice, such as the introduction of a specific mental health care program, diagnostic assessment procedure, and treatment criteria for personality disorders in older adults, a Delphi study was conducted among 35 Dutch and Belgian experts in the field of personality disorders in older adults. Consensus on a statement was defined as agreement by two thirds or more of the experts. This Delphi study ultimately yielded consensus concerning 20 of the 21 statements. It was generally agreed that late-onset personality disorder is a useful construct in geriatric psychiatry and that aging can lead to a distinct behavioral expression of personality disorders in older adults. The experts confirmed that a specific mental health program is useful to refine the diagnostic assessment and treatment in older patients with personality disorders as well as older adults with mild psychiatric problems often superimposed on personality disorders, such as adjustment disorders, dysthymic disorders, and diffuse anxiety disorders. The Longitudinal, Expert, and All Data (LEAD) standard combined with a stepwise, multidimensional diagnostic approach appears highly suitable for personality assessment. Finally, stratification of subjects among four treatment levels was regarded as a useful strategy and there was agreement concerning specific criteria for each level of treatment. In conclusion, it is recommended that age-specific aspects in the diagnosis and treatment of personality disorders be included in guidelines and protocols and addressed in future scientific research. Further research is indicated involving cross-validation studies of these Delphi statements in other countries and evaluation of the clinical implementation of the specific mental health care program, diagnostic assessment procedure, and treatment criteria on clinical utility.
    Clinical Gerontologist 01/2012; 35(1):27-41. DOI:10.1080/07317115.2011.628368 · 0.66 Impact Factor