Contents

Search

personality disorder

- patterns of culturally abnormal traits & behaviors associated with impaired social or occupational function - features must be present since young adulthood to meet criteria for personality disorder (see Differential diagnosis: below) [2] Classification: 1) cluster A: odd or eccentric behaviors - paranoid personality disorder - schizoid personality disorder - schizotypal personality disorder 2) cluster B: dramatic, emotional or erratic behaviors - antisocial personality disorder - borderline personality disorder - histrioninc personality disorder - narcissitic personality disorder 3) cluster C: anxious or fearful behaviors - avoidant personality disorder - dependent personality disorder - obsessive-compulsive disorder 4) provisional personality disorders - passive-aggressive personality disorder - depressive personality disorder * personality changes are common at the onset of dementia [2] (see Differential diagnosis: below) Epidemiology: - 10-18% of adults - personality disorders persist into late life [2] - 5-10% of elderly - schizoid personality disorder & obsessive-compulsive disorder more likely in elderly - avoidant personality disorder & dependent personality disorder more likely in younger patients [3] - cluster B disorders are more likely in younger patients [2] - 59% of psychiatric inpatients with comorbid personality disorder - under-recognized [5] Clinical manifestations: - features must be present since young adulthood to meet criteria for personality disorder [2] - personality features do not become more maladaptive with age [2] Diagnostic criteria: - diagnostic criteria are not age-adjusted [3] - unclear whether diagnostic criteria applied to younger adults is applicable to elderly [3] Differential diagnosis: - dementia in the elderly: - personality changes are common at the onset of dementia, including apathy, egocentricity, mistust, irritability, impulsivity (pathologic gambling), emotional lability - features of personality disorder must be present since young adulthood to meet criteria for personality disorder [2] Management: - clarify diagnosis & identify recent stressors contibuting to the presentation (GRS9) [2] (first priority) - depression, anxiety or emotional lability respond to an antidepressant - psychotherapy may be of benefit for depression but response is generally less beneficial than for patients without personality disorder - forming a strong doctor-patient relationship through frequent, regularly scheduled clinical visits (long process)

Interactions

disease interactions

Specific

cluster A personality disorder cluster B personality disorder cluster C personality disorder neuroticism provisional personality disorder

General

psychiatric disease; behavioral disorder chronic mental disorder

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1101-1104
  2. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010 - Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  3. Balsis S, Woods CM, Gleason ME, Oltmanns TF. Overdiagnosis and underdiagnosis of personality disorders in older adults. Am J Geriatr Psychiatry. 2007 Sep;15(9):742-53. PMID: 17804828
  4. Ingenhoven T1, Lafay P, Rinne T, Passchier J, Duivenvoorden H. Effectiveness of pharmacotherapy for severe personality disorders: meta-analyses of randomized controlled trials. J Clin Psychiatry. 2010 Jan;71(1):14-25. PMID: 19778496
  5. Stevenson J, Datyner A, Boyce P, Brodaty H. The effect of age on prevalence, type and diagnosis of personality disorder in psychiatric inpatients. Int J Geriatr Psychiatry. 2011 Sep;26(9):981-7. PMID: 21845601
  6. Ripoll LH, Triebwasser J, Siever LJ. Evidence-based pharmacotherapy for personality disorders. Int J Neuropsychopharmacol. 2011 Oct;14(9):1257-88. PMID: 21320390
  7. Pietrzak RH, Wagner JA, Petry NM. DSM-IV personality disorders and coronary heart disease in older adults: results from The National Epidemiologic Survey on Alcohol And Related Conditions. J Gerontol B Psychol Sci Soc Sci. 2007 Sep;62(5):P295-9. PMID: 17906171
  8. Lenzenweger MF, Lane MC, Loranger AW, Kessler RC. DSM-IV personality disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007 Sep 15;62(6):553-64. Epub 2007 Jan 9. PMID: 17217923
  9. 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. PMID: 21219195 Free PMC Article
  10. Schuster JP, Hoertel N, Le Strat Y, Manetti A, Limosin F. Personality disorders in older adults: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Am J Geriatr Psychiatry. 2013 Aug;21(8):757-68. PMID: 23567365
  11. van Alphen SP, Derksen JJ, Sadavoy JJ, Rosowsky EE. Features and challenges of personality disorders in late life. Aging Ment Health. 2012;16(7):805-10. PMID: 22417221
  12. Gleason ME, Powers AD, Oltmanns TF. The enduring impact of borderline personality pathology: risk for threatening life events in later middle-age. J Abnorm Psychol. 2012 May;121(2):447-57. PMID: 22022953 Free PMC Article
  13. Medical Knowledge Self Assessment Program (MKSAP) 18, American College of Physicians, Philadelphia 2018
  14. Penders KAP, Peeters IGP, Metsemakers JFM et al. Personality disorders in older adults: a review of epidemiology, assessment, and treatment. Curr Psychiatry Rep. 2020;22(3):14. PMID: 32025914 PMCID: PMC7002365 Free PMC article https://link.springer.com/article/10.1007/s11920-020-1133-x