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

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


As the average age of the population rises, mental health professionals have become increasingly aware of the critical importance of personality in mediating successful adaptation in later life. Personality disorders were once thought to "age out," and accordingly to have an inconsequential impact on the lives of the elderly. But recent clinical experience and studies underscore not only the prevalence of personality disorders in older people, but the pivotal roles they play in the onset, course, and treatment outcomes of other emotional and cognitive problems and physical problems as well. Clearly, mental health professionals must further develop research methods, assessment techniques, and intervention strategies targeting these disorders; and they must more effectively integrate what is being learned from advances in research and theory into clinical practice.

Inspired by these needs, the editors have brought together a distinguished group of behavioral scientists and clinicians dedicated to understanding the interaction of personality and aging. Offering a rich array of theoretical perspectives (intrapsychic, interpersonal, neuropsychological, and systems), they summarize the empirical literature, present phenomenological case reports, and review psychodynamic, cognitive-behavioral, and pharmacological treatment approaches. This comprehensive state-of-the-art guide will be welcomed by all those who must confront the complexity and the challenge of working with this population.


As geriatric mental health clinicians we know that certain of our older adult patients are difficult to treat. We know, too, that their being "difficult" is often a byproduct of their personality functioning -- who they are as people-and not exclusively a result of the Axis I disorder or medical condition for which they originally sought treatment. The interpersonal difficulties, affective instability, distortions of the clinician-patient relationship, and unpredictable responses to clinical interventions for which personality disorder patients are notorious are all to be found in older adults as well as in younger patients.

Yet we have discovered that neither the behavioral science nor the clinical literatures offer much guidance to the clinician or researcher seeking to understand the phenomenon of personality disorders in the second half of life. The data base on personality disorders in older adults is remarkably thin, providing only preliminary empirical research and descriptive clinical or theoretical articles. At a time when notions of "successful aging" and of successfully treating behavioral disorders of the elderly have begun to capture the imagination of both the scientific community and the broader public, this scarcity of research regarding geriatric personality disorder seemed striking and disproportionate to its relevance for geriatric mental health clinicians.

The catalyst for this volume was a symposium entitled Personality Disorders in the Elderly: Research Problems and Clinical Implications, presented at the annual meeting of the American Psychological Association in 1995, at which two of the editors (Erlene Rosowsky and Richard Zweig) were organizers and participants and the other editor (Robert Abrams) served as discussant. We brought differing scientific perspectives and clinical backgrounds to the effort, but we found that we shared a seemingly eccentric interest in an under-researched but exciting area of psychological inquiry. It was this discovery, and our surprise at the large attendance and high level of interest shown at the symposium, that inspired this effort to bring together such work as now exists into a single volume, in the hopes of inspiring more.

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