Introduction

The study of personality disorder in late life presents conceptual, diagnostic, and methodological difficulties. By definition, personality disorders are considered a group of personality traits that are relatively persistent through adulthood. However, the concept of personality disorders persisting throughout the lifespan contradicts widespread clinical belief that they become less severe with ageing. For example, DSM-IV(!) notes that 'some types of personality disorders...tend to become less evident or remit with age'.

There are several difficulties in studying personality disorder in the elderly. One has been the instability of the definition of personality disorder over time. Thus it is difficult to relate findings of studies undertaken between the 1940s and 1960s to those using current definitions of personality disorder. In addition, diagnostic criteria are subject to criticism when applied to the elderly, in that they may be 'age-biased'. (23) Finally, the methodology used to diagnose personality disorder has been highly variable and difficult to interpret between studies.

A major issue in the study of personality disorder is whether personality is fully developed by early adulthood and then remains unchanged, or whether personality continues to develop and change throughout the lifespan. The work of McCrae and Costa(4) has demonstrated that personality characteristics as measured by questionnaires, are relatively stable within individuals over a 30-year period with correlations ranging from 0.7 to 0.8. However, these correlations also demonstrate that there is not complete stability and suggest that while many personality characteristics do remain stable, certain aspects of the personality may still develop and change with ageing. This does lead to the possibility that personality disorders may indeed change over the lifespan as well.

Another issue is whether underlying traits that persist throughout the lifespan can rise to the level of a personality disorder depending on the life stage and environment. For example, traits that may be personality disordered in young adult life, such as extreme dependency, may be an appropriate and adaptive trait for an older individual with multiple physical disabilities. (5) Conversely, an individual may have a trait of extreme independence that may be adaptive in earlier life but which leads to distress and maladaptive functioning in a setting requiring dependence, such as a nursing home. Thus it is possible to have a personality disorder diagnosed for the first time in late life, which goes against the very definition of lifelong personality disorder.

Adult Dyslexia

Adult Dyslexia

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