Course of Personality Disorders

Studies and anecdotal reports suggest that the natural course of some personality disorders evidences little change over the life course, whereas others have a more fluctuating course or show marked improvement. As noted earlier, the more dramatic presentations of the Cluster B personality disorders often become less florid in old age. This can be understood in a number of ways. For example, this might reflect selective mortality, whether those with greater pathology die earlier, either through sequelae of risky behaviors or perhaps from actual suicide. Cases may not be recognized because they may not meet diagnostic criteria, showing instead proxy signs and symptoms more appropriate to the late-life context (Rosowsky & Gurian, 1992). The more withdrawn and anxious personality disorder (Clusters A and C) appear to change little over the life course (Livesley, 2004).

Some changes reflect biological maturation. This includes actual brain changes as well as changes in the total organism. For example, impulsivity and the more dramatic and histrionic behaviors take considerable energy, which becomes diminished with age.

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