In contrast to a patient being more open to recognizing and accepting an Axis I diagnosis, the personality disorder is so much a part of the fiber of who an individual is (i.e., the pattern is ego-syntonic) that there is great resistance to acknowledging it as psychopathology. Each individual experiences him- or herself as unique. It is a challenge to be able to take an individual's personality as object, and subject it to clinical diagnosis and treatment, especially so for the older adult with a personality disorder.
Among the most challenging patients to diagnose and treat is an older individual with a personality disorder who, in some cases, had a relatively quiescent phase at midlife. As noted, the personality pathology can be expected to become exaggerated as the individual faces the many challenges of aging (Sadavoy, 1987, 1996) and the individual's core vulnerabilities revealed. The hallmark of a personality disorder is the difficulty people have as they are in a close relationship with others, or as they avoid such relationships. In older age, people need to be able to establish and maintain connections with others to increasingly permit and enable mutual interdependence. How successfully this is accomplished often informs whether the personality is experienced by others as a disorder or rather as the individual's distinctive style. This important distinction, and its implications for treatment are addressed in Chapter 11.
The "Goodness of Fit" Model and Its Implications for Treatment
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