When considering treatment for the individual with a personality disorder in older age, what is it that we treat? This is an especially relevant question, because the "personality" is the essence of the individual. As clinicians, we treat individuals who are in distress and pain, hoping to improve their quality of life. When an older person comes to us for treatment, what they have been doing, thinking, and feeling for many years no longer works for them. We interpret their distress to mean that what they are being asked to handle is outstripping their ability to cope; changes occurred in themselves that now prevent them from responding as they have formerly. At times, older adults are required to cope with problems or situations with which they have not had experience or for which they lack adequate resources. For example, after losing a spouse, they might be on their own for the first time in their lives. They might enter a new community or need to make new friends and establish a social network for the first time in many years. As their lifelong ways of coping no longer work for them, they become even more distressed, function even less well, and their behavior worsens. This vicious cycle typically makes intervention quite challenging.

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