What Little Is Known

Although scant research has examined psychological treatments specifically for older adults with personality disorders, some has looked at the treatment of personality disorders of mixed ages, with younger adults being the most heavily represented. The findings can be summarized as follows:

■ Those with personality disorders being treated for Axis I disorders have a more complicated course and a poorer outcome than those without personality disorders (Bro-daty et al., 1993; Devanand, 2002; Shea & Yen, 2003; Shea et al., 1990; Stek, Van Exel, Van Tilburg, Westendorf, & Beekman, 2002).

■ Those with personality disorders develop Axis I disorders earlier in life; have more symptoms, more severe symptoms, longer episodes; and relapse more frequently than those without personality disorders (Abrams, Alexopoulos, Spielman, Klausner, & Kakuma, 2001; Devanand et al., 2000; Fava, Bouffides, Pava, & Rosenbaum, 1996; Trapler & Blackfield, 2001).

■ All psychotherapies have been found to be more difficult to conduct when a personality disorder is present, and these patients respond less positively to any intervention or treatment (Agronin & Maletta, 2000; Sadavoy, 1999; Thompson et al., 1988).

■ After treatment, those with a personality disorder evidence greater residual/continued negative effect on their level of functioning and quality of life (Abrams et al., 2001; Con-dello, Padoani, Uguzzoni, Caon, & DeLeo, 2003). This is especially observed in those individuals with more than one personality disorder diagnosis (Condello et al., 2003).

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