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Personality Disorder in Later Life: A Community Study

Published online by Cambridge University Press:  02 January 2018

Bruce J. Cohen
Affiliation:
Department of Psychiatry, Johns Hopkins Hospital, Baltimore, USA
Gerald Nestadt*
Affiliation:
Department of Psychiatry, Johns Hopkins Hospital, Baltimore, USA
Jack F. Samuels
Affiliation:
Department of Psychiatry, Johns Hopkins Hospital, Baltimore, USA
Alan J. Romanoski
Affiliation:
Department of Psychiatry, Johns Hopkins Hospital, Baltimore, USA
Paul R. McHugh
Affiliation:
Department of Psychiatry, Johns Hopkins Hospital, Baltimore, USA
Peter V. Rabins
Affiliation:
Department of Psychiatry, Johns Hopkins Hospital, Baltimore, USA
*
Professor Gerald Nestadt, Department of Psychiatry, Meyer 228, Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD 21287, USA

Abstract

Background

This exploratory study compares the prevalence of personality disorders and traits in people over and under 55 years of age. The comorbidity between personality and other psychiatric disorders is also examined.

Method

Psychiatrists examined 810 subjects in a two-stage community survey. The semi-structured Standardized Psychiatric Examination was used to diagnose all DSM-III personality disorders and other psychiatric disorders.

Results

The older subjects were significantly less likely than the younger subjects to have any personality disorder (6.6% v. 10.5%; relative odds = 0.42, 95% confidence interval = 0.25–0.70, P<0.001). Antisocial and histrionic personality disorders were much less prevalent in the older than younger subjects (P < 0.05). The older subjects also had significantly fewer maladaptive personality traits (x2 = 88.9, d.f. = 3, P < 0.001). The patterns of comorbidity between personality disorders and other psychiatric disorders were different in the two age groups.

Conclusions

It is important to evaluate personality in patients of all ages. While some older patients no longer meet criteria for personality disorder, maladaptive traits may become evident during times of stress.

Type
Papers
Copyright
Copyright © Royal College of Psychiatrists, 1994 

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References

Abrams, R. C., Alexopoulos, G. S. & Young, R. C. (1987) Geriatric depression and DSM-III-R personality disorder criteria. Journal of the American Geriatric Society, 35, 383386.Google Scholar
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn revised) (DSM-III-R). Washington, DC: APA.Google Scholar
Anthony, J. C., Folstein, M., Romanoski, A., et al (1985) Comparison of the Diagnostic Interview Schedule and a standardized psychiatric diagnosis. Archives of General Psychiatry, 42, 667675.Google Scholar
Coccaro, E. F. (1989) Central serotonin and impulsive aggression. British Journal of Psychiatry, 155 (suppl. 8), 5262.CrossRefGoogle Scholar
Cochrane, R. & Robertson, A. (1972) The life events inventory: a measure of relative severity of psychosocial stressors. Journal of Psychosomatic Research, 17, 135139.CrossRefGoogle Scholar
Costa, P. T. Jr & McCrae, R. R. (1990) Personality disorder and the five factor model of personality. Journal of Personality Disorders, 4, 362371.CrossRefGoogle Scholar
Davidson, J. M., Chen, J. J., Crapo, L., et al (1983) Hormonal changes and sexual function in aging men. Journal of Clinical Endocrinology and Metabolism, 57, 7177.Google Scholar
Eaton, W. W., Reiger, D. A., Locke, B. Z., et al (1981) The Epidemiologic Catchment Area program of the National Institute of Mental Health. Public Health Reports, 96, 319325.Google Scholar
Elliott, F. A. (1992) Violence, the neurologic contribution: an overview. Archives of Neurology, 49, 595603.Google Scholar
Fishbain, D. A. (1991) Personality disorder diagnoses in old age (letter). Journal of Clinical Psychiatry, 52, 477478.Google Scholar
Fogel, B. S. & Westlake, R. (1990) Personality disorder diagnoses and age in inpatients with major depression. Journal of Clinical Psychiatry, 51, 232235.Google Scholar
Folstein, M. F., Folstein, S. E. & McHugh, P. R. (1975) “Mini-Mental State”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.Google Scholar
Folstein, , Romanoski, A. J., Chahal, R., et al (1985) Eastern Baltimore Mental Health Survey clinical reappraisal. In Epidemiologic Field Methods in Psychiatry (eds Eaton, W. W. & Kessler, L. G.), pp. 298303. Orlando: Academic Press.Google Scholar
Goldberg, D. (1974) The Detection of Psychiatric Illness by Questionnaire: Maudsley Monograph 21. London: Oxford University Press.Google Scholar
Gray, A., Jackson, A. N. & McKinlay, J. B. (1991) The relation between dominance, anger, and hormones in normally aging men: results from the Massachusetts Male Aging Study. Psychosomatic Medicine, 53, 375385.CrossRefGoogle ScholarPubMed
Kroessler, D. (1990) Personality disorder in the elderly. Hospital and Community Psychiatry, 41, 13251329.Google Scholar
Malan, D. A., Heath, E. S., Bacal, H. A., et al (1975) Psychodynamic changes in untreated neurotic patients II: apparently genuine improvements. Archives of General Psychiatry, 32, 110126.Google Scholar
McCrae, R. R. & Costa, P. T. Jr (1990) Personality in Adulthood. New York: Guilford Press.Google Scholar
McEntee, W. J. & Crook, T. H. (1990) Age-associated memory impairment: a role for catecholamines. Neurology, 40, 526530.Google Scholar
McEntee, W. J. & Crook, , (1991) Serotonin, memory, and the aging brain. Psychopharmacology, 103, 143149.Google Scholar
McGlashan, T. H. (1984) The Chestnut Lodge Follow-up Study III: Long-term outcome of borderline personalities. Archives of General Psychiatry, 41, 573585.Google Scholar
McHugh, P. R. & Slavney, P. R. (1986) The Perspectives of Psychiatry. Baltimore: Johns Hopkins University Press.Google Scholar
Merikangas, K. & Weissman, M. M. (1986) Epidemiology of DSM-III axis II personality disorders. In American Psychiatric Association Annual Review, vol. 5 (eds Francis, A. J. & Hales, R. E.), pp. 258278. Washington, DC: American Psychiatric Press.Google Scholar
Morgan, D. G., May, P. C. & Finch, C. E. (1987) Dopamine and serotonin systems in human and rodent brain: effects of age and neurodegenerative disease. Journal of the American Geriatric Society, 35, 334345.Google Scholar
Nestadt, G., Romanoski, A. J., Chahal, R., et al (1990) An epidemiologic study of histrionic personality disorder. Psychological Medicine, 20, 413422.Google Scholar
Nestadt, G., Romanoski, A. J., Brown, C. H., et al (1991) DSM-III compulsive personality disorder: an epidemiologic survey. Psychological Medicine, 21, 461471.Google Scholar
Nestadt, G., Romanoski, A. J., Samuels, J. F., et al (1992) The relationship between personality and DSM-III axis I disorders in the population: results from an epidemiologic survey. American Journal of Psychiatry, 149, 12281233.Google Scholar
Post, F. (1972) The management and nature of depressive illnesses in late life: a follow-through study. British Journal of Psychiatry, 121, 393404.Google Scholar
Reich, J., Noyes, R. Jr, Coryellm, W., et al (1986) The effect of state anxiety on personality measurement. American Journal of Psychiatry, 143, 760763.Google Scholar
Reich, J., Nduaguba, M. & Yates, W. (1988) Age and sex distribution of DSM-III personality cluster traits in a community population. Comprehensive Psychiatry, 29, 298303.Google Scholar
Robins, L. N., Helzer, J. E. & Croughan, J. (eds) (1981) National Institute of Mental Health Diagnostic Interview Schedule, Version III. Rockville: NIMH.Google Scholar
Romanoski, A. J., Nestadt, G., Chahal, R., et al (1988) Inter-observer reliability of a “Standardized Psychiatric Examination (SPE)” for case ascertainment (DSM-III). Journal of Nervous and Mental Disease, 176, 6371.CrossRefGoogle Scholar
Rosowsky, E. & Gurian, B. (1992) Impact of borderline personality disorder in late life on systems of care. Hospital and Community Psychiatry, 43, 386389.Google Scholar
Siegel, D. J. & Small, G. W. (1986) Borderline personality disorder in the elderly: a case study. Canadian Journal of Psychiatry, 31, 859860.Google Scholar
Simeon, D., Stanely, B., Frances, A., et al (1992) Self-mutilation in personality disorders: psychological and biological correlates. American Journal of Psychiatry, 149, 221226.Google Scholar
Stone, M. H., Hurt, S. W. & Stone, D. K. (1987) The PI 500: Long-term follow-up of borderline inpatients meeting DSM-III criteria. I: Global outcome. Journal of Personality Disorders, 1, 291298.Google Scholar
Tyrer, P. J. (1987) Measurement of abnormal personality: a review. Journal of the Royal Society of Medicine, 80, 637639.Google Scholar
Virkkunen, M., DeJong, J., Bartko, J., et al (1989) Relationship of psychobiological variables to recidivism in violent offenders and impulsive fire setters: a follow-up study. Archives of General Psychiatry, 46, 600603.Google Scholar
Wiggins, J. S. & Pincus, A. L. (1989) Conceptions of personality disorders and dimensions of personality. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 1, 305316.Google Scholar
World Health Organization (1992) The ICD-10 Classification of Mental and Behavioural Disorders. Geneva: WHO.Google Scholar
Yeager, C. A. & Lewis, D. O. (1990) Mortality in a group of formerly incarcerated juvenile delinquents. American Journal of Psychiatry, 147, 612614.Google Scholar
Zimmerman, M. & Coryell, W. (1989) DSM-III personality disorder diagnoses in a non-patient sample; demographic correlates and comorbidity. Archives of General Psychiatry, 46, 682689.Google Scholar
Zimmerman, M., Pfohl, B., Stangl, D., et al (1986) Assessment of DSM-III personality disorders: the importance of interviewing an informant. Journal of Clinical Psychiatry, 47, 261263.Google ScholarPubMed
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