Chapter 18.Personality Disorders

Maladaptive personality tendencies, whether formally classified as a disorder or not, can wreak havoc on people’s lives at any age. This chapter reviews the central aspects of personality disorder, with a focus on older adults. Although there is a large literature on personality disorders, Agronin and Maletta (2000) observed more than 20 years ago that little of it involves older adults. This appears to still be the case, with one possible reason being that few personality disorder cohorts have entered later life (Newton-Howes et al. 2015). In contrast, a great deal of work in the past two decades has focused on personality traits in later life. Usually, but not always, this work has involved the five-factor model of personality (FFM), which focuses on the five broad dimensions of neuroticism, extroversion, agreeableness, openness to experience, and conscientiousness. Each dimension is a combination of several more specific traits, and configurations of these traits have been proposed to match DSM-5 personality disorders (American Psychiatric Association 2013; Widiger and Mullins-Sweatt 2009). Some of this work can augment a discussion of personality disorders in older adults. Unique challenges arise in the approach and management of personality disorders in late life, particularly because neurocognitive disorders (NCDs) often present with personality changes, and psychosocial histories are often incomplete (particularly in long-term care settings). A comprehensive understanding of the personality disorders is warranted for clinicians working with older adults because these disorders are common, are associated with significant morbidity and lower quality of life, and can negatively affect the outcomes of other psychiatric disorders and medical comorbidities.