Personality Disorders - Alzbrain



Personality Disorders

Personality does not usually change after age 50 in older people. The personal, social, or professional disabilities caused by personality disorders remain fairly constant over time. Some clinical symptoms of personality disorders will improve slightly in the latter phase of life. The new onset of a “personality disorder” in an older person is strongly suggestive of a new neurological or medical problem. The abrupt onset of a “personality disorder” suggests delirium, depression, or dementia. The acute worsening of personality symptoms also suggests worsening of some other illness.

The three main personality clusters include A- schizoid/schizotypal, B-antisocial narcisistic, and C- passive avoidant. The type A and type C personality disorders are relative uncommon in older people.

The type B personality cluster typically persists into late life. Anti-social personality disorders tend to demonstrate less criminal behavior; however, they retain their lack of empathy and failure to comply with social regulations. Many borderline personality disorders may commit suicide prior to old age. Those surviving borderline personality disorders demonstrate many of the distressing and disruptive symptoms that younger patients manifest. These individuals are prone to depression that can be treated with standard antidepressant therapy. Brief, psychotic episodes can be managed with a short course of newer antipsychotics; however, long-term antipsychotic medications should be avoided. Histrionic and narcisistic features persist into late life. The histrionic individual may demonstrate somatic complaints that frustrate the medical team; however, the physicians are obliged to investigate each complaint to exclude an underlying medical cause.

As in younger patients, the clinical team should always consider comorbid substance abuse with the personality disorders. Patients may drink alcohol excessively or abuse prescription tranquilizers.

The appropriate therapy for aging personality disorders includes psychotherapy, family therapy, and pharmacotherapy when indicated. Insight-oriented therapy has limited effect in aged personality disorders; however, supportive psychotherapy can help to alleviate anxiety and distress. Regular scheduled sessions with clear limits help establish the therapeutic boundaries. Family caregivers must be included in any therapeutic strategy. Many persons with personality disorders create chaotic family situations that produce transgenerational psychopathology.

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