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Personality Disorders and Older Adults: Diagnosis, Assessment, and Treatment



Personality Disorders and Older Adults: Diagnosis, Assessment, and Treatment

Daniel L. Segal, Frederick L. Coolidge, Erlene Rosowsky

ISBN: 978-0-470-03768-3 July 2006 352 Pages


The older adult population is booming in the United State and across the globe. With this boom comes an increase in the number of older adults who experience psychological disorders. Current estimates suggest that about 20% of older persons are diagnosable with a mental disorder: Personality disorders are among the most poorly understood, challenging, and frustrating of these disorders among older adults. This book is designed to provide scholarly and scientifically-based guidance about the diagnosis, assessment, and treatment of personality disorders to health professionals, mental health professionals, and senior service professionals who encounter personality-disordered or "difficult" older adults.



Chapter 1. Introduction to Personality Disorders and Aging.

The Demographics of Aging.

Mental Health and Aging: The Big Picture.

Overview of Personality and Personality Disorder.

History of the Personality Disorder Category.

Modern Conceptualizations.

The DSM-IV-TR Personality Disorders.

Challenges Associated with Personality Disorder Psychopathology.


About This Book.

Chapter 2. The Odd and Eccentric (Cluster A) Personality Disorders and Aging.

General Diagnostic Criteria.

Cluster A Personality Disorders: Paranoid, Schizoid, and Schizotypal.

Paranoid Personality Disorder.

Schizoid Personality Disorder.

Schizotypal Personality Disorder.

Chapter 3. The Dramatic, Emotional, and Erratic (Cluster B) Personality Disorders and Aging.

Cluster B Personality Disorders: Antisocial, Borderline, Histrionic, and Narcissistic.

Antisocial Personality Disorder.

Borderline Personality Disorder.

Histrionic Personality Disorder.

Narcissitic Personality Disorder.

Chapter 4. The Fearful or Anxious (Cluster C) Personality Disorders and Aging.

Cluster C Personality Disorders: Avoidant, Dependent, and Obsessive-Compulsive.

Avoidant Personality Disorder.

Dependent Personality Disorder.

Obsessive-Compulsive Personality Disorder.

Chapter 5. Other Personality Disorders and Aging: Sadistic, Self-Defeating, Depressive, Passive-Aggressive, and Inadequate.

Personality Disorders in DSM-III-R Appendix A and in DSM-IV-TR Appendix B.

Sadistic Personality Disorder: DSM-III-R Appendix A.

Self-Defeating Personality Disorder: DSM-III-R  Appendix A.

Depressive Personality Disorder: DSM-IV-TR  Appendix B.

Passive-Aggressive Personality Disorder: DSM-IV-TR Appendix B.

Inadequate Personality Disorder—A Manifestation of Frontal Lobe Syndrome?

Inadequate Personality Disorder.

Chapter 6. Epidemiology and Comorbidity.

Epidemiology of Personality Disorders in Later Adult Life.

Community and Psychiatric Samples.

The Debate about Stability versus Change for the Personality Disorders.

Epidemiology and Gender.

Course and Prognosis for the Personality Disorders.

Comorbidity: General Issues.

Comorbidity of Personality Disorders with Clinical Disorders and with other Personality Disorders.

Personality Disorders and Dementia.


Chapter 7. Theories of Personality Disorders: Cognitive, Psychoanalytic, and Interpersonal.

Cognitive Theories of Personality Disorders.

Cognitive Therapy Basics.

Application to Personality Disorders.

Psychoanalytic Theories of Personality Disorders.

Provinces and Instincts of the Psyche.

Neuroses, Psychoses, and Personality Disorders.

Psychoanalytic Theory and Aging.

A Brief Note about the Humanistic Approach.

Interpersonal Theories of Personality Disorders.

Horney’s Interpersonal View of the Personality, Personality Disorders, and the Basic Conflict.

Horney’s Description of Types.

The Resolution of Neurotic Conflict.

Horney, Feminist Psychology, and Humanism.

Horney, Aging, and Personality Disorders.


Chapter 8. Theories of Personality Disorders: Evolutionary and Neurobiological.

Evolutionary Theories of Personality Disorders.

Basic Concepts of Evolutionary Theory.

Application to Antisocial, Histrionic, Narcissistic, Dependent, and Avoidant Personality Disorders.

Application to Borderline Personality Disorder.

Application to Paranoid Personality Disorder.

Application to Schizoid, Schizotypal, and Avoidant Personality Disorders.

Neurobiological Theories of Personality Disorders.


Chapter 9. Assessment.

Chart/Records Review.

The Clinical Interview of the Patient.

Interview with Informants.

Self-Report Objective Personality Instruments.

Millon Clinical Multiaxial Inventory-III.

Personality Diagnostic Questionnaire-Fourth Edition Plus.

Coolidge Axis II Inventory.

Minnesota Multiphasic Personality Inventory-2.

NEO Personality Inventory-Revised.

Application of Personality Inventorieswith Older Adults.

Semi-Structured Clinical Interview.

Structured Interview for DSM-IV Personality.

International Personality Disorder Examination.

Structured Clinical Interview for DSM-IV Axis II Personality Disorders.

Personality Disorder Interview-IV 258

Diagnostic Interview for DSM-IV Personality Disorders.

Application of Semi-Structured Interviews with Older Adults.


Chapter 10. Treatment: General Issues and Models.

Core Features of Personality Disorder Affecting Treatment.

Reliance on Primitive Defenses.

Rigidity of Character Structure and Limited Repertoire.

Effect on Others.

Course of Personality Disorders.

Routes into Treatment.

Function of Buffering.

Function of Bolstering.

Function of Binding.

An Essential Caveat.

Goals of Treatment.

Invisibility of Personality Disorders.

What (Little) Is Known.

Comorbidity of Axis I and Axis II Disorders.

Understanding the Comorbidity.

Treatments and Therapies.

Somatic Treatments.

Psychological Treatments.


Guideposts for Treatment Planning and Goal Setting.

Understanding the Phenomenology of Personality Disorders and Helping Guide Treatment.

Patterns of Attachment.

Inside and Outside Feeders.

Rules of Personality Disorders.

Illusion of Uniqueness.

Chapter 11. The “Goodness of Fit” Model and Its Implications for Treatment.

“Goodness of Fit” Model.

Trait Template.

Utility of a Personality Trait Model.

Implications of the Goodness of Fit Model for Designing a Treatment Plan.


Author Index.

Subject Index.

"The foreword describes this book as the best of its kind in the field of personality disorders of the elderly. I fully agree and recommend it to practitioners, researchers, and educators. It should be required reading for graduate students in psychology and for those preparing for careers in mental health. It really is an outstanding book!"
—Norman Abeles (PsycCRITIQUES, August 15, 2007)

"The authors have provided a useful guide to understanding and treating older patients." (The Journal of Nervous and Mental Disease, volume 195, No 8, August 2007)