Personality Disorders In Older Adults: Symptoms And Treatments
Personality disorders can be described as mental health disorders impacting how a person thinks, experiences emotions, and behaves in society. There are 10 personality disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), including borderline personality disorder, antisocial personality disorder, and avoidant personality disorder, among others. While many personality disorders may be diagnosed in late adolescence or early adulthood, the prevalence of these disorders may continue in older populations. These disorders can impact a person’s daily life and make it challenging to maintain interpersonal relationships without treatment.
Personality disorders in older adults may be harder to detect and typically involve more nuance, as symptoms may be impacted by comorbid conditions. Regardless of a person’s age, working with a licensed therapist can often improve personality disorder symptoms.
Common personality disorders in older adults
A study on personality disorders in assisted living communities found that between 10.4% and 14.5% of individuals were living with personality disorders.
In a nursing home-residing population, that number rose to 57.8%. Older adults may experience a wide variety of personality disorders, including the following:
- Paranoid personality disorder (PPD): Individuals with PPD may experience a sense of suspicion or distrust of other people. Paranoid personality disorder symptoms may make it challenging for older adults to trust caregivers.
- Schizoid personality disorder: Schizoid personality disorder traits typically include social isolation and an emotionless response to praise and criticism. Older adults with schizoid personality disorder may refuse to join social activities and have few friends. This may make it challenging to identify changes in mood and may make diagnosis more challenging.
- Schizotypal personality disorder: Schizotypal personality disorder may present in similar ways to schizoid personality disorder, with a few key differences, including paranoia and the addition of eccentric beliefs. In older adults, schizotypal personality disorder may impact interpersonal relationships and make building trust with new people difficult.
- Antisocial personality disorder (ASPD): ASPD, formerly known as sociopathy, is a mental health disorder in which a person may not experience empathy for others and may manipulate or exploit others for personal gain. Older adults may act without regard for laws or rules set forth to maintain their safety, which can be dangerous for both themselves and others.
- Borderline personality disorder (BPD): Borderline personality disorder is a disorder involving unstable emotional responses that can be overly impulsive or dangerous. Individuals with BPD may take unreasonable risks and experience a sense of disconnection from themselves. In older populations, BPD symptoms may be muted, but they can still impact a person’s daily life.
- Histrionic personality disorder: Individuals with histrionic personality disorder usually have an overwhelming desire to be noticed, even if it means taking risks or engaging in dangerous behavior. People with this disorder may be unable to handle criticism or negative comments.
- Narcissistic personality disorder (NPD): NPD is usually characterized by an obsessive need to be admired, as well as a lack of empathy for others. Older adults with NPD may be threatened by their perceived decline in attractiveness. They may also find it challenging to ask for help or assistance, as they may view this as a loss of autonomy.
- Avoidant personality disorder: Individuals with avoidant personality disorder may experience intense social anxiety due to a fear of rejection or a sense of inadequacy. Older adults with avoidant personality disorder may refuse to engage in social interactions, even if they have a desire to be a part of a group.
- Dependent personality disorder: People with dependent personality disorders may believe that they are incapable of caring for themselves and that they need others for comfort and support. As a person ages, dependent personality disorder symptoms may be most intense after the loss of a spouse.
Symptoms of personality disorders in older adults
The symptoms of personality disorders in adults usually vary between disorders and are determined by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V). With that in mind, there are some general ways in which symptoms may be different for older adults when compared with adolescents or young adults. Many symptoms may be more muted or harder to detect. For example, individuals with antisocial personality disorder may not be as likely to have legal issues. However, ASPD symptoms may still cause challenges with interpersonal relationships.
Symptoms of personality disorders may shift as a person grows older. Working with a therapist throughout the years may be beneficial, even in cases in which a personality disorder was diagnosed and treated many years prior.
Challenges in diagnosing personality disorders in older adults
As a person ages, diagnosing a personality disorder for the first time can be challenging. Older adults may experience a wide variety of other mental and physical health conditions, such as depression, dementia, or anxiety, that can impact or mask personality disorder symptoms.
Another consideration may be the stigma and social expectations associated with personality disorders. For many older adults, mental health conditions may be viewed as embarrassments or something that shouldn’t be discussed. Educating patients about the causes and impacts of personality disorders, as well as discussing treatment options, can be a way to familiarize older individuals with them and reduce the stigma associated with mental health disorders.
Treatment options for personality disorders
Treatment for personality disorders usually involves therapy, and it may sometimes involve medication and lifestyle changes as well. In general, medication cannot directly treat personality disorders, but it may address co-occurring disorders like depression and anxiety. For older adults, it can be important to monitor any medication side effects and to discuss them regularly with a doctor.
Lifestyle changes may also be recommended for people with personality disorders. It may be important to ensure that you are getting enough sleep, getting daily exercise, and eating nutrient-rich foods. These changes may reduce symptoms and improve overall well-being.
Working with a licensed therapist can be beneficial for older adults who are living with a personality disorder. A therapist may use a combination of dialectical behavior therapy and cognitive behavioral therapy, alongside other techniques, such as mindfulness and exposure therapy, to treat a personality disorder. With cognitive behavioral therapy, a therapist may focus on identifying negative or maladaptive thought patterns and reframing them to positively impact emotions and behavior.
Making it to a brick-and-mortar office for a weekly therapy session can be challenging for older adults, but online therapy may make it more convenient to consistently attend appointments. Online therapy sessions can take place from anywhere with an internet connection, making it possible for individuals to get the professional help they deserve from the comfort of their homes or another preferred location.
Therapy tends to be a foundational treatment for most personality disorders, and research suggests that online therapy can be an effective way to manage symptoms of personality disorders in older adults.
Takeaway
- Previous Article
- Next Article