Abstract and Keywords
Diagnosis of personality disorder (PD) in older adults is clinically difficult. In DSM-5, no specific provisions for the diagnosis in later life have been included. This omission makes it difficult not only to come to accurate commonly accepted diagnoses but distorts the accuracy of the epidemiological studies of PD in older adults which are reviewed in this chapter. Personality essentially remains stable over the lifespan although the expression of underlying personality dynamics becomes less dramatic with ageing. The somewhat different phenomenology of PD in old age is examined. Personality is interactive with the capacity to adapt to the challenges of ageing and affects both the psychology and physiology of adaptation. Five key developmental tasks of early life that affect the older person’s adaptation are presented together with examination of how understanding and evaluation of these elements is key to effective treatment. A clinical case vignette illustrates how PD can lead to rupture of the therapeutic relationship and the need for specific techniques of intervention to heal it.
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