Personality disorder in later life: no longer a diagnosis of exclusion
| Published date | 14 December 2010 |
| DOI | https://doi.org/10.5042/mhrj.2010.0742 |
| Pages | 63-70 |
| Date | 14 December 2010 |
| Author | Lisle Scott,Elizabeth Kemp |
| Subject Matter | Health & social care |
Mental Health Review Journal Volume 15 Issue 4 December 2010 © Pier Professional Ltd 63
10.5042/mhrj.2010.0742
Lisle MA Scott
MBChB and Psychodrama Psychotherapist, Oxfordshire Complex Needs Service, Oxfordshire and Buckinghamshire
Mental Health NHS Foundation Trust, Oxford, UK
Elizabeth Kemp
Counselling Psychologist, Psychological Services, Oxfordshire and Buckinghamshire Mental Health NHS Foundation
Trust, Oxford, UK
Personality disorder in later
life: no longer a diagnosis of
exclusion
Abstract
Adults over the age of 65 who are diagnosable with personality disorder face numerous problems within
current mental health service provision. These include a lack of diagnostic clarity and a lack of specialist
personality disorder-specific interventions. The authors present a pilot mini therapeutic community service
for older adults diagnosable with personality disorder consistent with recommendations from NSF, NIMHE
and NICE. Clinical experience suggests that positive outcomes demonstrated in similar services for adults
of working age may be possible in this group and preliminary outcome results described in the article
suggest a trend of clinical and functional improvement, and some economic benefits. This will need to be
replicated and tested with a larger sample to confirm these findings.
Key words
Personality disorder, older people, exclusion, service provision, suicide.
Background
Personality disorder (PD) is often undiagnosed
in older adults, but evidence of its clinical
significance and impact is growing (Segal et al,
2006). As with adults of working age, morbidity
for older adults is high (Abrahams et al, 2001)
and they have a lower overall quality of life
(Condello et al, 2003). They experience marked
interpersonal difficulties and the diagnosis is
associated with impaired social support (Vine
& Steingart, 1994). Completed suicide is more
common in older adults with a diagnosis
of PD (Lebret et al, 2006), which is itself an
independent predictor of suicide in older adults
(Harwood et al, 2001).
The reported prevalence of diagnosable PD in
adults over 65 years in the community is 10%
with a range of 2.8% to 11% (Coolidge et al,
2006). It is higher in inpatient and residential
settings (Kenan et al, 2000; Molinari et al,
1994). Interestingly, Coid et al (2006) estimated
community prevalence to be highest in the age
group 55–74 years at 5.8%, compared with 4.4%
for the age group 35–54 years and 3.4% for the
age group 16–34 years.
An important consideration is that cluster
B symptom expression appears to improve
(Seivewright et al, 2002) while other maladaptive
underlying processes, eg. affective instability,
persists (Stevenson et al, 2003). However,
symptom expression in clusters A and C appears
to change very little (Livesley, 2004) or intensify
(Seivewright et al, 2002) in later life.
Comorbidity is significant within Axis II,
and with Axis I (Coolidge et al, 2006) and Axis
III disorders including age-related medical
conditions. Bender et al (2001) report a lifetime
prevalence approaching 100% of at least one
comorbid Axis I disorder, while Paris (2003)
hypothesised that older patients with histrionic
OLDER
PEOPLE
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