Contents
Chapter 1
Introduction to Personality Disorders and Aging 1
The Demographics of Aging 2
Mental Health and Aging: The Big Picture 3
Overview of Personality and Personality Disorder 5
History of the Personality Disorder Category 8
Modern Conceptualizations 10
The DSM-IV-TR Personality Disorders 12
Challenges Associated with Personality
Disorder Psychopathology 15
Conclusions 19
About This Book 20
Chapter 2
The Odd and Eccentric (Cluster A) Personality Disorders and Aging 23
General Diagnostic Criteria 24
Cluster A Personality Disorders: Paranoid,
Schizoid, and Schizotypal 27
Paranoid Personality Disorder 27
Schizoid Personality Disorder 36
Schizotypal Personality Disorder 44
Chapter 3
The Dramatic, Emotional, and Erratic (Cluster B)
Personality Disorders and Aging 55
Cluster B Personality Disorders: Antisocial, Borderline,
Histrionic, and Narcissistic 55
Antisocial Personality Disorder 56
Borderline Personality Disorder 67
Histrionic Personality Disorder 81
Narcissitic Personality Disorder 92
Chapter 4
The Fearful or Anxious (Cluster C)
Personality Disorders and Aging 103
Cluster C Personality Disorders: Avoidant, Dependent,
and Obsessive-Compulsive 103
Avoidant Personality Disorder 104
Dependent Personality Disorder 113
Obsessive-Compulsive Personality Disorder 124
Chapter 5
Other Personality Disorders and Aging: Sadistic, Self-Defeating,
Depressive, Passive-Aggressive, and Inadequate 137
Personality Disorders in DSM-III-R Appendix A and in
DSM-IV-TR Appendix B 138
Sadistic Personality Disorder: DSM-III-R Appendix A 138
Self-Defeating Personality Disorder: DSM-III-R
Appendix A 143
Depressive Personality Disorder: DSM-IV-TR
Appendix B 148
Passive-Aggressive Personality Disorder: DSM-IV-TR
Appendix B 151
Inadequate Personality Disorder—A Manifestation of
Frontal Lobe Syndrome? 155
Inadequate Personality Disorder 155
Chapter 6
Epidemiology and Comorbidity 159
Epidemiology of Personality Disorders in Later Adult Life 160
Community and Psychiatric Samples 160
The Debate about Stability versus Change for the
Personality Disorders 163
Epidemiology and Gender 168
Course and Prognosis for the Personality Disorders 169
Comorbidity: General Issues 175
Comorbidity of Personality Disorders with Clinical Disorders
and with other Personality Disorders 176
Personality Disorders and Dementia 181
Conclusions 183
Chapter 7
Theories of Personality Disorders:
Cognitive, Psychoanalytic, and Interpersonal 185
Cognitive Theories of Personality Disorders 186
Cognitive Therapy Basics 188
Application to Personality Disorders 190
Psychoanalytic Theories of Personality Disorders 193
Provinces and and Instincts of the Psyche 194
Neuroses, Psychoses, and Personality Disorders 195
Psychoanalytic Theory and Aging 197
A Brief Note about the Humanistic Approach 197
Interpersonal Theories of Personality Disorders 198
Horney’s Interpersonal View of the Personality, Personality
Disorders, and the Basic Conflict 199
Horney’s Description of Types 200
The Resolution of Neurotic Conflict 204
Horney, Feminist Psychology, and Humanism 204
Horney, Aging, and Personality Disorders 205
Conclusions 206
Chapter 8
Theories of Personality Disorders: Evolutionary
and Neurobiological 209
Evolutionary Theories of Personality Disorders 209
Basic Concepts of Evolutionary Theory 210
Application to Antisocial, Histrionic, Narcissistic, Dependent,
and Avoidant Personality Disorders 212
Application to Borderline Personality Disorder 216
Application to Paranoid Personality Disorder 218
Application to Schizoid, Schizotypal, and Avoidant
Personality Disorders 219
Neurobiological Theories of Personality Disorders 220
Conclusions 226
Chapter 9
Assessment 229
Chart/Records Review 232
The Clinical Interview of the Patient 234
Interview with Informants 239
Self-Report Objective Personality Instruments 240
Millon Clinical Multiaxial Inventory-III 242
Personality Diagnostic Questionnaire-Fourth Edition Plus 244
Coolidge Axis II Inventory 245
Minnesota Multiphasic Personality Inventory-2 247
NEO Personality Inventory-Revised 249
Application ofPersonality Inventorieswith Older Adults 250
Semi-Structured Clinical Interviews 251
Structured Interview for DSM-IV Personality 252
International Personality Disorder Examination 254
Structured Clinical Interview for DSM-IV Axis II
Personality Disorders 256
Personality Disorder Interview-IV 258
Diagnostic Interview for DSM-IV
Personality Disorders 259
Application of Semi-Structured Interviews
with Older Adults 260
Conclusions 262
Chapter 10
Treatment: General Issues and Models 265
Core Features of Personality Disorder Affecting Treatment 266
Reliance on Primitive Defenses 266
Rigidity of Character Structure and Limited Repertoire 267
Effect on Others 267
Course of Personality Disorders 268
Routes into Treatment 268
Function of Buffering 269
Function of Bolstering 270
Function of Binding 270
An Essential Caveat 271
Goals of Treatment 272
Invisibility of Personality Disorders 275
What (Little) Is Known 275
Comorbidity of Axis I and Axis II Disorders 276
Understanding the Comorbidity 277
Treatments and Therapies 278
Somatic Treatments 278
Psychological Treatments 281
Countertransference 284
Guideposts for Treatment Planning and Goal Setting 287
Understanding the Phenomenology of Personality Disorders
and Helping Guide Treatment 288
Patterns of Attachment 288
Inside and Outside Feeders 289
Rules of Personality Disorders 290
Illusion of Uniqueness 290
Chapter 11
The “Goodness of Fit” Model and Its Implications
for Treatment 293
“Goodness of Fit” Model 296
Trait Template 297
Utility of a Personality Trait Model 301
Implications of the Goodness of Fit Model for Designing a Treatment Plan 302
References 307
