7 Old age psychiatry7.7 Personality dysfunction in older people
7.7 Personality in old age
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Written by Resident Doctor Committee · Published
Stability and change with age
Personality traits usually stay recognisable across a lifetime, though how they show depends on health, roles and relationships.
ICD-11 allows a later onset once other explanations are excluded; the disturbance must be enduring and evident across situations.
Pattern with age | Personality disorders |
|---|---|
Stable or rising | Cluster C (dependent, obsessive-compulsive, avoidant), schizoid, paranoid |
Declining | Impulsive Cluster B, such as borderline and antisocial |
Obsessive-compulsive personality disorder is the commonest personality disorder in later life.
New change is a red flag
An abrupt or marked change needs assessment. Do not put it down to normal ageing or a longstanding diagnosis.
Differential | What distinguishes it |
|---|---|
Behavioural variant frontotemporal dementia | Progressive disinhibition, loss of empathy or altered eating; memory screens may be normal |
Mania | Episodic activation and reduced need for sleep; look for secondary causes |
Depression | New depressive symptoms or apathy |
Late-life psychosis | New delusions beyond longstanding suspiciousness |
Delirium | Acute, fluctuating attention and arousal |
Adjustment disorder | Distress or impaired adaptation linked to a stressor |
Loss of scaffolding after retirement, bereavement or illness can remove the support that let someone cope, so poorer coping alone does not mean a new personality disorder.
Management
Dialectical behaviour, mentalisation-based and schema therapies have limited evidence in older adults, so adapt the pace, communication and session length.
Predictable routines, meaningful roles and consistent care help, and comorbid depression or anxiety is treated alongside.