The Presentation of Narcissistic Personality Disorder in an Octogenarian: Converging Evidence from Multiple Sources

Little is known about personality disorders (PDs) in later life. One reason for this dearth of knowledge is that many investigators believe that PDs soften with age. Recent anecdotal and empirical evidence, however, suggests that PDs are still very relevant in later life and may actually have unique presentations and consequences. The DSM-IV PD criteria seem to overlook these possibilities, perhaps because the personalities of older adults were not sufficiently understood when these criteria were written. But without age-appropriate criteria, clinicians and investigators who work with older adults may be unable to measure PDs adequately in their clients and research participants. A starting point for better understanding these disorders in older adults is the presentation of rich, empirical, clinical descriptions of symptoms and related behaviors using data from multiple instruments and sources. To this end, we describe in depth a case of narcissistic PD (NPD) in a woman in her mid 80s. This case study reveals that NPD is indeed relevant in the context of later life and impairs functioning in significant ways.