A Delphi study of late-onset personality disorders

Area of Science:

• Geriatric Psychiatry
• Clinical Psychology
• Psychopathology

Background:

• The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) posits personality disorders (PDs) emerge in early life and persist throughout lifespan.
• Case studies and expert opinions suggest the existence of late-onset PDs, but little is known about their presentation in older adults.
• Current assessment instruments for PDs in late life are not well-validated, necessitating further research.

Purpose of the Study:

• To explore the characteristics of late-onset personality disorders (PDs).
• To investigate the accuracy of core diagnostic criteria for late-onset PDs.
• To understand the presentation and potential triggers of PDs in older adults.

Main Methods:

• A three-round Delphi study involving 21 international experts in personality disorders.
• Experts included published authors, researchers, and educators from diverse geographical locations.
• A survey with varied question formats was used to gather expert consensus on late-onset PDs.

Main Results:

• Consensus was reached that a variant of PD can emerge de novo in old age.
• The core features of inflexibility and pervasiveness may not apply to late-onset PD.
• Significant life events, such as the death of a spouse or relocation to assisted living, were identified as selective contributors to late-onset PD expression.

Conclusions:

• The majority of experts agreed that PDs can present for the first time in old age.
• Late-onset PDs can be clinically identifiable without prior diagnosis in earlier life stages.
• This study highlights the need to consider late-onset PDs in geriatric mental health assessments.