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Personality disorders can improve with treatment. However, sometimes when people are extremely stressed they may fall back into former habits of thought and behavior. This sort of off-and-on pattern is not uncommon.
But what happens when a personality disorder is not detected until later in life? Or when it appears to worsen in later years? How can you know if the symptoms are age-related or health-related? And what is the best course of action if you suspect a senior adult in your life may be experiencing some form of personality disorder?
It can be difficult to untangle symptoms that are a normal part of growing older (more rigid thinking, less patient, etc.) from those that may point to a diagnosable personality disorder. It is usually a matter of behaviors becoming rather extreme before a mental health condition is even suspected. And when seniors don’t have a lot of social contact, symptoms can go unchecked for a long time. Regular interaction with the older adult is the best way to gauge what are gradual changes due to aging and what are sharp breaks in personality or normal behavior.
The other difficulty in diagnosing a personality disorder with older patients is the fact that they may, and often do, have another condition that is affecting their feelings and behavior.
Because many seniors spend time cut off from regular social contact and interaction, they often feel isolated. Without work and the sense of purpose derived from work, it is easy for lonely seniors to become depressed.
Others may be starting to show early signs of dementia as their brains slow down and are fuzzier in processing information. Deteriorating mental or physical health can complicate diagnosis and treatment of a later life personality disorder.
It’s important for the older adult to be seen by their doctor and then a trained mental health professional in order to gain a clear diagnosis. But loved ones should understand that even if a definite personality disorder diagnosis is given, the treatment plan will most likely aim toward helping manage stress conditions and extreme symptoms rather than promise recovery.
It’s harder to make pervasive changes in thinking and responding as the years go by – especially if there are co-occurring physical or mental health conditions involved.
The most promising option for seniors will be psychotherapy through regular counseling. Depending on the disorder, therapies such as cognitive behavioral therapy or dialectic behavioral therapy can provide measurable improvement. Other disorders may be normally treated with therapy plus medication such as an anti-anxiety medication or anti-depressants, but medicating older patients is a risky option.
For one thing, most older people are already taking one or more medications for a physical ailment. The problem of drug interactions is a serious concern. The side effects of these medications are another consideration since they may be more pronounced in older populations. Older patients may forget when to take medicine or how many pills to take and can easily take too much too often, thereby running some dangerous risks.
If the older person lives independently it can be helpful for another family member to be in regular communication with the therapist and perhaps share in some family therapy. If the disorder has caused family ruptures, this can be a difficult and even impossible task.
On the other hand, the person living in an assisted care facility has built in eyes and ears who can monitor conditions, oversee medication and even identify what situations or people cause stress and trigger difficult behavior.