Personality pathology in older adults is largely understudied. Here, we present a case report of an older adult who presented to an inpatient geriatric psychiatry unit with dependent personality traits in the context of chronic major depressive disorder, followed by a systematic review of the literature to identify research regarding the diagnosis and prevalence of dependent personality in depressed older adults. We identified 11 studies relevant to this topic. Synthesis of these data revealed that dependent personality is generally more common in depressed older adults compared to other personality disorders. However, studies were limited by small sample sizes and the use of assessments not validated for use in older adults. Therefore, it is difficult to draw conclusions from the available data. Potential implications for patient outcomes and health care services utilization are discussed. Our review highlights the need for larger scale research and personality assessments which are sensitive to age-related factors in order to draw evidence-based conclusions.
BornsteinRF. Reconceptualizing personality pathology in DSM-5: limitations in evidence for eliminating dependent personality disorder and other DSM-IV syndromes. J Pers Disord. 2011;25(2):235–247. doi:10.1521/pedi.2011.25.2.235
2.
American Psychiatric Association. Personality disorders. In: Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013. doi:10.1176/appi.books.9780890425596
3.
AgroninMEMalettaG. Personality disorders in late life. Understanding and overcoming the gap in research. Am J Geriatr Psychiatry. 2000;8(1):4–18. doi:10.1097/00019442-200002000-00002
4.
LingiardiVMcWilliamsN. The psychodynamic diagnostic manual—2nd edition (PDM-2). World Psychiatry. 2015;14(2):237–239. doi:10.1002/wps.20233
5.
MoherDLiberatiATetzlaffJAltmanDG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi:10.1371/journal.pmed.1000097
6.
TrullTJWidigerTA. Dimensional models of personality: the five-factor model and the DSM-5. Dialogues Clin Neurosci. 2013;15(2):135–146.
7.
Depressive Disorders. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association Publishing; 2013.
8.
CamusVde Mendonça LimaCAGaillardMSimeoneIWertheimerJ. Are personality disorders more frequent in early onset geriatric depression?J Affect Disord. 1997;46(3):297–302. doi:10.1016/s0165-0327(97)00152-3
9.
ThompsonLWGallagherDCzirrR. Personality disorder and outcome in the treatment of late-life depression. J Geriatr Psychiatry. 1988;21(2):133–153.
10.
AgbayewaMO. Occurrence and effects of personality disorders in depression: are they the same in the old and young?Can J Psychiatry. 1996;41(4):223–226. doi:10.1177/070674379604100406
11.
FogelBSWestlakeR. Personality disorder diagnoses and age in inpatients with major depression. J Clin Psychiatry. 1990;51(6):232–235.
12.
AbramsRCRosendahlECardCAlexopoulosGS. Personality disorder correlates of late and early onset depression. J Am Geriatr Soc. 1994;42(7):727–731. doi:10.1111/j.1532-5415.1994.tb06532.x
13.
KunikMEMulsantBHRifaiAH, et al.Personality disorders in elderly inpatients with major depression. Am J Geriatr Psychiatry. 1993;1(1):38–45. doi:10.1097/00019442-199300110-00006
14.
SchneiderLSZemanskyMFBenderMSloaneRB. Personality in recovered depressed elderly. Int Psychogeriatr. 1992;4(2):177–185. doi:10.1017/s1041610292001005
15.
VineRGSteingartAB. Personality disorder in the elderly depressed. Can J Psychiatry. 1994;39(7):392–398. doi:10.1177/070674379403900702
16.
LawtonEMOltmannsTF. Personality pathology and mental health treatment seeking in a community sample of older adults. Personal Ment Health. 2013;7(3):203–212. doi:10.1002/pmh.1198
17.
FuchsT. Patterns of relation and premorbid personality in late paraphrenia and depression. Psychopathology. 1999;32(2):70–80. doi:10.1159/000029070
18.
AbramsRCAlexopoulosGSYoungRC. Geriatric depression and DSM-III-R personality disorder criteria. J Am Geriatr Soc. 1987;35(5):383–386. doi:10.1111/j.1532-5415.1987.tb04658.x
19.
CourtoisREnfouxAPlaisantO, et al.Exploratory study toward development of the French version of the Questionnaire on Personality Traits (QPT/VKP-4) in an elderly population in comparison to young adults. Psychol Rep. 2014;115(1):115–132. doi:10.2466/08.09.PR0.115c12z6
20.
SkodolAEStoutRLMcGlashanTH, et al.Co-occurrence of mood and personality disorders: a report from the collaborative longitudinal personality disorders study (CLPS). Depress Anxiety. 1999;10(4):175–182. doi:10.1002/(SICI)1520-6394(1999)10:4<175::. AID-DA6>3.0.CO;2-2
21.
BjørkløfGHEngedalKSelbækGKouwenhovenSEHelvikAS. Coping and depression in old age: a literature review. Dement Geriatr Cogn Disord. 2013;35(3-4):121–154. doi:10.1159/000346633
22.
OverholserJCKabakoffRNormanWH. The assessment of personality characteristics in depressed and dependent psychiatric inpatients. J Pers Assess. 1989;53(1):40–50. doi:10.1207/s15327752jpa5301_5
23.
HirschfeldRMKlermanGLGoughHGBarrettJKorchinSJChodoffP. A measure of interpersonal dependency. J Pers Assess. 1977;41(6):610–618. doi:10.1207/s15327752jpa4106_6
24.
LoasGVerrierAGayantCGuelfiJD. Depression and dependency: distinct or overlapping constructs?J Affect Disord. 1998;47(1-3):81–85. doi:10.1016/s0165-0327(97)00121-3
25.
BirtchnellJDeahlMFalkowskiJ. Further exploration of the relationship between depression and dependence. J Affect Disord. 1991;22(4):221–233. doi:10.1016/0165-0327(91)90068-4
WidigerTAAndersonKG. Personality and depression in women. J Affect Disord. 2003;74(1):59–66. doi:10.1016/S0165-0327(02)00431-7
28.
PilleronSClémentJPBandzouziBN, et al.Is dependent personality disorder associated with mild cognitive impairment and dementia in Central Africa? A result from the EPIDEMCA programme. Int Psychogeriatr. 2015;27(2):279–288. doi:10.1017/S104161021400180X
29.
MorseJQPilkonisPAHouckPRFrankEReynoldsCF. Impact of cluster c personality disorders on outcomes of acute and maintenance treatment in late-life depression. Am J Geriatr Psychiatry. 2005;13(9):808–814. doi:10.1176/appi.ajgp.13.9.808
30.
BottonariKRobertsJThomasSReadJ. Stop thinking and start doing: switching from cognitive therapy to behavioral activation in a case of chronic treatment-resistant depression. Cogn Behav Pract. 2008;15(4):376–386. doi:10.1016/j.cbpra.2008.02.005
31.
RasmussenKG. Do patients with personality disorders respond differentially to electroconvulsive therapy? A review of the literature and consideration of conceptual issues. J ECT. 2015;31(1):6–12. doi:10.1097/YCT.0000000000000165
32.
BornsteinRF. Illuminating a neglected clinical issue: societal costs of interpersonal dependency and dependent personality disorder. J Clin Psychol. 2012;68(7):766–781. doi:10.1002/jclp.21870
33.
BornsteinRF. Interpersonal dependency and physical illness: the mediating roles of stress and social support. J Soc Clin Psychol. 1995;14(3):225–243. doi:10.1521/jscp.1995.14.3.225
