Stability of personality disorders across the life span and the contributing psychological factors of personality disorders in older adults with mental health problems

Abstract

Personality disorders (PD) are among the most complex aspects of human behaviour to understand and manage. Stability is thought to be one of the major distinguishing features between PD’s and other forms of psychopathology, however, recent studies have challenged this notion. Borderline personality disorder (BPD) is the focus of this review and is characterised by interpersonal and emotion regulation difficulties. This thesis aimed to first examine the naturalistic course of BPD, through systematic review of the current literature. Following screening, 12 studies, that met all inclusion/exclusion criteria, were critically evaluated. The results, from studies rated as methodologically sound, suggested that the categorical diagnosis of BPD has poor stability over time, with only 3%-35% of participants retaining a diagnosis of BPD over time. However, the studies reviewed were limited by the population they examined: mainly working age adults with mental health problems. Therefore, studies need to be continued and replicated to increase our understanding of the lifespan course of BPD. PD’s within older adults with mental health problems is a highly debated topic. Clinicians have highlighted the presence of PD symptoms within this group and the need for appropriate therapies. Schema therapy is one intervention that has shown to be effective in the treatment of PD symptoms within a working adult population. A recent Delphi-study led to the consensus that existing therapies for PD, such as schema therapy, that have shown to be effective in working aged adults are applicable to older adults. Therefore, the empirical project focused on exploring the theoretical underpinnings of schema therapy in older adults with mental health problems. 3 self-report questionnaires were administered to 62 participants (aged 65- 85 years); Young’s Schema Questionnaire – Short Form (YSQ-S3), Coolidge Axis-II Inventory (Short) (SCATI-II) and The Regulation of Emotions Questionnaire (REQ- 2). Analysis highlighted that YSQ-S3 and REQ-2 scores significantly predicted 69% of the variance in SCATI-II scores. To the author’s knowledge, this study is the first of its kind to find support for the relationships between early maladaptive schemas (EMS), PD symptoms and the use of dysfunctional emotion regulation (ER) strategies, consistent with the schema therapy model, in older adults with mental health problems.