Resilience and Personality Disorders in Older Age

  • Erlene RosowskyEmail author
  • Aileen Peters


The chapter begins with an overview of what is meant by “personality disorder” and how it is diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This is followed by a discussion of the aging of personality disorders including a description of what can be expected to change and perhaps more relevantly what can be expected to remain the same throughout the course of sentient life. The next section discusses the functions of resilience and challenges to resilience for those with personality disorders. This leads to the final section on implications for treatment. This entire volume is dedicated to understanding what is meant by the concept of resilience and how it applies to old age. This chapter focuses on that group of older adults who have struggled with life all their life and who are especially poorly equipped to meet the challenges of aging. They are in many ways the antithesis of resilient individuals. They are addressed in the clinical literature as having a personality disorder.


Older adult personality disorder Resilience Elderly coping 


  1. American Psychiatric Association (APA). (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: American Psychiatric Association.Google Scholar
  2. Ames, A., & Molinari, V. (1994). Prevalence of personality disorder in community-living elderly. Journal of Geriatric Psychiatry and Neurology, 7, 189–194.PubMedCrossRefPubMedCentralGoogle Scholar
  3. Asendorph, J., & van Aken, M. (1999). Resilient, overcontrolled, and undercontrolled personality prototypes in childhood: Replicabilty, predictive power, and the trait-type issue. Journal of Personality and Social Psychology, 77, 815–832.CrossRefGoogle Scholar
  4. Balsis, S., Segal, D. L., & Donahue, C. (2009). Revising the personality disorder diagnostic criteria for the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-V): Consider the later life context. American Journal of Orthopsychiatry, 79(4), 452–460.PubMedCrossRefPubMedCentralGoogle Scholar
  5. Bartone, P., Ursano, R., Wright, K., & Ingraham, L. (1989). The impact of a military air disaster on the health of assistance workers: A prospective study. Journal of Nervous and Mental Disease, 177, 317–327.PubMedCrossRefPubMedCentralGoogle Scholar
  6. Beck, A. T., Davis, D. D., & Freeman, A. (2015). Cognitive therapy of personality disorders. New York: The Guilford Press.Google Scholar
  7. Beckmann, J., & Kellmann, M. (2004). Self-regulation and recovery: Approaching an understanding of the process of recovery from stress. Psychological Reports, 95, 1135–1153.PubMedCrossRefPubMedCentralGoogle Scholar
  8. Bergeman, C., & Wallace, K. (1999). Resiliency in later life. In T. Whitman, T. Merluzzi, & R. White (Eds.), Life-span perspectives on heath and Illness (pp. 207–223). Mahwah, NJ: Lawrence Erlbaum Associates.Google Scholar
  9. Bernstein, D., Iscan, C., & Maser, J. (2007). Opinions of personality disorder experts regarding the DSM-IV personality disorders classification system. Journal of Personality Disorders, 21(5), 536–551.PubMedCrossRefPubMedCentralGoogle Scholar
  10. Black, D. W., Blum, N., Pfohl, B., & Hale, N. (2004). Suicidal behavior in borderline personality disorder: Prevalence, risk factors, prediction, and prevention. Journal of Personality Disorders, 18(3), 226–239.PubMedCrossRefPubMedCentralGoogle Scholar
  11. Caqueo-Urízar, A., Alessandrini, M., Zendjidjian, X., Urzúa, A., Boyer, L., & Williams, D. R. (2016). Religion involvement and quality of life in caregivers of patients with schizophrenia in Latin-America. Psychiatry Research, 246, 769–775.PubMedCrossRefPubMedCentralGoogle Scholar
  12. Cohen, B., Nestadt, G., Samuels, J., Romanoski, A., McHugh, P., & Rabins, P. (1994). Personality disorder in later life: A community study. British Journal of Psychiatry, 165, 493–499.PubMedCrossRefPubMedCentralGoogle Scholar
  13. Collins, A., & Smyer, M. (2005). The resilience of self-esteem in late adulthood. Journal of Aging and Health, 17(4), 471–489.PubMedPubMedCentralCrossRefGoogle Scholar
  14. Coolidge, F., & Merwin, M. (1992). Reliability and validity of the Coolidge Axis II Inventory: A new inventory for the assessment of personality disorders. Journal of Personality Assessment, 59, 223–238.PubMedCrossRefPubMedCentralGoogle Scholar
  15. Cooper, L. D., Balsis, S., & Oltmanns, T. F. (2014). Aging: Empirical contribution: A longitudinal analysis of personality disorder dimensions and personality traits in a community sample of older adults: Perspectives from selves and informants. Journal of Personality Disorders, 28(1), 151–165.PubMedPubMedCentralCrossRefGoogle Scholar
  16. Costa, P., & McCrae, R. (1988). Personality in adulthood: A 6-year longitudinal study of self-reports and spouse ratings on the NEO personality inventory. Journal of Personality and Social Psychology, 54(5), 853–863.PubMedCrossRefPubMedCentralGoogle Scholar
  17. Devanand, D., Turret, N., Moody, B., Fitzsimmons, L., Peyser, S., Mickle, K., et al. (2000). Personality disorders in elderly patients with dysthymic disorders. American Journal of Geriatric Psychiatry, 8, 188–195.PubMedCrossRefPubMedCentralGoogle Scholar
  18. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. (2013). Arlington, VA: American Psychiatric Association.Google Scholar
  19. Dijk, S. D., & Van Alphen, S. (2016). Personality disorders in older adults. Encyclopedia of Geropsychology, 1–12.Google Scholar
  20. Engels, G., Duijsens, I., Haringsma, R., & van Putten, R. (2003). Personality disorders in the elderly compared to four younger age groups: A cross-sectional study of community residents and mental heath patients. Journal of Personality Disorders, 17(5), 447–459.PubMedCrossRefPubMedCentralGoogle Scholar
  21. Glaser, J., Van Os, J., Mengehers, R., & Myin-Germeys, I. (2007). A momentary assessment study of the reported emotional phenotype associated with borderline personality disorder. Psychological Medicine, 38(9), 1231–1239.PubMedPubMedCentralGoogle Scholar
  22. Goodman, M., Weiss, D., Koenigsberg, H., Kotlyarevsky, V., Neu, A., Mitropoulou, V., et al. (2003). The role of childhood trauma in differences in affective instability in those with personality disorders. CNS Spectrums, 8(10), 763–770.PubMedCrossRefPubMedCentralGoogle Scholar
  23. Gottschling, J., Segal, D. L., Marty, M. A., & Coolidge, F. L. (n.d.). Depressive, passive-aggressive, sadistic, and self-defeating personality disorders predict suicidal ideation. PsycEXTRA Dataset.Google Scholar
  24. Groves, J. (1978). Taking care of the hateful patient. New England Journal of Medicine, 298(16), 883–887.PubMedCrossRefPubMedCentralGoogle Scholar
  25. Gutiérrez, F., Vall, G., Peri, J. M., Baillés, E., Ferraz, L., Gárriz, M., et al. (2012). Personality Disorder features through the life course. Journal of Personality Disorders, 1–12.Google Scholar
  26. Hategan, A., Bourgeois, J. A., Hirsch, C. H., & Giroux, C. (2018). Geriatric Psychiatry: A Case-Based Textbook. Cham: Springer International Publishing.Google Scholar
  27. Harwood, D., Hawton, K., Hope, T., & Jacoby, R. (2001). Psychiatric disorder and personality factors associated with suicide in older people: A descriptive and case-control study. International Journal of Geriatric Psychiatry, 16(2), 155–165.PubMedCrossRefPubMedCentralGoogle Scholar
  28. Heisel, M. J., Links, P. S., Conn, D., Reekum, R. V., & Flett, G. L. (2007). Narcissistic personality and vulnerability to late-life suicidality. American Journal of Geriatric Psychiatry, 15(9), 734–741.PubMedCrossRefPubMedCentralGoogle Scholar
  29. Hildon, Z., Smith, G., Netaveli, G., & Blane, D. (2008). Understanding adversity and resilience at older ages. Sociology of Health & Illness, 30(5), 726–740.CrossRefGoogle Scholar
  30. Hillman, J., Stricker, G., & Zweig, R. (1997). Clinical psychologists’ judgments of older adult patients with character pathology: Implications for practice. Professional Psychology: Research and Practice, 28(2), 179–183.CrossRefGoogle Scholar
  31. Hoermann, S., Zupanick, C., & Dombeck, M. (n.d.). Alternative diagnostic models for personality disorders: The DSM-5 dimensional approach. Retrieved from
  32. Hooker, K. (2000). New directions for research in personality and aging: A comprehensive model for linking levels, structures and processes. Paper presented at the Annual Meeting of the Gerontological Society of America, Washington, DC.Google Scholar
  33. Jahn, D. R., Poindexter, E. K., & Cukrowicz, K. C. (2015). Personality disorder traits, risk factors, and suicide ideation among older adults. International Psychogeriatrics, 27(11), 1785–1794.PubMedCrossRefPubMedCentralGoogle Scholar
  34. Jang, K., Taylor, S., & Livesley, W. J. (2006). The University of British Columbia twin project: Personality is something and personality does something. Twin Research and Human Genetics, 9(6), 739–742.PubMedCrossRefPubMedCentralGoogle Scholar
  35. Jeste, D. V., Savla, G. N., Thompson, W. K., Vahia, I. V., Glorioso, D. K., Martin, A. S., et al. (2013). Association between older age and more successful aging: Critical role of resilience and depression. American Journal of Psychiatry, 170(2), 188–196.CrossRefGoogle Scholar
  36. Joska, J., & Fisher, A. (2005). The assessment of need for mental health services. Social Psychiatry and Psychiatric Epidemiology, 40, 529–539.PubMedCrossRefPubMedCentralGoogle Scholar
  37. Kegan, R. (1982). The evolving self. Cambridge, MA: Harvard University Press.Google Scholar
  38. Kessler, E. M., & Staudinger, U. (2009). Affective experience in adulthood and old-age: The role of affective arousal and perceived affect regulation. Psychology and Aging, 24(2), 349–362.PubMedCrossRefPubMedCentralGoogle Scholar
  39. Lamond, A., Depp, C., Allison, M., Langer, R., Reichstadt, J., Moore, D., et al. (2008). Measurement and predictors of resilience among community-dwelling older women. Journal of Psychiatric Research, 43(2), 148–154.PubMedPubMedCentralCrossRefGoogle Scholar
  40. Lautenschlager, N., & Förstl, H. (2007). Personality change in old age. Current Opinions in Psychiatry, 20, 62–66.CrossRefGoogle Scholar
  41. Leipold, B., & Werner, G. (2009). Resilience: A conceptual bridge between coping and development. European Psychologist, 14(1), 44–50.CrossRefGoogle Scholar
  42. Magai, C., & Passman, V. (1997). The interpersonal basis of emotional behavior and emotion regulation in adulthood. Annual Review of Geriatrics and Gerontology, 17, 104–137.Google Scholar
  43. Magnavita, J. (2004). Classification, prevalence, and etiology of personality disorders: Related issues and controversy. In J. Magnavita (Ed.), Handbook of personality disorders: Theory and practice (pp. 3–23). Hoboken, NJ: Wiley.Google Scholar
  44. Marulanda, S., & Addington, J. (2014). Resilience in individuals at clinical high risk for psychosis. Early Intervention in Psychiatry, 10(3), 212–219.PubMedPubMedCentralCrossRefGoogle Scholar
  45. Masten, A. (1999). Resilience comes of age: Reflections on the past and outlook for the next generation of research. In M. Glantz & L. Jeanette (Eds.), Resilience and development: Positive life adaptations. Longitudinal research in the social and behavioral sciences (pp. 281–296). Dordrecht, Netherlands: Kluwer-Academic.Google Scholar
  46. Macleod, S., Musich, S., Hawkins, K., Alsgaard, K., & Wicker, E. R. (2016). The impact of resilience among older adults. Geriatric Nursing, 37(4), 266–272.PubMedPubMedCentralCrossRefGoogle Scholar
  47. McGrath, L. M., Cornelis, M. C., Lee, P. H., Robinson, E. B., Duncan, L. E., Barnett, J. H., et al. (2013). Genetic predictors of risk and resilience in psychiatric disorders: A cross-disorder genome-wide association study of functional impairment in major depressive disorder, bipolar disorder, and schizophrenia. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 162(8), 779–788.CrossRefGoogle Scholar
  48. McCrae, R., & Costa, P. (1990). Personality in adulthood. New York: Guilford.Google Scholar
  49. Morgan, T. A., Chelminski, I., Young, D., Dalrymple, K., & Zimmerman, M. (2013). Differences between older and younger adults with Borderline Personality Disorder on clinical presentation and impairment. Journal of Psychiatric Research, 47(10), 1507–1513.PubMedCrossRefPubMedCentralGoogle Scholar
  50. Neugarten, B. (1964). Personality in middle and late life: Empirical studies. Oxford: Atherton Press.Google Scholar
  51. Oldham, J. M. (2015). The alternative DSM-5 model for personality disorders. World Psychiatry, 14(2), 234–236.PubMedPubMedCentralCrossRefGoogle Scholar
  52. Padesky, C. A., & Mooney, K. A. (2012). Strengths-based cognitive-behavioural therapy: A four-step model to build resilience. Clinical Psychology & Psychotherapy, 19(4), 283–290.CrossRefGoogle Scholar
  53. Paris, J. (2003). Personality Disorders Over Time: Precursors, Course and Outcome. Journal of Personality Disorders, 17(6), 479–488. Scholar
  54. Pearlin, L., & Skaff, M. (1995). Stressors and adaptation in late life. In M. Gatz (Ed.), Emerging issues in mental health and aging (pp. 97–123). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  55. Powers, A. D., Gleason, M. E., & Oltmanns, T. F. (2013). Symptoms of borderline personality disorder predict interpersonal (but not independent) stressful life events in a community sample of older adults. Journal of Abnormal Psychology, 122(2), 469–474.PubMedPubMedCentralCrossRefGoogle Scholar
  56. Problems with the Diagnostic System For Personality Disorders. (n.d.). Retrieved from
  57. Quirk, S. E., Berk, M., Chanen, A. M., Koivumaa-Honkanen, H., Brennan-Olsen, S. L., Pasco, J. A., & Williams, L. J. (2016). Population prevalence of personality disorder and associations with physical health comorbidities and health care service utilization: A review. Personality Disorders: Theory, Research, and Treatment, 7(2), 136–146. Scholar
  58. Reynolds, K., Pietrzak, R. H., El-Gabalawy, R., Mackenzie, C. S., & Sareen, J. (2015). Prevalence of psychiatric disorders in U.S. older adults: Findings from a nationally representative survey. World Psychiatry, 14(1), 74–81.PubMedPubMedCentralCrossRefGoogle Scholar
  59. Rosowsky, E. (2005). Ageism and professional training in aging: Who will be there to help? Generations, 29, 55–58.Google Scholar
  60. Rosowsky, E., & Gurian, B. (1992). Impact of borderline personality disorder in late life on systems of care. Hospital & Community Psychiatry, 43, 386–389.Google Scholar
  61. Rossi, N., Bisconti, T., & Bergeman, C. (2007). The role of dispositional resilience in regaining life satisfaction after the loss of a spouse. Death Studies, 31, 863–883.CrossRefGoogle Scholar
  62. Rutter, M. (1987). Psychosocial resilience and protective mechanisms. American Journal of Orthopsychiatry, 57(3), 316–331.CrossRefGoogle Scholar
  63. Ryff, C., & Singer, B. (1996). Psychological well-being: Meaning, measurement and implications for psychotherapy research. Psychotherapy and Psychosomatics, 65, 14–23.PubMedCrossRefPubMedCentralGoogle Scholar
  64. Schneider, L., Zemansky, M., Berden, M., & Sloane, R. (1992). Personality in recovered depressed elderly. International Psychiatry, 4, 177–185.CrossRefGoogle Scholar
  65. Schilling, O. K., & Diehl, M. (2015). Psychological vulnerability to daily stressors in old age. Zeitschrift für Gerontologie und Geriatrie, 48(6), 517–523.PubMedCrossRefPubMedCentralGoogle Scholar
  66. Schooler, C., & Caplan, L. (2009). How those who have, thrive: Mechanisms underlying the well-being of the advantaged in later life. In H. Bosworth & C. Hertzog (Eds.), Aging and cognition: Research methodologies and empirical advances (pp. 121–141). Washington, DC: APA.CrossRefGoogle Scholar
  67. Segal, D. L., Gottschling, J., Marty, M., Meyer, W. J., & Coolidge, F. L. (2015). Relationships among depressive, passive-aggressive, sadistic and self-defeating personality disorder features with suicidal ideation and reasons for living among older adults. Aging & Mental Health, 19(12), 1071–1077. Scholar
  68. Segal, D., Hook, J., & Coolidge, F. (2001). Personality dysfunction, coping style and clinical symptoms in younger and older adults. Journal of Clinical Geropsychology, 7, 201–212.CrossRefGoogle Scholar
  69. Segal, D. L., Marty, M. A., Meyer, W. J., & Coolidge, F. L. (2012). Personality, suicidal ideation, and reasons for living among older adults. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 67(2), 159–166. Scholar
  70. Shea, M., Zlotnick, C., Dolan, R., Warshaw, M., Phillips, K., Brown, et al. (2000). Personality dis-orders, history of trauma, and posttraumatic stress disorder in subjects with anxiety disorders. Comprehensive Psychiatry, 41(5), 315–325.PubMedCrossRefPubMedCentralGoogle Scholar
  71. Simeon, D., Yehuda, R., Cunill, R., Knutelska, M., Putnam, F., & Smith, L. (2007). Factors associated with resilience in healthy adults. Psychoneuroendocrinology, 32(8–10), 1149–1152.PubMedCrossRefPubMedCentralGoogle Scholar
  72. Small, B., Hertzog, C., Hultsch, D., & Dixon, R. (2003). Stability and change in adult personality over 6 years: Findings from the Victoria Longitudinal Study. Journal of Gerontology: Psychological Sciences, 58B(3), 166–176.CrossRefGoogle Scholar
  73. Smith, T. (2006). Personality as risk and resilience in physical health. Current Directions in Psychological Science, 15(5), 222–231.CrossRefGoogle Scholar
  74. Smith, B., Dalen, J., Wiggins, K., Tooley, E., Christopher, P., & Bernard, J. (2008). The brief resilience scale: Assessing the ability to bounce back. International Journal of Behavioral Medicine, 15(3), 194–200.PubMedPubMedCentralCrossRefGoogle Scholar
  75. Smyer, M., Zarit, S., & Qualls, S. (1990). Psychological intervention with the aging individual. In J. Birren & K. Schaie (Eds.), Handbook of the psychology of aging (3rd ed., pp. 373–440). San Diego, CA: Academic.Google Scholar
  76. Staudinger, U., & Fleeson, W. (1996). Self and personality in old and very old age: A sample case of resilience? Development and Psychopathology, 8(4), 867–885.CrossRefGoogle Scholar
  77. Southwick, S. M., & Charney, D. S. (2012). The science of resilience: Implications for the prevention and treatment of depression. Science, 338(6103), 79–82.CrossRefGoogle Scholar
  78. Stawski, R., Sliwinski, M., Almeida, D., & Smyth, J. (2008). Reported exposure and emotional reactivity to daily stressors: The roles of adult age and global perceived stress. Psychology and Aging, 23(1), 52–61.PubMedPubMedCentralCrossRefGoogle Scholar
  79. Stevenson, J., Meares, R., & Comerford, A. (2003). Diminished impulsivity in older patients with borderline personality disorder. American Journal of Psychiatry, 160, 165–166.PubMedCrossRefPubMedCentralGoogle Scholar
  80. Svanborg, P., Gustavsson, P., Mattila-Evenden, M., & Asberg, M. (1999). Assessment of maladaptiveness: A core issue in the diagnosing of personality disorders. Journal of Personality Disorders, 13(3), 241–256.PubMedCrossRefPubMedCentralGoogle Scholar
  81. Svrakic, D., Lecic-Toseviski, D., & Divac-Janovic, M. (2008). DSM Axis II: Personality disorders or adaptation disorders? Current Opinion in Psychiatry, 22, 111–117.CrossRefGoogle Scholar
  82. Tackett, J., Quilty, L., Sellbom, M., Rector, N., & Bagby, M. (2008). Additional evidence for a quantitative hierarchical model of mood and anxiety disorders for DSM-V: The context of personality structure. Journal of Abnormal Psychology, 4, 812–825.CrossRefGoogle Scholar
  83. Torgersen, S., Lygren, S., Quien, P., Ingunh, S., Onstad, S., & Evardsen, J. (2000). A twin study of personality disorders. Comprehensive Psychiatry, 41, 416–425.PubMedCrossRefPubMedCentralGoogle Scholar
  84. Tyrer, P. (1998). Feedback for the personality disordered. Journal of Forensic Psychiatry, 9, 1–4.CrossRefGoogle Scholar
  85. Tugade, M., Fredrickson, B., & Barrett, L. (2004). Psychological resilience and positive emotional granularity: Examining the benefits of positive emotions on coping and health. Journal of Personality, 77(6), 1161–1190.CrossRefGoogle Scholar
  86. Valliant, G. (2002). Aging well. Boston: Little, Brown.Google Scholar
  87. Van Alphen, S., Engelen, G., Kuin, Y., & Derksen, J. (2006). The relevance of a geriatric sub-classification of personality disorders in the DSM-V. International Journal of Geriatric Psychiatry, 21, 205–209.PubMedCrossRefPubMedCentralGoogle Scholar
  88. Van Alphen, S. P., Dijk, S. D., Videler, A. C., Rossi, G., Dierckx, E., Bouckaert, F., et al. (2014). Personality disorders in older adults: Emerging research issues. Current Psychiatry Reports, 17(1), 1–7.Google Scholar
  89. Wakefield, J. (2008). The perils of dimensionalization: Challenges in distinguishing negative traits from personality disorders. Psychiatric Clinics of North America, 31(3), 379–393.PubMedCrossRefPubMedCentralGoogle Scholar
  90. Wallace, K., Bisconti, T., & Bergeman, C. (2001). The mediational effect of hardiness on social support and optimal outcomes in later life. Basic and Applied Social Psychology, 23, 267–279.CrossRefGoogle Scholar
  91. Weed, K., Keough, D., & Borkowski, P. (2006). Stability of resilience in children of adolescent mothers. Journal of Applied Developmental Psychology, 27, 60–77.CrossRefGoogle Scholar
  92. Widiger, T., & Lowe, J. (2008). A dimensional model of personality disorder: Proposal for DSM-V. Psychiatric Clinics of North America, 31(3), 363–378.PubMedCrossRefPubMedCentralGoogle Scholar
  93. Windle, G., Markland, D., & Woods, R. (2008). Examination of a theoretical model of psychological resilience in older age. Aging & Mental Health, 12(3), 285–292.CrossRefGoogle Scholar
  94. Yates, T., Egeland, B., & Sroufe, L. (2003). Rethinking resilience: A developmental process perspective. In S. Luthar (Ed.), Resilience and vulnerability: Adaptation in the context of childhood adversities (pp. 243–266). New York: Cambridge University Press.CrossRefGoogle Scholar
  95. Zautra, A., Finch, J., Reich, J., & Guarnaccia, C. (1991). Predicting the everyday life events of older adults. Journal of Personality, 59(3), 507–538.PubMedCrossRefPubMedCentralGoogle Scholar
  96. Zivian, M., Larsen, W., Knox, J., Gekoski, W., & Hatchette, V. (1992). Psychotherapy for the elderly: Psychotherapists’ preferences. Psychotherapy: Theory, Research, Practice, Training, 29(2), 668–674.CrossRefGoogle Scholar
  97. Zweig, R., & Agronin, M. (2006). Personality disorders in late life. In M. Agronin & G. Maletta (Eds.), Principles and practice of geriatric psychiatry (pp. 446–449). Philadelphia: Lippincott, Williams & Wilkins.Google Scholar

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Authors and Affiliations

  1. 1.William James CollegeNewtonUSA

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