Auntie Laurena wonders if is there such a thing as midlife or late life onset Personality Disorder?

Someone I have known for 25 years has been increasingly showing more and more dysfunctional behaviours, and I started to wonder if she is getting worse or was I blind to the real her until now. I consider her a friend, so it’s natural for me to want to make excuses for her. Her husband left her for another woman, and later a boyfriend swapped her for younger women, so she now thinks that all men will eventually cheat on her. The most recent incident made me reconsider her behaviour though; not just her attitude towards men but also towards me. She informed me that she was coming to stay with me for 5 weeks without first discussing her plan with me! When I expressed my doubts about her plans, she got snarky with me. Which brought me to this question: can someone develop a personality disorder at an older age? So I started googling.

keywords: #personalitydisorder #DSM5 #ICD11 #lifespan #developmentalperspective #psychopathology #midlife #lateadulthood #developmentalpsychology

According to several researchers, both the DSM-V and the ICD-11 don’t help in the diagnosis of personality in older adults, since it is believed that personality disorders emerge during adolescence or early adulthood and one’s personality stabilises with age. Hence, most studies are done on people who are between the ages of 18 and 45, and longitudinal studies are few and far between. Majority of the participants are drawn from either convenience samples (i.e., psychology undergraduates) or clinical samples. Much work still needs to be done in this field.

At this point in time, how do research on personality disorders reflect real life outside universities and clinics? How valid are personality disorders as constructs without lifespan perspectives??Afterall, people do change. Our experiences and our circumstances can change us, for better or for worse, and regardless of age. That same applies to personality disorders too. For instance, it is observed that people with histrionic personality disorder start relying on other means to attract attention as they age and become physically less attractive. So, instead of using their looks to gain admiration, they might use sob stories or physical ailments to gain sympathy. Hey, some attention is better than no attention, right???

I started by asking whether people can develop personality disorders at a later age, through experiencing stressful life events. (BTW, personality could also change after being hit in the head with a frying pan, but this friend didn’t suffer a traumatic brain injury.) Oltmanns and Balsis (2011) reminded me that things are more complicated than DSM-5 criterias, due to how personality disorders are defined and researched. They suggested that the construct validity of personality disorders should be evaluated using the ultimate criteria of health and longevity. I suppose they meant the health and longevity of the person with the personality disorder rather than those around him? I, however, can imagine having to live with someone who has, say a narcissistic personality disorder, would be bad for your health and could shorten your lifespan…?

Perhaps Bangash (2020) could offer a possible answer to my question. Significant others in the lives of those with personality disorder(s) could help them mask or compensate for their interpersonal difficulties and personality dysfunction (Videler et al., 2019). Significant others and/or social roles could provide a buffer between the individual and others, bolster the individual’s adaptive traits so that expression of maladaptive traits are reduced, and binding the individual’s dysfunctional behaviours (Bangash, 2020). When the individual loses those significant others or social roles, and with that the protective factors, the individual’s personality disorder “emerges” or becomes hard to ignore.??

This brings me to another question: although I am not her significant other, was I the bolster, or worse, was I an enabler of her dysfunctional behaviour?! Perhaps a bit of both??

I have been telling her that she lives in a recurring nightmare she refuses to wake up from: meet some guy who lives far far away via social media, fall in love and meet up for a holiday, start accusing him of cheating on her with other women, rinse and repeat. When the “being cheated on” phase starts, she would start telling me (and likely others) about being cheated on. I would challenge her perceptions when she showed me social media posts that she considered proof that he was cheating on her. After a few rounds of that, I flatly refused to discuss the “evidence” with her. So she started developing another pattern. She would find some guy from far far away via social media, befriend him and make him feel sorry for her. She is staying with one of them now, for the second time, and was planning to fly over to the Netherlands to stay with me for 5 weeks without first asking me. When I expressed my doubt about her staying with me for that long, she said that she might go stay with a mutual friend in the next town. So I got in touch with that friend, and found out that she has been telling him sob stories about her life too, and he was thinking about bringing her here via a spousal visa. The blinkers fell off my eyes, and I told him the truth about her visit to the neighbouring country. No, she is not there with a group of friends, but visiting some guy whom she hopes could rescue her from her recurring nightmare. After that I informed her that she cannot come stay with me. I do hope that the guy whom she is visiting now would let her stay till it is time for her flight back home. Rather him than me.?

I have counselled her for almost 10 years now, and it looks like I have not made any difference. Time to throw in the towel. Life is too short. She might be heading for a lonely future filled with bitterness and emptiness. Although I wish her well, and I don’t want to be part of her dysfunction.

Footnote

* some personal details were changed or left out to maintain confidentiality

Reference:

Bangash, A. (2020). Personality disorders in later life: Epidemiology, presentation and management. BJPsych Advances, 26(4), 208-218. doi:10.1192/bja.2020.16

Oltmanns, T. F., & Balsis, S. (2011). Personality disorders in later life: questions about the measurement, course, and impact of disorders. Annual review of clinical psychology, 7, 321–349. https://doi.org/10.1146/annurev-clinpsy-090310-120435

Videler, A. C., Hutsebaut, J., Schulkens, J. E., Sobczak, S., & Van Alphen, S. P. (2019). A life span perspective on borderline personality disorder. Current psychiatry reports, 21(7), 1-8. https://doi.org/10.1007/s11920-019-1040-1