background Although it is generally agreed that personality disorders are an important topic in old-age psychiatry, dsm-5 has paid relatively little attention to older persons affected with this severe mental disorder.
aim To look closely and carefully at several aspects of the way in which dsm-5 defines personality disorders relating to older persons.
method We make a critical evaluation of the description of personality disorders given in dsm-5.
results First of all, we question whether the phrase ‘personality change due to another medical condition’ should really be included in the dsm-5 chapter of personality disorders because a personality change actually has the features of a persistent conduct disorder. Secondly, we argue that in a future revised version of dsm-5 personality disorders affecting older persons should be referred to specifically as ‘late-onset’ personality disorders. Thirdly, we stress that the research programme relating to the dimensional dsm-5 model of personality disorders should involve a larger number of older persons. In addition, more research is needed with regard to the use, wording and validity of the phrase ‘personality change due to a medical condition’. Those responsible for the revision of the Dsm-5 should ensure that the concept ‘late-onset personality disorders’ is incorporated in the text.
conclusion The description of personality disorders in dsm-5 is confusing. This is probably due to the transitional period between the old categorical (dsm-iv) system and the newly proposed dimensional approach to personality disorders in dsm-5, an approach that needs further investigation. However, this intervening period could be a good opportunity for doing further research into personality disorders in older adults.