Psychotherapeutic treatment levels of personality disorders in older adults

Treatment of personality disorders (PDs) in older adults is a highly underexplored topic. In this article clinical applicability of the findings from a recent Delphi study regarding treatment aspects of PDs in older adults is explored. This concerns the relevance of three psychotherapeutic treatment levels for PDs in later life: (a) personality-changing treatment, (b) adaptation-enhancing treatment, and (c) supportive-structuring treatment. By means of three cases concerning the three levels, all from a cognitive behavioral perspective, namely (a) schema therapy, (b) cognitive behavioral therapy, and (c) behavioral therapy, we illustrate the usefulness of the different levels in the selection of treatment for older adults with PDs. Throughout all treatment levels, attention to specific age-related psychotherapeutic topics—such as loss of health and autonomy, cohort beliefs, sociocultural context, beliefs about and consequences of somatic comorbidity, intergenerational linkages, and changing life perspectives—is crucial, as they often cause an exacerbation of personality pathology in later life. Suggestions as to how to adapt existing treatments within a cognitive behavioral framework in order to better mold them to the needs and experiences of older adults with PDs are discussed.