Personality disorders and personality change in later life

Two different things can bring a question about "personality" in later life. The first is a long-standing personality disorder that a person has lived with for decades, now shaped by aging, loss and illness. The second is a new change in how someone acts or feels, starting after age 60. That second case is not a personality disorder until a doctor has ruled out other causes.

This page covers both. It explains how personality disorders can look with age, why a sudden or new change in personality is a reason to see a doctor, and what can help families and caregivers.

Do personality disorders fade with age?

Partly. Some parts fade, and some do not.

In a large U.S. survey of adults aged 55 and older, about 14 in 100 had a personality disorder. The rate was about 18 in 100 for ages 55 to 64. It was about 10 in 100 for ages 75 and older.¹ In another large survey of adults over 50, the most common type was obsessive-compulsive personality disorder, at about 6 in 100 people.¹ (This is not the same as obsessive-compulsive disorder, or OCD. It is a lifelong style of being very rule-bound and perfectionist.)

The dramatic types, such as borderline and narcissistic, dropped the most. In the same survey, borderline personality disorder fell from about 5 in 100 in the younger group to about 1 in 100 in the oldest group.¹

But lower numbers do not tell the whole story. Experts note that studies may miss problems in older people. Tools such as the standard diagnostic criteria were built for younger adults and may not fit later life well.^1,2 The core trouble spots, such as stormy relationships and hard-to-manage emotions, can continue.²

How personality disorders can look in later life

Symptoms change shape with age. Here are some examples that experts describe.²

• Borderline personality disorder: Strong emotions, tense relationships and many physical complaints can remain. Self-harm may look different and be quieter, such as not taking needed medicines.
• Avoidant or schizoid traits: Withdrawal and anxiety can grow, and the person may become very isolated.
• Paranoid traits: Distrust can rise when a person has to move or depend on strangers for care.
• Narcissistic traits: The need for admiration can grow when health, looks or status decline.
• Antisocial traits: Aggression often lessens as strength fades, but disruptive behavior in care homes still happens.
• Obsessive-compulsive and histrionic traits: These can sharpen when a person loses control, routine or a helper.

Why a disorder can seem to appear "out of nowhere"

Some people manage a personality disorder for years with the help of a spouse, a job or a steady routine. Then a loss removes that support. Retirement, the death of a partner, the loss of a caregiver, a health decline or a move to a care home can bring old patterns back.²

Family members are often surprised. A husband or wife may have quietly held things together for decades.² If this sounds like your family, see also losing a husband or wife and retirement and mental health.

New personality change after 60: a warning sign

Say a person has always been calm and caring. Now they are rude, careless with money, or cold toward family. Or a lifelong quiet person becomes irritable and suspicious. This is not "just getting older" and it is not a new personality disorder. It is a reason to see a doctor.

Frontotemporal dementia

Frontotemporal dementia (FTD) is a group of brain diseases that damage the front and side parts of the brain. The most common form, behavioral variant FTD, often starts with changes in personality, behavior and judgment. People may act on impulse, lose interest in family and hobbies, show less empathy, or overeat. They often do not see that anything has changed.⁴ Memory is often fairly normal at first, which can mislead families.⁵

About 6 in 10 people with FTD are between 45 and 64, so it often starts earlier than other dementias. It can start at other ages too.⁴ It is often mistaken for depression or another mental health condition.^4,5 There is no cure, but doctors can treat symptoms, and a care team can help the family plan.⁴ Read more on the FTD page and on unusual or embarrassing behavior.

Other brain-related causes

• Early signs of other dementia. Researchers have proposed a pattern called mild behavioral impairment. It means new changes in drive, mood, impulse control, social behavior or beliefs that last at least six months later in life. It may be an early sign of brain disease in some people. The checklist is still being tested.⁶ See also mild cognitive impairment.
• Stroke. A stroke can bring impulsiveness, apathy (loss of drive), anger, anxiety, sudden crying or laughing, and depression. Impulsiveness is more common after strokes on the right side or the front of the brain.¹⁰
• Dementia making an old pattern worse. Dementia can strengthen, soften or hide an existing personality disorder.²

Depression, delirium and medicines

• Depression. Depression can bring changes in mood, energy, sleep or appetite, and aches or pains with no clear cause. It can be treated.⁹ See depression in later life.
• Delirium. Delirium is a sudden state of confusion that develops over hours or days. It can come from infections, dehydration, pain, surgery, or certain medicines. It is usually treatable, so sudden changes need quick medical attention.¹¹
• Medicines. About 1 in 3 U.S. adults in their 60s and 70s take five or more prescription medicines. Taking many can raise the chance of side effects, including problems with thinking.¹² See medicines that can affect mood and memory.

Other treatable health problems can also change thinking and behavior. Read about conditions that look like dementia.

What to do if you notice a change

1. Write it down. Note what changed, when it began, and examples. A behavior diary helps.
2. Make a list of every medicine and supplement. Include over-the-counter ones and alcohol.
3. See a primary care doctor soon. Say clearly that this is a change from the person's usual self. Sudden changes in a few hours or days need care right away.¹¹
4. Bring someone who knows the person well. People with brain changes may not notice them, and family can fill in the story.^4,2
5. Ask about a specialist. A geriatric psychiatrist, neurologist or memory clinic can look at both mental health and brain causes. See which specialist to see and finding geriatric mental health care.

If you want to talk with a group that knows FTD, the Association for Frontotemporal Degeneration HelpLine is 1-866-507-7222.⁵

Getting a careful assessment

For a possible personality disorder in an older adult, a good assessment looks at the person's whole life, not only today. A clinician will want to know how the person acted in earlier decades and what has changed lately. Reports from family or friends can fill gaps when hearing, vision or memory problems make self-report hard.^1,2

The clinician also has to separate a personality disorder from dementia, depression, psychosis, medical illness and medicine effects.² Personality disorders are also found in some older people whose depression does not improve with usual treatment, so they are worth considering.² Read more about getting diagnosed.

What helps in later life

Research here is still limited. Most studies of personality disorders were done with younger people, and treatment trials in older adults are few and small.^1,2 Here is what we know.

For more detail on approaches for all ages, see treatment for personality disorders.

Caring for someone: the strain on families and staff

Living with a personality disorder can be exhausting for relatives. Some family members have spent a lifetime in crises. Others suddenly become caregivers when a spouse can no longer cope. After a bereavement, an adult with dependent traits may lean heavily on grown children, who can feel overwhelmed. Care staff may also struggle.²

Caregivers of adults with mental health conditions often feel exhausted, isolated and helpless, and can develop depression or anxiety of their own.¹³

What can help:

• Learn about the condition. Understanding why someone acts this way often lowers blame on both sides. See supporting someone with a personality disorder.
• Set calm, clear limits. See setting boundaries as a caregiver.
• Use peer and family support. NAMI offers a Family Support Group and Family-to-Family, an education program. The NAMI HelpLine is 800-950-6264.¹³
• Watch your own health. Read about caregiver burnout.
• Plan for crises. See when a family member is in a mental health crisis.

When to get help

See a doctor soon if a person over 60 has a new change in personality, behavior or judgment, or if long-standing relationship problems have grown worse after a loss. The first stop can be a primary care doctor, who can refer to a mental health professional.⁹

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.