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Personality Disorders Change Over Time

'Flamboyants' Get Better, Others Get Worse
By
WebMD Health News
Reviewed by Gary D. Vogin, MD

June 28, 2002 -- The textbooks say people with personality disorders don't change without help. But now it looks as though some problem personalities mellow with age while others get worse.

If you have a personality disorder, you probably don't know it. You know you have trouble forming stable relationships. Your work and personal life suffer. But you probably think it's other people, not you, who are the problem. If you also suffer from depression or anxiety, treatments that help other people likely don't work as well for you.

Without the help of a psychiatrist or psychologist, personality disorders aren't supposed to change much over time. Now a report in the June 29 issue of The Lancet suggests that most personality disorders -- those in the "odd/eccentric" and "anxious/fearful" clusters -- get worse as a person ages. Those in the "flamboyant" cluster, however, get a bit better.

"Flamboyant personality gets better," study leader Peter Tyrer, MD, tells WebMD. "For the others -- and it worries me slightly as we deal with an aging population -- but they are increasing their [suffering]."

Tyrer, head of the department of psychological medicine at Imperial College School of Medicine in London, began the study 12 years ago with 202 patients. All were treated for depression, generalized anxiety disorder, or panic disorder. Tyrer found that more than half of the patients also suffered from underlying personality disorders.

He recently found 178 of the patients and again looked at their symptoms. He found that most of them suffered more from their personality disorders. The findings:

  • The odd/eccentric cluster includes people with paranoid, schizoid, and schizotypal personalities. These are the most severe types of personality disorders. Most of these patients became significantly less functional over time.
  • The fearful/anxious cluster includes people with avoidant, dependent, and obsessive-compulsive personalities. These patients also experienced significantly more difficulty over time.
  • The flamboyant cluster includes people with histrionic, antisocial, borderline, and narcissistic personalities. Except for the borderlines -- considered the most difficult personality disorder to treat -- these patients enjoyed significantly better lives over time.

Tyrer says that most personality disorders get a bit better as a person goes from youth to the prime of life. But as a person with one of these disorders becomes elderly, the problems get worse than ever.

"These are very common disorders in the older population," Tyrer says. "We are going to have some more problems with people whose problems actually are becoming more pronounced. Old grandmother lives with us, she is a cantankerous old woman -- that sort of problem will become larger. We don't know why they get worse. It could be social isolation. Perhaps you can compensate by living in those gregarious communities you have in the U.S. But if left to their own devices they will get more cantankerous, nervous, and irritable."

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