Personality Disorders and Higher Medical Resource Utilization with Aging

Dr. Abigail Powers PhD
Clinical Psychology Postdoctoral Fellow
Emory University School of Medicine What are the main findings of the study?

Dr. Powers: Personality disorders (i.e., problematic personality patterns that cause significant distress and dysfunction in individuals’ lives across many areas of functioning) are associated with many negative health outcomes in young adulthood. The goal of this research study was to determine the relationship between personality pathology and medical resource utilization as individuals age and develop new physical health problems.  Among community-dwelling later middle-aged adults (ages 55-64), we found that personality pathology was related to higher reported medical resource utilization (including doctor visits, hospitalizations, and number of outpatient procedures) independent of health status. Of the 10 DSM-IV personality disorders assessed, narcissistic and antisocial personality disorder features were associated with greater medical resource utilization independent of the presence of physical health problems. Also, among individuals with a greater number of physical health problems, histrionic and dependent personality disorder features were related to greater medical resource utilization, suggesting that important interactions between personality pathology and health conditions may occur in older age and impact resource use. Were any of the findings unexpected?

Dr. Powers: Rates of many personality disorders, including antisocial and histrionic, are thought to decline in later adulthood. Our results showing that antisocial and histrionic personality disorder symptoms are predictive of greater use of medical resources among older adults suggests that even if individuals fall short of a categorical diagnosis, the symptoms that are maintained as individuals age may still be detrimental to functioning in various ways. What should clinicians and patients take away from your report?

Dr. Powers: Personality pathology remains a relevant predictor of greater medical resource utilization into later adulthood and should be considered an important risk factor when trying to determine ways to reduce costly overuse of healthcare resources among older adults. What recommendations do you have for future research as a result of this study?

Dr. Powers: Identifying specific personality features or behaviors that can be targeted in the context of, or in combination with, physical healthcare may be a useful next step in reducing healthcare burden and promoting successful aging. Treating personality pathology in the context of physical ailments could carry over into many aspects of individuals’ health and wellbeing beyond medical use, to areas like perceived health status and health behaviors, which are also important aspects of successful aging. Research must continue to evaluate the effects of personality pathology across the lifespan, and determine the distinctive role personality pathology may play in health and functioning as individuals age.


Personality pathology and increased use of medical resources in later adulthood

Abigail Powers, Michael J. Strube, Thomas F. Oltmanns

The American Journal of Geriatric Psychiatry – 29 October 2013 (10.1016/j.jagp.2013.10.009)

Last Updated on November 18, 2013 by Marie Benz MD FAAD