Created at 1pm, Jan 8
Ms-RAGPsychology
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The Presentation of Narcissistic Personality Disorder in an Octogenarian: Converging Evidence from Multiple Sources
q_q-k0KFNwhLgU1CpQJ4MH4GfJVuV_uVdrCqeOfRJlA
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PDF
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71
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hnsw

STEVE BALSIS, PhD,Texas A&M University, College Station, Texas, USANICHOLAS R. EATON, MA,University of Minnesota, Minneapolis, Minnesota, USALUKE D. COOPER, MA, andTexas A&M University, College Station, Texas, USATHOMAS F. OLTMANNS, PhDWashington University, St. Louis, Missouri, USALittle is known about personality disorders (PDs) in later life. One reason for this dearth of knowledge is that many investigators believe that PDs soften with age. Recent anecdotal and empirical evidence, however, suggests that PDs are still very relevant in later life and may actually have unique presentations and consequences. The DSM-IV PD criteria seem to overlook these possibilities, perhaps because the personalities of older adults were not sufficiently understood when these criteria were written. But without age-appropriate criteria, clinicians and investigators who work with older adults may be unable to measure PDs adequately in their clients and research participants. A starting point for better understanding these disorders in older adults is the presentation of rich, empirical, clinical descriptions of symptoms and related behaviors using data from multiple instruments and sources. To this end, we describe in depth a case of narcissistic PD (NPD) in a woman in her mid 80s. This case study reveals that NPD is indeed relevant in the context of later life and impairs functioning in significant ways.

NEO PI-RWe submitted NAS's NEO PI-R responses to its publisher, Psychological Assessment Resources, to use its Professional Report Service. Our first impression of NAS's present profile was the extremity of her scores, which were often 2 SDs from the norm (i.e., below the third percentile or above the 97th percentile). Indeed, NAS responded Strongly Agree or Strongly Disagree to 73% and Neutral to only 6% of the NEO PI-R items, possibly reflecting a tendency to think or behave in extremes. NAS's retrospective profile also showed numerous personality extremes. NAS's general personality at the factor-level remained relatively stable between her present and retrospective reports; her score levels (e.g., Very High, High, etc.) were unchanged in four of the five factors. NAS's overall Agreeableness score increased one level from Low (retrospective) to Average (present). Overall, the correlation between her 35 (5 domains, 30 facets) present and retrospective T scores was high (r = .91, df =
id: 9dea73b58db452fc96924cde9ea06380 - page: 8
33, p < .001).
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Axis I Psychopathology
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SCID-IV, BDI-II, and BAIThe results of NAS's SCID-IV revealed that she meets the DSM-IV diagnostic requirements for alcohol abuse. NAS also reported experiencing some difficult events (e.g., her father died during her early childhood and she was sexually abused as an adolescent), but there was no evidence for clinically significant posttraumatic stress disorder. On the BDI-II, NAS received a score of 2; she reported having less energy than in the past and having somewhat less appetite. Her very low score indicated essentially no selfreported depression. NAS scored a 7 on the BAI, which indicated a low level of anxiety. The items she endorsed were somatic items, including sweating, having a racing heart, experiencing dizziness, and feeling numbness/tingling sensations. Given that NAS is in her mid 80s, she may have endorsed these items because of physiological rather than psychological disturbances. In fact, NAS explicitly stated that two of these symptoms were due to medical conditio
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