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Journal of Personality Disorders, 26(5), 763774, 2012

2012 The Guilford Press

Personality Disorder Features


Through the Life Course
Fernando Gutirrez, PhD, Gemma Vall, BSc,
Josep Maria Peri, PhD, Eva Baills, PhD, Liliana Ferraz, BSc,
Miguel Grriz, BSc, and Xavier Caseras, PhD

Personality Disorders have proved to be more fluid through the life


course than previously thought. However, because analyses have usually been undertaken at the level of diagnostic categories, relevant findings may be obscured. An examination at the criteria level could bypass
arbitrary aggregations of heterogeneous traits and thus offer more accurate information. To this end, we administered the Personality Diagnostic Questionnaire-4+ (PDQ-4+) to 1,477 patients aged 15 to 82. Nine
of 12 disorders declined to some extent over the lifespan, but the evolution of individual criteria diverged within categories. At this level, 45 of
93 criteria showed age-related decreases, whereas only seven presented increases. A clearer picture is offered of the PD traits that change
and those that remain stable. Thus, pathological features are not only
more fluid, but developmentally more heterogeneous than previously
believed.

Although Personality Disorders (PD) are usually conceptualized as stable


and enduring maladaptive patterns of thought, feeling, and behavior, empirical findings are consistently challenging the notion that stability is a
definitional component of pathological personality (Seiverwright, Tyrer, &
Johnson, 2002; Zanarini, Frankenburg, Hennen, Reich, & Silk, 2005).
Longitudinal studies have reported unexpected levels of change in PD
scores and diagnoses during follow-up (Clark, 2009). In nonclinical samples, the number of PD criteria met has been shown to decline linearly at
a rate of 1% per year (Cohen, Chen et al., 2005). Remission rates can be
dramatic in clinical samples, which may lose up to 40% of their symptomThis article was accepted under the editorship of Paul S. Links.
From Hospital Clnic Barcelona, Spain (F. G., J. M. P., M. G.); IDIBAPS, Barcelona, Spain
(F. G.); Hospital Santa Maria, Lleida, Spain (G. V.); Pompeu Fabra University, Barcelona,
Spain (E. B.); Clnic Foundation for Biomedical Research, Barcelona, Spain (L. F.); and Cardiff University, Cardiff, U.K. (X. C.).
This work was partially supported by grants from Spains Ministerio de Educacin y Ciencia
(FIS 03/0464 and FIS 07/0033) awarded to F. Gutierrez.
Address correspondence to Fernando Gutirrez, Servei Psicologia Clnica, Institut Clnic
Neurocincies, Hospital Clnic de Barcelona, Villarroel 170, 08036 Barcelona, Spain; E-mail:
fguti@clinic.ub.es

763

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GUTIRREZ ET AL.

atology in two years (Grilo et al., 2004). Even in the case of allegedly
chronic and severe disorders such as Borderline, half of them are undiagnosable after 6 years of follow-up, and three quarters have remitted at 10
years (Zanarini et al., 2005). Declines are more patent for Cluster B features than for others (Harpur & Hare, 1994; Johnson et al., 2000). Indeed,
whereas A and C traits have been reported to fall in some studies (Cohen,
Crawford, Jonson, & Kasen, 2005; Johnson et al., 2000), they rise in others (Engels, Duijsens, Haringsma, & Van Putten, 2003).
As follow-up studies are subject to attrition and their high costs may
limit the sample size, the age span, or the range of targeted diagnoses,
cross-sectional designs provide crucial complementary information. They
confirm a reduced likelihood of PD as age increases (Abrams & Bromberg,
2006; Jackson & Burgess, 2000), especially in cluster B (Torgersen, Kringlen, & Cramer, 2001). Importantly, rates of impulsivity and deliberate
self-harm in borderline subjects, as well as dissocial acting-out in psychopaths, have been reported to fall at older ages (Huchzermeyer et al., 2008;
Stepp & Pilkonis, 2008). Conversely, A and C clusters appear to remain
stable over the life span (Coid, Yang, Tyrer, Roberts, & Ullrich, 2006; Samuels et al., 2002) or even increase (Torgersen et al., 2001).
Otherwise, the literature in this field is limited by the fact that DSM-IV
PDs are not natural kinds, but largely arbitrary arrangements based on
consensus. Indeed, diagnostic categories have proved to be relatively heterogeneous, grouping criteria that are not particularly correlated with
each other (Widiger & Trull, 2007). As a consequence, not only may each
diagnostic category evolve differently over time (Johnson et al., 2000), but
individual criteria within the same disorder appear to evolve in opposite
directions and at different rates. A notable example is that while self-mutilation, parasuicide, and demandingness subside quickly in Borderline
patients, feelings of intense anger or abandonment persist for a long time
(Zanarini et al., 2005). This heterogeneity may have led to some confusing
findings, and may have obscured some relevant developmental divergences. Moreover, it has been one of the reasons for the overhaul of the taxonomy in the future DSM-5, which may render previous knowledge obsolete.
Against this background, the current study cross-sectionally examines
in a clinical sample the change patterns in the full range of personality
disorders and criteria over the lifespan.

Method
Participants
The sample was composed of 1,477 patients between ages 15 and 82 (M=
34.5, SD=11.6), 54% female, consecutively referred to the Psychology Department of a General Hospital for personality assessment during a 6-year
period. Most of them (84.5%) had a Personality Disorder diagnosis accord-

764

GUTIRREZ ET AL.

atology in two years (Grilo et al., 2004). Even in the case of allegedly
chronic and severe disorders such as Borderline, half of them are undiagnosable after 6 years of follow-up, and three quarters have remitted at 10
years (Zanarini et al., 2005). Declines are more patent for Cluster B features than for others (Harpur & Hare, 1994; Johnson et al., 2000). Indeed,
whereas A and C traits have been reported to fall in some studies (Cohen,
Crawford, Jonson, & Kasen, 2005; Johnson et al., 2000), they rise in others (Engels, Duijsens, Haringsma, & Van Putten, 2003).
As follow-up studies are subject to attrition and their high costs may
limit the sample size, the age span, or the range of targeted diagnoses,
cross-sectional designs provide crucial complementary information. They
confirm a reduced likelihood of PD as age increases (Abrams & Bromberg,
2006; Jackson & Burgess, 2000), especially in cluster B (Torgersen, Kringlen, & Cramer, 2001). Importantly, rates of impulsivity and deliberate
self-harm in borderline subjects, as well as dissocial acting-out in psychopaths, have been reported to fall at older ages (Huchzermeyer et al., 2008;
Stepp & Pilkonis, 2008). Conversely, A and C clusters appear to remain
stable over the life span (Coid, Yang, Tyrer, Roberts, & Ullrich, 2006; Samuels et al., 2002) or even increase (Torgersen et al., 2001).
Otherwise, the literature in this field is limited by the fact that DSM-IV
PDs are not natural kinds, but largely arbitrary arrangements based on
consensus. Indeed, diagnostic categories have proved to be relatively heterogeneous, grouping criteria that are not particularly correlated with
each other (Widiger & Trull, 2007). As a consequence, not only may each
diagnostic category evolve differently over time (Johnson et al., 2000), but
individual criteria within the same disorder appear to evolve in opposite
directions and at different rates. A notable example is that while self-mutilation, parasuicide, and demandingness subside quickly in Borderline
patients, feelings of intense anger or abandonment persist for a long time
(Zanarini et al., 2005). This heterogeneity may have led to some confusing
findings, and may have obscured some relevant developmental divergences. Moreover, it has been one of the reasons for the overhaul of the taxonomy in the future DSM-5, which may render previous knowledge obsolete.
Against this background, the current study cross-sectionally examines
in a clinical sample the change patterns in the full range of personality
disorders and criteria over the lifespan.

Method
Participants
The sample was composed of 1,477 patients between ages 15 and 82 (M=
34.5, SD=11.6), 54% female, consecutively referred to the Psychology Department of a General Hospital for personality assessment during a 6-year
period. Most of them (84.5%) had a Personality Disorder diagnosis accord-

PERSONALITY DISORDER IN THE LIFE COURSE765

ing to the PDQ-4+, with all disorders being represented. Half of the patients also presented concomitant Axis I disorders, mainly affective and
anxiety disorders, which were clinically diagnosed by the referring staff
and again by an experienced clinical psychologist (FG). Exclusion criteria
were psychosis, severe affective disorder or cognitive impairment. All patients gave informed consent to participate in the study.

Instruments
The Personality Diagnostic Questionnaire4+ (PDQ-4+; Hyler, 1994) is a
99-item self-report whose items closely reflect the DSM-IV criteria for PDs.
It assesses the ten official PDs plus the Negativistic and Depressive disorders. For this study we used dimensional criteria counts instead of categories. The Spanish version of the PDQ-4+ has shown suitable psychometric properties (Calvo, Caseras, Gutirrez, & Torrubia, 2002).

Data Analysis
Multiple linear regressions were performed with age predicting the total
PDQ-4+ score, clusters, and individual PDs. Logistic regressions were performed for the 93 PD criteria. In both cases, sex and agesex effects were
controlled for. Age2 and age3 were additionally introduced in order to detect nonlinear associations. Age was next polytomized into seven categories (from 20 or less to 50 or more) for graphical purposes. Percentages of
change were obtained from the mean difference between the initial and
the final age categories. SPSS 16.0 was used for all analyses.

Results
The PDQ-4+ total score decreased with age by a rate of .191 criteria lost
per year, that is, 5.7 (15.4%) criteria over 30 years (age 20 to 50). Though
the three clusters declined, they did so at different rates: B traits at .085
per year (22.2% through the lifespan), C traits at .044 (12.6%), and A
traits at .027 (9.7%).
Changes in individual disorders were highly variable, ranging from losses of .039 to gains of .011 criteria per year, or from 44.9% criteria lost to
17.5% criteria gained over 30 years (Table 1). Nine of 12 individual disorders decreased to some extent across age groups. From greater to lesser
effect size, we found significant declines for Antisocial, Borderline, Paranoid, Negativistic, Dependent, Avoidant, Narcissistic, Schizotypal, and Depressive disorders. While Histrionic and Obsessive PDs did not change
significantly, Schizoid features tended to increase slightly with age. Age
explained a range of between R2=.001 (Obsessive) to R2=.045 (Antisocial) of this variation, with mean R2=.015.
Additionally, differences between age groups in clusters and disorders
were examined graphically in search of nonlinear developmental patterns.

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GUTIRREZ ET AL.
Table 1. Mean Scores, Percentages of Change with Age,
and Multiple Linear Regressions of PDQ-4+ Disorders on Age
% Change
Multiple Regression
Mean
Age 20
DSM-IV PDs1,2
Score (SD)
to 50
R
B
p
PAR
SZD ()
STP
HIS
NAR
BOR ()
ANT
AVD
DEP
OBS ()
NEG
DPR
CLUSTER A
CLUSTER B
CLUSTER C ()
PDQ TOTAL

2.6
2.0
3.1
2.5
2.4
3.9
1.4
3.5
2.6
3.8
2.4
4.3
7.8
10.2
9.9
34.5

(1.9)
(2.1)
(1.5)
(1.7)
(1.8)
(2.3)
(1.5)
(1.7)
(2.0)
(2.2)
(1.6)
(2.0)
(4.3)
(5.6)
(4.6)
(14.7)

24.9
17.5
11.4
8.4
13.1
26.2
44.9
12.9
23.8
4.1
22.3
8.7
9.7
22.2
12.6
15.4

.024
.007
.005
.003
.005
.039
.045
.008
.015
.001
.022
.006
.005
.031
.013
.023

.025
.011
.013
.007
.011
.039
.028
.016
.023
.005
.020
.013
.027
.085
.044
.191

<.001
.001
.007
.053
.006
<.001
<.001
<.001
<.001
.163
<.001
.004
.006
<.001
<.001
<.001

Notes. 1PAR=Paranoid; SZD=Schizoid; STP=Schizotypal; HIS=


Histrionic; NAR=Narcissistic; BOR=Borderline; ANT=Antisocial;
AVD=Avoidant; DEP=Dependent; OBS=Obsessive; NEG=Negativistic; DPR=Depressive. 2=significantly greater change for men; =
significantly greater change for women.

Although most disorders roughly fitted linear relationships, Figures 1 and


2 also show some meandering developments. Cluster A features declined
more sharply around age 30 and then followed divergent pathways: whereas Schizoid features constantly increased and Paranoid features decreased, Schizotypal features followed an irregular pattern, double-peaking in the second and fourth decades of life. B features (plus Negativistic,

Figure 1. Change in the number of criteria for A, B, and C clusters across age groups.

PERSONALITY DISORDER IN THE LIFE COURSE767

Figure 2. Change in the number of criteria for individual disorders across age groups.

768

GUTIRREZ ET AL.

not reported) showed abrupt falls at the beginning of the third and the
fourth decades of life, reaching their lowest rates at age 45, preceded in
the case of Histrionic features by a peak around age 30. Finally, cluster C
disorders (plus Depressive) seemed to remain quite stable until age 35,
then declining gradually over the following two decades. However, the regressions did not fit quadratic or cubic relationships for any disorder.
Some agesex interactions were significant, with greater decreases for
men in Borderline features (.054, p<.001 vs. .021, p=.004) and for
women in Schizoid (.020, p<.001 vs .002, p=.745), Obsessive-Compulsive (.014, p=.008 vs .004, p=.432) and cluster C features (.064, p<
.001 vs .023, p=.125).
Because of the acknowledged heterogeneity within PD categories we extended the analyses to the level of individual criteria. Forty-five of 93 criteria decreased with age, while only seven increased (Table 2, only significant coefficients reported). Changes were nontrivial, ranging from losses
of 65.2% to gains of 134.7% over the initial score. Thirty-two criteria
descended by 25% or more from age 20 to age 50. Overall, the criteria
followed the tendency of their corresponding disorder, though with a considerable degree of dispersion. For some disorders, however, regression
coefficients represented an average parameter that merely obscured a
number of diverging trends in criteria. For example, Histrionic and Obsessive-compulsive features were heterogeneous, in spite of their apparent
linear stability. Whereas three Histrionic criteria significantly decreased
(Seductive, Theatrical/dramatic, and Attention seeking), one criterion increased (Shifting/shallow emotions) and the rest remained stable. As for
Obsessive PD, Workaholism and Stinginess increased with age, while Preoccupied with details and Reluctant to delegate decreased. Likewise, the
decline of Depressive features was supported by only three criteria (Pessimism, Inadequacy/worthlessness, and Guilty/remorseful), whereas one
of them increased (Brooding/worried). Additionally, agesex interactions
were found for 13 criteria, with decreases most often attributable to women (Table 2).
Finally we checked for the existence of floor or ceiling effects, that is,
scores increasing or decreasing more intensely simply because they were
lower or higher in the youngest group. We correlated the initial score (age
20) with the age-related change coefficient. A trend was indeed detected,
though the correlation was nonsignificant (r=.143, p=.171).

Discussion
Our results suggest that many pathological personality features abate
with age. Subjects aged over 50 have lost on average a sixth of all their
pathological criteria compared with the youngest group. This decline is
asymmetrical, with the largest falls occurring in B traits. Shrinkage also
presents exceptions, as Histrionic and Obsessive-Compulsive scores do

PERSONALITY DISORDER IN THE LIFE COURSE769


Table 2. Relative Frequencies, Percentages of Change with Age,
and Logistic Regressions of the PDQ-4+ Criteria on Age1
%
Change
Logistic Regression2
Relative
Age 20
DSM-IV-TR Criteria3,4
Frequency
to 50
RN

p
NEG Passive resistance to tasks
NAR Fantasies of unlimited success
NEG Envy/resentment
ANT Failure to conform to norms
ANT Irresponsibility
ANT Conduct disorder before 15
ANT Recklessness
ANT Deceitfulness
PAR Perceives attacks to reputation
BOR Impulsivity
PAR Doubts partners fidelity
DEP Need reassurance in decisions
DEP Need replace relationships ()
STP Suspiciousness
BOR Intense/unstable relationships ()
BOR Affective instability ()
PAR Doubts friends loyalty
BOR Dissociative/paranoid
HIS Seductive ()
DEP No doing things by his/her own
AVD Socially inhibited
HIS Theatrical/dramatic
DEP Transfers his/her responsibilities
STP Ideas of reference
BOR Identity disturbance
DEP Need of nurturance/support
HIS Attention seeking ()
ANT Failure to plan ahead
NEG Complaints of misfortune
PAR Finds hidden meanings
BOR Intense anger ()
STP Narrowed/inappropriate affect ()
NEG Feels misunderstood
DPR Pessimism
OBS Preoccupied with details
DPR Inadequacy/worthlessness
DPR Guilty/remorseful
BOR Chronic emptiness
STP Odd thinking/speech
AVD Feels inept/inferior
NAR Sense of uniqueness
BOR Abandonment avoidance
AVD Preoccupied about rejection
AVD Avoids new activities
OBS Reluctant to delegate ()
DPR Brooding/worried
HIS Shifting/shallow emotions
SZD Indifferent to criticism ()
OBS Stinginess ()
OBS Workaholism
SZD No interest in sex
SZD-STP No close friends

.24
.24
.15
.14
.13
.13
.27
.18
.32
.43
.29
.34
.23
.36
.24
.50
.49
.24
.13
.43
.30
.29
.33
.43
.58
.30
.22
.42
.41
.41
.48
.36
.42
.56
.60
.65
.60
.45
.38
.65
.61
.64
.70
.71
.80
.68
.61
.28
.18
.31
.15
.12

65.2
65.1
63.1
61.4
60.9
55.9
55.1
53.7
51.9
47.5
43.3
39.0
36.4
36.1
35.8
33.4
32.0
31.7
31.6
31.2
30.5
30.0
28.9
27.1
26.8
25.9
25.9
25.8
25.3
22.9
22.3
21.7
21.7
21.4
21.4
18.1
16.6
16.4
16.2
16.0
16.0
11.1
10.5
9.6
7.4
11.9
20.7
23.3
35.6
40.1
102.5
134.7

.064
.064
.039
.033
.031
.025
.045
.028
.046
.057
.026
.024
.013
.022
.013
.031
.028
.010
.006
.020
.012
.011
.011
.015
.026
.008
.006
.013
.012
.009
.012
.007
.009
.015
.018
.016
.010
.005
.004
.012
.010
.005
.006
.004
.006
.006
.011
.004
.006
.011
.025
.031

.046
.046
.039
.037
.036
.031
.037
.031
.036
.038
.027
.025
.020
.023
.020
.027
.025
.017
.015
.022
.017
.017
.017
.018
.025
.014
.013
.017
.017
.015
.016
.013
.014
.019
.020
.019
.015
.011
.010
.017
.015
.011
.012
.010
.013
.012
.017
.010
.013
.016
.028
.032

<.001
<.001
<.001
<.001
<.001
<.001
<.001
<.001
<.001
<.001
<.001
<.001
<.001
<.001
<.001
<.001
<.001
.002
.034
<.001
.001
.001
.001
<.001
<.001
.004
.021
<.001
<.001
.001
<.001
.007
.002
<.001
<.001
<.001
.001
.016
.038
<.001
.001
.017
.011
.031
.018
.014
<.001
.047
.021
.001
<.001
<.001

Notes. 1Only criteria changing significantly are shown; 2RN=Nagelkerkes R; 3PAR=Paranoid; SZD=Schizoid; STP=Schizotypal; HIS=Histrionic; NAR=Narcissistic; BOR=Borderline; ANT=Antisocial; AVD=Avoidant; DEP=Dependent; OBS=Obsessive; NEG=Negativistic; DPR=Depressive; 4=significantly greater change for men; =significantly
greater change for women.

770

GUTIRREZ ET AL.

not show significant linear changes, whereas Schizoid features seem to


increase over the life course.
Analyses at the criterion level have special relevance, as they bypass
arbitrary aggregations of weakly related features that may conceal true
relationships. Our results reveal that, with the passage of time, major
changes occur concerning behavioral control, normativity, mood, relationships, autonomy, and achievement. Specifically, antisocial and risky behaviors decline, and older people become more prudent, normative, and
responsible. Negative affects such as pessimism, emptiness, or guilt decrease, and mood attains greater stability. Self-esteem and sense of identity are strengthened, while feelings of inadequacy decline. Relationships
mellow in several forms: they lose turbulence and neediness, and become
less affected by envy, suspicion, jealousy, resentment, and rage. Finally,
regarding achievement, subjects renounce unrealistic ambitions, complain less, and have less difficulty assuming responsibilities, initiating
projects, and taking decisions. Though this picture may appear overstated
at first glance, age-related reductions actually range from 7.4% to 65.2%,
representing a change that is by no means negligible. This said, the other
half of the criteria remain largely impervious to aging. Among the most
stable (i.e., the ones that change less than 10%) we found traits of paramount clinical relevance such as abandonment fear, unhappiness, helplessness, anhedonia, self-blaming, hypermorality, hypercriticism, perfectionism, detachment, odd beliefs/perceptions, or argumentativeness.
On the one hand, our findings agree with the notion that personality
does not stop developing in young adulthood (Helson, Kwan, John, &
Jones, 2002). At least pathological traits do not, as changes fit linear rather than quadratic relationships and are detectable up to age 50. A corollary is that stability is not a distinctive quality of personality pathology,
nor does it differentiate PDs from the rest of psychopathology (Krueger &
Tackett, 2005). For example, agoraphobia, social phobia, or posttraumatic
stress disorder have been found to be more persistent than PDs in a twoyear follow-up (Shea & Yen, 2003).
On the other hand, our results support the previous finding that personality, either normal or disordered, generally develops towards greater
maturity; that is, less negative affectivity, greater control, and enhanced
self-esteem (Caspi, Roberts, & Shiner, 2005; Hopwood et al., 2011). The
analysis at the criterion-level offers a more fine-grained account of these
changes. For example, we found confirmation for a more pronounced drop
in cluster B traits, but it is specifically the externalizing aspects of B that
fall: impulsivity, rule breaking and emotional turmoil. Interpersonal styles
like selfishness, self-importance, remorselessness, lack of empathy, manipulation, and abandonment fears remain the same. The results also
confirm less dramatic declines in A and C features, but it is neediness and
suspiciousness that abate notably, whereas social fears, rigidity, rareness, or detachment remain roughly stable or increase slightly. Changes
are hardly attributable to concomitant psychopathology, even though de-

PERSONALITY DISORDER IN THE LIFE COURSE771

pression and anxiety have been reported to lessen with ageing (Kessler et
al., 2010; Ramsawh et al., 2009). The facts that impulsivity, antisociality,
or mistrust decreased the most, that unhappiness, helplessness, anhedonia, and self-blaming did not change at all, and that equivalent personality changes are usually reported in nonclinical populations, suggest that
they are the traits themselves that move. Finally, the finding of divergent
developmental trajectories supports the suggestion that PDs may be hybrid entities: whereas enduring temperamental traits constitute the hardcore of the disorder, acute traits may be present which are more volatile
and amenable to the shaping forces of socialization, psychotherapy, or life
swings (Clark, 2009; Skodol et al., 2005).
If the longitudinal changes of PDs remain poorly understood, their
causes are pure conjecture. Approaches upholding an intrinsic maturation process have shown that we share with other species not only our
personality structure (Goslin, 2008), but also age-related developmental
patterns. The decreases in Extraversion and Openness and the increases
in Agreeableness and Conscientiousness recorded in chimpanzees parallel
those observed in humans, both in direction and effect size (King, Weiss,
& Sisco, 2008). Personality changes may then be manifestations of preprogrammed, naturally selected changes with an evolutionary significance. For instance, B traits such as impulsivity, sensation-seeking, risktaking or aggressiveness would peak in young adults because they play a
key role in intra- and inter-sexual competition (Archer, 2009). Indeed,
these features have proved to increase the number of mates, including
extra-pair mates (Nettle, 2006), and then burn out around age 40 (Harpur
& Hare, 1994; Paris, 2004). Likewise, the peak in histrionic features in the
30s coincides with a peak in sexual activity that would increase reproduction in a long-term mating context (Schmitt et al., 2002). Cluster C disorders, for their part, are rooted in fear/anxiety devices whose alleged function is to notice and manage threats (Lang, Davis & hman, 2000). These
traits remain stable until the end of the reproductive age and then decline,
just when natural selection becomes weaker.
However, age-related changes are better understood as the result of the
interaction between intrinsically biological maturation and ulterior calibrations by life experience (Roberts, Caspi, & Moffit, 2003). Despite greater evidence of interactional effects at early ages (Belsky, 2010), it is not
implausible that PDs could, through the permanent interaction with the
environment, become settled in more favorable niches or develop more efficacious coping strategies (Ready & Robinson, 2008). The result would be
a mitigation of part of their symptomatology during the lifetime. Indeed,
both intrinsic maturation and the environment have proved to carry
weight regarding ageing-related personality changes (Hopwood et al.,
2011).
The interpretation of our findings requires some caveats. Cross-sectional designs are vulnerable to cohort effects. For example, subjects born in
the 1960s grew up in a very different cultural context than those born in

772

GUTIRREZ ET AL.

the 1990s, with possibly significant effects on their personalities. Likewise, people may seek professional advice for different problems as they
grow old. In addition, some Axis II criteria may be less applicable in elderly samples (Balsis, Woods, Gleason-Marci, & Oltmanns, 2007): for example, the rise in Schizoid traits with age is partly due to the falling off in
sexual interest and the number of friends, and hence is as attributable to
physical ageing or to life changes as to true declines in affiliation mechanisms. Finally, the PDQ-4+ is a screening instrument assessing self-reported traits. This allowed us to obtain a considerable sample size, but the
measured traits cannot be taken as formal PD diagnoses.
In short, half of the pathological personality features decrease to some
extent over the lifespan, and a third of them have lost over a quarter of
their prevalence by the fifth decade of life. Individual PD criteria change in
a different degree and at a different rate even within the same diagnostic
category, including opposite-sign evolutions within the Histrionic, Obsessive, and Depressive disorders. Our findings suggest that PDs are less
stable, but also more developmentally heterogeneous, than previously
thought.

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