SELF-MUTILATION IN AN ELDERLY PATIENT WITH PERSONALITY DISORDER

✍ Scribed by CHANAKA WIJERATNE; JULIAN STERN; ROBERT HOWARD

• Publisher: John Wiley and Sons
• Year: 1996
• Tongue: English
• Weight: 465 KB
• Volume: 11
• Category: Article
• ISSN: 0885-6230
• DOI: 10.1002/(sici)1099-1166(199601)11:1<75::aid-gps278>3.0.co;2-h

✦ Synopsis

A 76-year-old woman presenting with depression, self-mutilation and substance abuse, in the context of physical illness, was referred for psychotherapy. Her past history was marked by long-standing dysthymia, a propensity to somatization, drug overdoses and antisocial behaviour, including the killing of her grandson. She had suffered substantial deprivation and abuse from her earliest years. She was considered unsuitable for dynamic psychotherapy because of her personality organization, her use of primitive defence mechanisms and her inability to tolerate frustration, given her propensity to act out in destructive ways towards herself and others. She was managed within a multidisciplinary team in an old age day hospital. This patient illustrates that personality dysfunction does not necessarily ameliorate with advancing age. Less overt manifestations of destructive behaviour, such as sabotage of treatment, starvation and polypharmacy, may be seen in this age group.

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