اختلالات شخصیت و شیوه های مقابله در میان افراد مسن مضطرب

Abstract This study examined the interrelationships among anxiety, personality disorders, and coping strategies in anxious older adults Full-size image (<1 K), nonanxious older adults Full-size image (<1 K), and anxious younger adults Full-size image (<1 K). Younger participants were college students and older participants were community-based family members of the students or recruits from local senior centers. Participants completed the Coolidge Axis II Inventory, the Coping Orientations to Problems Experienced scale, and the Brief Symptom Inventory. Results indicated that the prevalence of generalized anxiety states was relatively low and similar in both older and younger groups and dependent on measurement scale and criterion. At least one personality disorder was found in 61% of the older persons group; obsessive-compulsive, schizoid, and avoidant were the most frequently assigned personality disorders. Anxious older adults had elevated rates of dependent and avoidant personality disorder compared with nonanxious older adults. Younger anxious persons were found to have significantly greater personality dysfunction compared with older anxious persons. Finally, coping differences existed between older anxious and older nonanxious adults and between older anxious and younger anxious adults. Implications for diagnosis and treatment of anxiety in older adults were discussed.

Results The sample of older persons Full-size image (<1 K) was first examined for the overall rates of anxiety. On the BSI anxiety scale 22% (28 of 128 cases) had T scores of 60 or more, and 3% (4 of 128 cases) had T scores of 70 or more. The anxiety scale of the CATI appeared to be more conservative: 7% (9 of 128 cases) had T scores of 60 or more, and less than 1% (1 of 128 cases) had T scores or more than 70. Correlations between age and the BSI anxiety scale Full-size image (<1 K) and the CATI anxiety scale Full-size image (<1 K) were both small. Interestingly, a specific item on the CATI, “I worry a lot,” also had a small correlation with age of r = −.06. Thirty percent of the sample answered “More True Than False” and 16% answered “Strongly True” to the latter item; however, these percentages are not significantly different than in the CATI normative sample Full-size image (<1 K). The prevalence of personality disorders was also examined in the older anxious group (based on elevated BSI anxiety scale scores), and the results are presented in Table 1. Sixty-one percent of the sample (17 of 28 cases) met criteria Full-size image (<1 K) for at least one personality disorder. The mean number of personality disorders per person in this sample was 1.4, and the range was from 0 to 6 personality disorders. As seen in Table 1, the most prevalent personality disorders were obsessive-compulsive (39%), schizoid (39%), and avoidant (29%). Table 1. Prevalence of Personality Disorders on the Coolidge Axis II Inventory Among Anxious Older Adults (N= 28;T≥ 60) Personality Disorder Scales n Percentage Obsessive-compulsive 11 39 Schizoid 11 39 Avoidant 7 29 Dependent 2 7 Depressive 2 7 Self-defeating 2 7 Paranoid 1 4 Histrionic 1 4 Antisocial 0 0 Borderline 0 0 Narcissistic 0 0 Sadistic 0 0 Passive-aggressive 0 0 Schizotypal 0 0 CATI = The Coolidge Axis II Inventory. Table options To test the first hypothesis that personality disorder differences may exist between anxious and nonanxious older persons, the older sample Full-size image (<1 K) was divided into two groups on the basis of their BSI anxiety T score: those with a T score of 60 or more were classified as anxious; those with a T score less than 60 were classified as nonanxious. Multiple analyses of variance (ANOVAs) were performed on the 14 personality disorder scales of the CATI between the anxious elderly group Full-size image (<1 K) and the nonanxious elderly group Full-size image (<1 K). A summary of the means, standard deviations, and ANOVAs for the 14 CATI scales appears in Table 2. Table 2. A Summary of ANOVAs on the Coolidge Axis II Inventory Personality Disorder Scale T Scores in the Elderly Sample as a Function of Anxiety Grouping Personality Disorder Scale Anxiety Group Mean Standard Deviation F Value Significance Level (α) Dependent Anxious 50.9 6.3 15.85 .001* Nonanxious 44.0 8.4 Avoidant Anxious 53.3 9.2 11.34 .001* Nonanxious 46.4 9.5 Obsessive-compulsive Anxious 55.8 9.4 7.71 .006 Nonanxious 50.0 10.0 Depressive Anxious 49.7 8.4 7.68 .006 Nonanxious 44.4 9.2 Borderline Anxious 44.8 5.7 7.53 .007 Nonanxious 41.0 6.7 Passive-aggressive Anxious 47.2 7.4 5.70 .018 Nonanxious 42.7 9.2 Self-defeating Anxious 51.4 6.5 5.46 .021 Nonanxious 47.5 8.0 Paranoid Anxious 46.2 8.7 4.58 .034 Nonanxious 41.9 9.4 Schizotypal Anxious 46.8 6.9 3.98 .048 Nonanxious 43.0 9.5 Narcissistic Anxious 43.9 5.8 1.65 .201 Nonanxious 41.5 9.3 Schizoid Anxious 56.3 10.1 0.42 .517 Nonanxious 57.6 9.2 Histrionic Anxious 45.1 8.5 0.18 .676 Nonanxious 44.3 8.8 Antisocial Anxious 42.1 5.3 0.25 .876 Nonanxious 42.3 7.3 Sadistic Anxious 42.7 4.9 0.02 .885 Nonanxious 42.5 6.3 * Significant according to the Holm's modified Bonferroni procedure. All other contrasts are considered nonsignificant. Table options To control for the experiment-wise error rate across these contrasts while maintaining sufficient statistical power, a modified Bonferroni method suggested by Holm (1979) was used. According to Holm, the p values of the F values in the ANOVAs are ordered from smallest to largest. The smallest p value is measured against an alpha of .05 divided by the total number of contrasts performed. If the contrast is found to be significant at this level, then the next smallest p value is measured against an alpha level of .05 divided by the value k − 1, representing the remaining number of contrasts. This procedure is continued until a nonsignificant difference is observed. At that point, all remaining contrasts are considered nonsignificant. Using the Holm procedure, it was found that the dependent and avoidant personality disorders were both significantly elevated in the anxious group at p < .004. Eta2 was used as a measure of effect size (i.e., the proportion of variance in one variable that can be accounted for by the other variable). The Eta2 for the dependent personality disorder and anxiety indicated that they shared 11% of common variance. The Eta2 for the avoidant personality disorder and anxiety showed 8% common variance. These findings suggest a small to modest effect size. To test the second hypothesis that anxious and nonanxious older persons would use different coping mechanisms, three between-group ANOVAs were performed on the three cluster scores of the COPE scale. According to the Holm technique, only the dysfunctional cluster was significantly elevated in the anxious group relative to the nonanxious group, Full-size image (<1 K). The Eta2 for the dysfunctional cluster and anxiety was .10. Two of the five subscales of the COPE dysfunctional cluster were significantly elevated in the anxious group on subsequent investigation with Holm's modified Bonferroni technique: the mental disengagement scale, Full-size image (<1 K), and the behavioral disengagement scale, Full-size image (<1 K). Coping differences between the anxious older and anxious younger persons were also examined. Again, three between-group ANOVAs were performed on the three cluster scores of the COPE. According to the Holm technique, both the dysfunctional cluster and the problem-focused cluster scores were significantly different between the older and younger anxious adults. The younger group was significantly more elevated on the dysfunctional cluster Full-size image (<1 K), and the older group was significantly more elevated on the problem-focused cluster Full-size image (<1 K). Regarding dysfunctional coping, younger adults were significantly higher on the mental disengagement subscale as well as the alcohol and drug use subscale. With respect to problem-focused coping, older adults were higher on the planning, restraint coping, and suppression of competing activities subscales. To test the third hypothesis that older anxious people would have different personality disorder features than younger anxious people, the same sample of anxious elderly persons was compared with a group of younger anxious persons (n = 131, BSI Anxiety T score > 60, age ≤ 30 years) on the 14 personality disorder scales of the CATI. First, however, T tests were performed on the anxiety scales of the BSI and the CATI to determine the equivalence of the groups in their anxiety levels. These tests revealed no significant differences in anxiety between the two groups on either scale, but both groups were elevated on both scales. Multiple ANOVAs were performed on the 14 scales between the older anxious group and younger anxious group. Holm's technique revealed that the younger sample was significantly elevated on 9 of the 14 scales, whereas the older adults were significantly elevated on only the schizoid personality disorder scale. A summary of the means, standard deviations, ANOVAs, and Eta2 values for the scales appears in Table 3. Table 3. A Summary of ANOVAs on the Coolidge Axis II Inventory Personality Disorder Scale T Scores in the Younger and Older Anxious Samples Personality Disorder Scale Age Group Mean Standard Deviation F Value Significance Level (α) Eta2 Borderline Younger 55.4 8.8 36.93 .001* .19 Older 44.8 5.7 Narcissistic Younger 53.9 8.5 35.30 .001* .18 Older 43.9 5.8 Antisocial Younger 53.3 10.2 32.25 .001* .17 Older 42.1 5.3 Sadistic Younger 52.1 9.4 26.49 .001* .14 Older 42.7 4.9 Passive-aggressive Younger 53.4 8.8 21.24 .001* .12 Older 47.1 7.4 Schizoid Younger 47.2 10.0 19.20 .001* .11 Older 56.3 10.1 Histrionic Younger 52.4 9.5 13.99 .001* .08 Older 45.1 8.5 Schizotypal Younger 52.3 8.3 10.60 .001* .06 Older 46.8 6.9 Paranoid Younger 53.4 11.1 10.57 .001* .06 Older 46.2 8.7 Self-defeating Younger 56.0 8.1 8.03 .005* .05 Older 51.4 6.5 Depressive Younger 54.4 10.1 5.36 .022 .03 Older 49.7 8.4 Dependent Younger 54.8 9.3 4.60 .034 .03 Older 50.9 6.3 Obsessive-compulsive Younger 51.9 9.6 3.94 .049 .02 Older 55.8 9.4 Avoidant Younger 53.0 9.3 0.02 .876 .00 Older 53.3 9.2 ANOVA = analysis of variance. * Significant according to the Holm's modified Bonferroni procedure.