To ascertain the prevalence of personality disorder in elderly patients with major depression and to explore issues of diagnostic practice and bias, the authors reviewed triaxial diagnoses of 2322 psychiatric hospital inpatients with Axis I diagnoses of major depression. They found that Axis II diagnoses had been made in 367 cases (15.8%). Patients older than 65 years of age had a significantly lower rate of Axis II diagnoses. The age effect was greatest for women with comorbid physical illness. In contrast to the age-related decline in rate of Axis II diagnoses in general, the diagnosis of compulsive personality disorder increased with age and comprised 46% of all Axis II comorbidities in patients 65 years or older. Possible explanations and implications for future research are discussed.
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