The research on personality disorders in late life is sparse. This book provides a meta-analysis review of the literature. Contrary to the notion that personality disorders attenuate, the review indicates that the overall prevalence for the 50-plus-year-old age group is 20%, compared with 22% for the under-50-year-old age group. The most frequent personality disorders in the older group were paranoid, schizoid, and self-defeating disorders. More interesting yet is that the authors believe DSM guidelines discourage clinicians from making this diagnosis. This seems right. How many thousands of charts have we all seen without an axis II diagnosis? Rather than a negative age effect on the rate of personality disorders in the elderly, it may be that there is a slightly higher rate resulting from the significant and difficult adjustments required of the older patient, who, because of latent or mild maladaptive personality traits, is less able to change and adjust effectively. It appears that older individuals with personality disorders are more vulnerable to major depression, likely reflecting their increasingly poor adaptation. From my own work in nursing homes, the 20% rate seems generally right, although a much higher rate of 60% and higher in some facilities with large psychiatric populations is not uncommon.