Question

My grandmother's behavior is destructive, controlling and somewhat manipulative, in an effort to gain attention. What can be done?

Answer

Several authors have suggested that an anti-social personality results from a failure of social learning. They do not identify a particular problem occurring in older people. There are several theories about anti-social behaviour and one, which may be appropriate, is that it may have been learnt as a way of overcoming some emotional problem, such as to hide inferiority or perhaps a developing condition such as Alzheimer's disease. It may also have been learnt because of the poor ability to otherwise sustain attention. There may be an association with brain injury. It may result from depression or a feeling of vulnerability. Often the personality may be the same as that which was apparent at a younger age but more so. Perhaps old age, poverty, loss or isolation can best be borne by a hostile primitive attitude. There may be some situations where adjustments in coping mechanisms have failed. It may also be that the person has been unable to cope with setbacks except through attack (using it as a means of defense) with subsequent attempts to move aggressively against some perceived threat.

The question must be whether the personality trait causes the patient harm or tries the relatives beyond the point of endurance. If either is so, then perhaps some intervention may be justified. Equally, perhaps the first step would be in defining the nature of the personality problem and if possible, identifying the causes for it. It is unlikely that such teasing out of the problem would be possible without expert help.