Aetiology

A growing body of research supports a multifactorial model of personality disorder, incorporating both biological and environmental factors. A recent review found that about half the variance in personality trait scores is attributable to the genetic differences between individuals (Bouchard, 1997), but investigators have not yet managed to identify the genes responsible for specific personality traits or disorders. Lang & Vernon (2001) observe that the controversies about definitions and classifications of personality disorder have hampered progress in the field because the clearly defined phenotypes required by genetic methodologies are not yet available to provide a suitable starting point. Meanwhile, research continues into neurophysiological, cognitive and structural correlates of personality disorder. Among the neurotransmitters, serotonin has been most extensively investigated and has been consistently linked with aggression and impulsivity. A smaller number of studies into the role of the catecholamines in personality disorder have so far yielded conflicting results but suggest that dopamine function may be positively correlated with positive symptoms in schizotypal patients and negatively correlated with deficit symptoms in those individuals. Neuroimaging and neuropsychological studies have mainly focussed on individuals with schizotypal personality disorder and show that these subjects, particularly those with deficit symptoms, are likely to demonstrate impairment on attentional tasks and tests of executive function, which seems to be associated with increased ventricular size and reduced dopamine function (Coccaro, 2001).

Psychosocial perspectives on personality disorder identify the main risk factors for development of these disorders as dysfunctional families (family breakdown, parental psy-chopathology and inadequate/abusive parenting); trauma (particularly childhood abuse or neglect) and social stressors such as the reduced availability of extrafamilial social supports in modern society (Millon, 1993; Paris 1992, 1996). Attachment theory has received renewed attention in understanding the genesis of the interpersonal difficulties that identify personality disorders (Bartholomew, Kwong & Hart, 2001). Reviewing the literature, Paris (2001) concludes:

• the psychosocial risk factors for many types of psychological disorder are similar;

• many (perhaps most) children exposed to any of these risk factors will not develop a psychological disorder; and

• multiple adversities have a cumulative effect, eventually overwhelming children's natural resilience.

The current consensus is that childhood adversities interact with biological vulnerabilities expressed as personality traits to produce personality disorders; these traits may also increase the individual's exposure to adverse events (Rutter & Rutter, 1993).

Letting Go, Moving On

Letting Go, Moving On

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