Aetiological risk factors for personality disorders

Background Elucidation of aetiological processes leading to development of Axis II disorders is important in category validation and could lead to new treatments. Aims To establish aetiological associations between Axis II disorders and specific risk factors. Method Male and female subjects (n = 260) in maximum security hospitals and prisons were interviewed to determine DSM - III Axis II and lifetime Axis I diagnoses. Aetiological risk factors were obtained at interview and from case files. Independent statistical associations were established by logistic regression. Results Axis II categories were divided into four groups: (a) disorders of character development, secondary to an adverse early environment: antisocial, self-defeating and paranoid; (b) disorder; of temperament, secondary to constitutional aetiology: avoidant, dependent, schizoid and schizotypal; (c) a 'mixed' disorder of constitutional and environmental aetiology: borderline; and (d) aetiological associations not established: narcissistic, histrionic, compulsive and passive-aggressive. Conclusions The study validates several Axis II categories but challenges the inclusion of others within Axis II of DSM - IV, in particular schizoid, schizotypal, avoidant and borderline personality disorders. The findings have implications for future treatment interventions.