Aetiological risk factors for personality disorders

<jats:sec><jats:title>Background</jats:title><jats:p>Elucidation of aetiological processes leading to development of Axis II disorders is important in category validation and could lead to new treatments.</jats:p></jats:sec><jats:sec><jats:title>Aims</jats:title><jats:p>To establish aetiological associations between Axis II disorders and specific risk factors.</jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p>Male and female subjects (<jats:italic>n</jats:italic>=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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>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) disorders 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.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>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.</jats:p></jats:sec>