A recent study by Modestin, Oberson, & Erni (Acta Psychiatrica Scandinavica, 97, 260-266 (1998)) addressed the important topic of whether there are clear environmental forerunners to personality disorders as we are led to believe. This study was an ambitious undertaking that involved conducting initial diagnostic interviews on 102 patients (out of a total of 361 eligible) admitted to a psychiatric facility in Switzerland; 73 of the patients met criteria for a personality disorder. The Scandinavica investigators employed a semi-structured psychiatric interview; early traumatic experiences such as physical or sexual abuse, witnessing of domestic violence, broken home, and separation of significant others were included in the interview.

Unfortunately, the author's conclusions that early childhood traumatic experiences and negative parental attitudes are likely antecedents to personality disorder can be taken only as suggestive. A number of limiting factors in the research design preempt any firm conclusions because alternative hypotheses not studied (for example, genetic factors) could explain the results equally well. These included small sample sizes, no reliability estimates to assure that the diagnoses were accurate, and no control group from which to draw differential conclusions.

Although the study finds early traumatic and negative parental factors present in many of the cases, these factors have not been shown to be either necessary or sufficient to bring on personality disorders. Can the results of this study provide any guidance to mental health and legal professionals working in the area of family law? The findings of the study, along with other research in the field, do reflect an association between environmental trauma and negative parenting and deviant personality development. This link between early trauma and later personality clearly warrants some consideration when important decisions about family placements, custody, and so forth need to be made.