Cluster B:histrionic traits

[psychma]

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I have a relatively new client of 3 months that I inherited from a retiring psychologist. No personality pathology, PTSD, OCD, and bipolar 1 disorder. Client has had middle insomnia since November 2022 and is often sleeping 2-4 hours a night. She once fell asleep during our session. This client also stopped her risperdal cold Turkey due to excessive weight gain. She has had a sleep study, seen a sleep psychologist and has tried every sleep medication. She is now on Belsomra and her sleep is improved but insomnia symptoms persist. I have found the client to be irritable, easily frustrated and tired. She has responded to her psychiatrist in dramatic ways recently. Her psychiatrist responded by telling her she has developed cluster B traits:histrionic. My client is distraught over this and I’m having trouble processing this with her due to her experiencing overwhelming waves of anxiety and feelings of panic.

I’m not an expert on the diagnosis of cluster b but find it a little unusual that she developed this in mid life during this period of prolonged insomnia and risperdal withdrawal. Could going off risperdal and months of middle insomnia play a role in her dramatic behavior. Her psychiatrist would like to speak to me next week and I feel very uncomfortable and unsure of what to say as she is approaching me and I want to strike a balance between respecting my client and being upfront with her psychiatrist. Also, I’m not sure if I should carry over the diagnosis clinically to my practice. I have met with the husband who said she has completely changed since the insomnia and going off risperdal and he doesn’t recognize her.

 

[wolfvgang22]

I have a relatively new client of 3 months that I inherited from a retiring psychologist. No personality pathology, PTSD, OCD, and bipolar 1 disorder. Client has had middle insomnia since November 2022 and is often sleeping 2-4 hours a night. She once fell asleep during our session. This client also stopped her risperdal cold Turkey due to excessive weight gain. She has had a sleep study, seen a sleep psychologist and has tried every sleep medication. She is now on Belsomra and her sleep is improved but insomnia symptoms persist. I have found the client to be irritable, easily frustrated and tired. She has responded to her psychiatrist in dramatic ways recently. Her psychiatrist responded by telling her she has developed cluster B traits:histrionic. My client is distraught over this and I’m having trouble processing this with her due to her experiencing overwhelming waves of anxiety and feelings of panic.

I’m not an expert on the diagnosis of cluster b but find it a little unusual that she developed this in mid life during this period of prolonged insomnia and risperdal withdrawal. Could going off risperdal and months of middle insomnia play a role in her dramatic behavior. Her psychiatrist would like to speak to me next week and I feel very uncomfortable and unsure of what to say as she is approaching me and I want to strike a balance between respecting my client and being upfront with her psychiatrist. Also, I’m not sure if I should carry over the diagnosis clinically to my practice. I have met with the husband who said she has completely changed since the insomnia and going off risperdal and he doesn’t recognize her.

There's nothing wrong with telling the psychiatrist you are wondering if the insomnia and coming off Risperidone is contributing to the patients recent behavior. Also nothing wrong with telling the psychiatrist the patient is distraught with the histrionic label. Rather than directly challenge the histrionic traits diagnosis, I might just tell the psychiatrist that I myself am "ruling out" cluster B traits and haven't put it in the chart yet myself and giving the patient time to get throughthis rough patch, because if it is a personality disorder it will still be there to put in the chart later. 😉 A good psychiatrist will listen and appreciate your input, whether they end up agreeing or not. I would say " Is there something I can do to help the patient sleep better? Would medication help?"

I would not bluntly say "this patient needs a med change or something for sleep." I get defensive when I hear that. I try not to, but I do sometimes, because it's usually uttered by our newer therapists who don't realize the patient has already tried a number of medications, doesn't adhere to them, doesn't engage in therapy with the last 4 therapists, etc, etc.

 

[psychma]

There's nothing wrong with telling the psychiatrist you are wondering if the insomnia and coming off Risperidone is contributing to the patients recent behavior. Also nothing wrong with telling the psychiatrist the patient is distraught with the histrionic label. Rather than directly challenge the histrionic traits diagnosis, I might just tell the psychiatrist that I myself am "ruling out" cluster B traits and haven't put it in the chart yet myself and giving the patient time to get throughthis rough patch, because if it is a personality disorder it will still be there to put in the chart later. 😉 A good psychiatrist will listen and appreciate your input, whether they end up agreeing or not. I would say " Is there something I can do to help the patient sleep better? Would medication help?"

I would not bluntly say "this patient needs a med change or something for sleep." I get defensive when I hear that. I try not to, but I do sometimes, because it's usually uttered by our newer therapists who don't realize the patient has already tried a number of medications, doesn't adhere to them, doesn't engage in therapy with the last 4 therapists, etc, etc.

I like your response. I don’t know if it will come across well from a lowly therapist. Something weird about this case is that my client was distraught when she was told and she said her psychiatrist told her that she (the psychiatrist) had tested positive for histrionic personality disorder on the Million and it was “no big deal.” I feel weird about this. I think it’s strange.

 

[TexasPhysician]

Patients commonly misinterpret what we say and have negative automatic thoughts when tired or depressed.

In your first post, you typed that the patient heard the psychiatrist say she has developed or has cluster B traits. Of course the patient has cluster B traits - we all do along the spectrum. I don’t see why they wouldn’t be more prevalent when dealing with a medical or mental health crisis. This is normal and may have been discussed with a purpose of looking at issues objectively. We weren’t there, so who knows?

In your second post, you type that the patient claimed there was a test and subsequent positive result for cluster B personality disorder. What test? What happened?

Even within your posts, I could misinterpret what was believed to have happened as first there was concern about histrionic traits and now someone has a full fledged personality disorder revealed by a test in your second post. I’m not pointing this out to criticize you as I am trying to highlight that this isn’t a clear picture. If I were sleeping 2-4 hours/night, I wouldn’t be clear either.

Inquire as to what steps the psychiatrist has taken, reveal concerns that you may have about the patient, and ask how you can be of assistance. Think of this as a discovery period to improve upon the overall plan.

 

[psychma]

Patients commonly misinterpret what we say and have negative automatic thoughts when tired or depressed.

In your first post, you typed that the patient heard the psychiatrist say she has developed or has cluster B traits. Of course the patient has cluster B traits - we all do along the spectrum. I don’t see why they wouldn’t be more prevalent when dealing with a medical or mental health crisis. This is normal and may have been discussed with a purpose of looking at issues objectively. We weren’t there, so who knows?

In your second post, you type that the patient claimed there was a test and subsequent positive result for cluster B personality disorder. What test? What happened?

Even within your posts, I could misinterpret what was believed to have happened as first there was concern about histrionic traits and now someone has a full fledged personality disorder revealed by a test in your second post. I’m not pointing this out to criticize you as I am trying to highlight that this isn’t a clear picture. If I were sleeping 2-4 hours/night, I wouldn’t be clear either.

Inquire as to what steps the psychiatrist has taken, reveal concerns that you may have about the patient, and ask how you can be of assistance. Think of this as a discovery period to improve upon the overall plan.

It was the PSYCHIATRIST who tested positive for histrionic personality disorder on the Millon according to what she told the client.

 

[wolfvgang22]

It was the PSYCHIATRIST who tested positive for histrionic personality disorder on the Millon according to what she told the client.

Well a psychiatrist probably shouldn't be telling anyone the psychiatrist has a personality disorder. 🤣🤣😅

 

[Indiana_Jane]

Well a psychiatrist probably shouldn't be telling anyone the psychiatrist has a personality disorder. 🤣🤣

Agree.

Also, from a psychometric perspective OP, no one “tests positive” on the Millon. There is no bona fide cutoff score that indicates a person does or does not have a particular personality disorder. It is one data point that should be interpreted within the context of a full assessment.

I agree with the other posters - I’d start by gaining a clearer understanding of what’s been done clinically versus what may be perceived by the patient.

If referring to the MCMI, it is notorious for overpathologizing. I wouldn’t put much stock in the findings from an MCMI absent other data, and even then…. Eh……

 

[splik]

I haven't diagnosed anyone with histrionic PD or traits since I was an intern. I work with a pt population that would historically and conceptually be viewed as highly likely to have histrionic pathology and honestly, I don't see it. The construct validity and reliability of the diagnosis is poor. The diagnosis has been largely used against women and gay men. Most people who seem to endorse these traits on the SCID-PD meet criteria for narcissistic or antisocial PD. Many of the traits such as shallow affect, speech lacking in detail, and promiscuity are classic features of psychopathy. It is a diagnosis best avoided.

That said your pt has OCD, PTSD, bipolar, and insomnia impervious to multiple pharmacological remedies. It is more likely than not that they have some degree of clinically relevant personality pathology even if they don't meet criteria for a personality disorder.

 

[psychma]

I haven't diagnosed anyone with histrionic PD or traits since I was an intern. I work with a pt population that would historically and conceptually be viewed as highly likely to have histrionic pathology and honestly, I don't see it. The construct validity and reliability of the diagnosis is poor. The diagnosis has been largely used against women and gay men. Most people who seem to endorse these traits on the SCID-PD meet criteria for narcissistic or antisocial PD. Many of the traits such as shallow affect, speech lacking in detail, and promiscuity are classic features of psychopathy. It is a diagnosis best avoided.

That said your pt has OCD, PTSD, bipolar, and insomnia impervious to multiple pharmacological remedies. It is more likely than not that they have some degree of clinically relevant personality pathology even if they don't meet criteria for a personality disorder.

Very interesting. Do you have any good literature you could share about the construct validity and reliability of the diagnosis?

What personality disorders should I look out for. She doesn’t meet criteria or come close for the other cluster B’s.

 

[smalltownpsych]

Very interesting. Do you have any good literature you could share about the construct validity and reliability of the diagnosis?

What personality disorders should I look out for. She doesn’t meet criteria or come close for the other cluster B’s.

How does this patient not have some Borderline traits? Hopefully you’re not of the mindset that BPD only includes annoying or obnoxious patients since that is not a diagnostic criteria. What I will say is that you are getting pulled into a bit of idealizing/devaluing split. It’s easy to get pulled into that when another treatment provider serves something like that up, but it doesn’t help the patient to get on their side. Practice neutrality. Read up on Kernberg’s Object Relations therapy for Borderline PD which actually has great info for people all along the various personality spectrums.

 

[Stagg737]

Well a psychiatrist probably shouldn't be telling anyone the psychiatrist has a personality disorder. 🤣🤣😅

Kind of checks out for histrionic traits though…

 

[docksan]

Kind of checks out for histrionic traits though…

I came into this topic to say the conversation is interesting and fascinating! I appreciate all the adulation, given my background as a psychiatrist! Psychiatrists are just the best! I agree the traits check out!

 

[futureapppsy2]

How does this patient not have some Borderline traits? Hopefully you’re not of the mindset that BPD only includes annoying or obnoxious patients since that is not a diagnostic criteria. What I will say is that you are getting pulled into a bit of idealizing/devaluing split. It’s easy to get pulled into that when another treatment provider serves something like that up, but it doesn’t help the patient to get on their side. Practice neutrality. Read up on Kernberg’s Object Relations therapy for Borderline PD which actually has great info for people all along the various personality spectrums.

By definition, PDs/PD traits have to be enduring and present across situations. If the patient is only demonstrating these in the context of insomnia and a medication withdrawal, I wouldn't think they would qualify as PD traits.

 

[smalltownpsych]

By definition, PDs/PD traits have to be enduring and present across situations. If the patient is only demonstrating these in the context of insomnia and a medication withdrawal, I wouldn't think they would qualify as PD traits.

I wasn’t talking about the irritability, frustration, and tiredness as the result of recent medication change as those aren’t really Borderline PD traits anyway. I was referencing the likelihood of having Bipolar, OCD, and trauma lead to some personality disruption. The patients I have worked with that had this type of presentation I actually referred to as “growing up Bipolar” to refer to how it is to learn to cope with the world with a high degree of emotional instability so I wouldn’t tend to emphasize the traits or the personality disorder other than to help the patient understand how dealing with this degree of symptomatology affected them and the way they interact with the world.

 

[Candidate2017]

She has a bipolar diagnosis but has gone off her meds, so...

Anyway, I suggest paying for supervision or completing a PhD at a reputable program. The alternative is to become another "therapist" who serves "clients". As we know, clients are always right and should get what they want (which is someone who never questions them, accepts hearsay, participates in splitting, and otherwise enables them to stay their maladaptive comfort zone).

 

[psychma]

She has a bipolar diagnosis but has gone off her meds, so...

Anyway, I suggest paying for supervision or completing a PhD at a reputable program. The alternative is to become another "therapist" who serves "clients". As we know, clients are always right and should get what they want (which is someone who never questions them, accepts hearsay, participates in splitting, and otherwise enables them to stay their maladaptive comfort zone).

Actually, I do consultative work with a PhD psychologist. He’s on vacation. I was more interested in how to talk with the psychiatrist. I’m not a therapist who serves “clients”.

 

[PsyDr]

…. I actually referred to as “growing up Bipolar” to refer to how it is to learn to cope with the world with a high degree of emotional instability …

That is not what Bipolar Disorder is, though. Affective instability is neither mania, nor sufficient evidence of Bipolar Disorder. You need a 4+ day period of time with a reduced need for sleep combined with increased goal directed activity.

The PD literature is very clear that parental behavior, and childhood experiences are the most likely etiology of PDs. The number of geographic moves in childhood is highly predictive of ASPD. The combined rate of adverse parental behaviors is predictive of development of most PDs, with some specificity of behaviors related to certain PDs.

 

[clausewitz2]

That is not what Bipolar Disorder is, though. Affective instability is neither mania, nor sufficient evidence of Bipolar Disorder. You need a 4+ day period of time with a reduced need for sleep combined with increased goal directed activity.

Affective instability is not one of the criteria for bipolar disorder, but it is unquestionably a frequent feature of bipolar disorder, even in between more pronounced episodes. It is also the case that if you look at relatives of people with bipolar disorder, they tend to be more affectively unstable. This iwould be a predicted consequence of most models of bipolar disorder, a relative fragility of mood and/or circadian states.

 

[smalltownpsych]

That is not what Bipolar Disorder is, though. Affective instability is neither mania, nor sufficient evidence of Bipolar Disorder. You need a 4+ day period of time with a reduced need for sleep combined with increased goal directed activity.

The PD literature is very clear that parental behavior, and childhood experiences are the most likely etiology of PDs. The number of geographic moves in childhood is highly predictive of ASPD. The combined rate of adverse parental behaviors is predictive of development of most PDs, with some specificity of behaviors related to certain PDs.

You are arguing with points I’m not making. Didn’t state that affective instability means Bipolar and I didn’t state that Bipolar causes Borderline. The point that I am making is that childhood presentations of mental disorders can affect development and lead to some similar traits which can also lead to misdiagnosis or misunderstanding of how best to treat. I don’t think Bipolar causes or equals Borderline which is why I made up a new concept of “growing up Bipolar” to describe these patients. This is also part of the problem with our lack of etiology being included in diagnostic criteria.

 

[Egg122]

Actually, I do consultative work with a PhD psychologist. He’s on vacation. I was more interested in how to talk with the psychiatrist. I’m not a therapist who serves “clients”.

I think Candidate's point is that regardless of if the patient meets true criteria for a cluster B diagnosis or not, he or she may be engaging in some splitting behaviors to be aware of and base communication accordingly.

 

[PsyDr]

You are arguing with points I’m not making. Didn’t state that affective instability means Bipolar and I didn’t state that Bipolar causes Borderline. The point that I am making is that childhood presentations of mental disorders can affect development and lead to some similar traits which can also lead to misdiagnosis or misunderstanding of how best to treat. I don’t think Bipolar causes or equals Borderline which is why I made up a new concept of “growing up Bipolar” to describe these patients. This is also part of the problem with our lack of etiology being included in diagnostic criteria.

My apologies. If you are saying that people often misdiagnosis untreated bipolar disorder as a personality disorder, I fully agree with you.

Affective instability is not one of the criteria for bipolar disorder, but it is unquestionably a frequent feature of bipolar disorder, even in between more pronounced episodes. It is also the case that if you look at relatives of people with bipolar disorder, they tend to be more affectively unstable. This iwould be a predicted consequence of most models of bipolar disorder, a relative fragility of mood and/or circadian states.

Outside of some hypomanic/cyclothymic state, how would you reconcile that with things like the kindling theory?

 

[Crayola227]

My apologies. If you are saying that people often misdiagnosis untreated bipolar disorder as a personality disorder, I fully agree with you.

Outside of some hypomanic/cyclothymic state, how would you reconcile that with things like the kindling theory?

I really don't understand your question. It would seem there is nothing to reconcile because kindling theory and what clausewitz is describing seem perfectly compatible to me?

Some people have the notion that outside of full blown mood episodes, bipolar individuals are completely emotionally normal at all times otherwise. But, and I could be corrected if wrong, my understanding is that a great many bipolar individuals spend a lot of their time between full blown (DSM criteria meeting) mood episodes with a low level depression, if only mildly/not meeting full criteria for MDD.

Now I'm not trying to say, being depressed/having depressive symptoms is synonymous or causing of personality disorder or PD traits. As already said, everyone in the population exists along a spectrum of PD traits anyway. But yes, coping with affective symptoms like clausewitz mentions....

Also keep in mind that between episodes, bipolar individuals must still reckon with the consequences to their lives of what takes place and their actions and how it affects other people, during episodes. So you could see a whole number of coping mechanisms some which may not be adaptive or may be cluster B.

As far as kindling theory, some of that is based on what may be simularities in how seizure activity happens in the brain and BPAD, and a "re-treading" of certain aberrant neural circuits making triggering of episodes a lower and lower threshold. And that suggests that between seizures and mood episodes, there may be some aberrant brain activity going on, just perhaps not clinically detectable (meaning not rising to the level of clinical significance, yknow, until it does). These pathways in the brain don't just disappear between episodes. So could there be a background activity that leads to some abnormalities or unstable affect, that needs coping mechanisms? Perhaps.

Not to mention as clausewitz does, that often there are mood disorders hanging out in the family tree of BPAD, if not BPAD itself. And every mood disorder will have concomitant coping mechanisms. That we pick up from our relatives.

So to me, it all makes sense, and kindling theory, if there is something to that, also seems to be able to be reconciled with all of these above?

 

[Stagg737]

Very interesting. Do you have any good literature you could share about the construct validity and reliability of the diagnosis?

What personality disorders should I look out for. She doesn’t meet criteria or come close for the other cluster B’s.

You might find some of the data on the HiTOP model and Alternative Model of PDs (AMPD) interesting. In newer models, histrionic PD has been completely eliminated and ICD-11 actually eliminated all of the specific PDs and just uses "mild/moderate/severe PD" as diagnosis with dysfunction of the 5 trait domains as specifiers. They did make an exception for BPD as a unique specifier, but it's based on updated criteria used in the AMPD and not the DSM criteria for BPD.

Until you get the other problems, both mental and medical, addressed and decently controlled you don't really need to be looking at PDs unless you get some very reliable collateral who is able to confirm specific symptoms longitudinally during periods where they are otherwise generally stable. In terms of histrionic PD, the studies I've seen on construct validity and reliability showed fairly weak results but grouped patients into more exhibitionist vs impressionable categories. The former being more likely associated with dependent personality traits and the latter being associated with other cluster B traits, specifically narcissistic and borderline to a lesser extent.

ETA: Histrionic PD and 3 others (schizoid, paranoid, and dependent) were eliminated in the AMPD d/t poor construct validity and very high rates of co-morbidity with other psychiatric conditions.

 

[psychma]

You might find some of the data on the HiTOP model and Alternative Model of PDs (AMPD) interesting. In newer models, histrionic PD has been completely eliminated and ICD-11 actually eliminated all of the specific PDs and just uses "mild/moderate/severe PD" as diagnosis with dysfunction of the 5 trait domains as specifiers. They did make an exception for BPD as a unique specifier, but it's based on updated criteria used in the AMPD and not the DSM criteria for BPD.

Until you get the other problems, both mental and medical, addressed and decently controlled you don't really need to be looking at PDs unless you get some very reliable collateral who is able to confirm specific symptoms longitudinally during periods where they are otherwise generally stable. In terms of histrionic PD, the studies I've seen on construct validity and reliability showed fairly weak results but grouped patients into more exhibitionist vs impressionable categories. The former being more likely associated with dependent personality traits and the latter being associated with other cluster B traits, specifically narcissistic and borderline to a lesser extent.

Thank you.

 

[smalltownpsych]

My apologies. If you are saying that people often misdiagnosis untreated bipolar disorder as a personality disorder, I fully agree with you.

Outside of some hypomanic/cyclothymic state, how would you reconcile that with things like the kindling theory?

That is what I am saying and also that sometimes there is some reason for this misdiagnosis because the invalidation that can result from experiencing severe mental illness at a very early age can shape or disrupt normal personality development and functioning. In the last setting that I worked, we had a number of patients who had been experiencing significant psychological distress and symptoms and treatment from a very early age. Part of what I was treating was the secondary effects of that including iatrogenic effects. Rapid 50 pound weight gain after antipsychotics being administered to young females being one of those. Being treated for ADHD and having everyone in your life think that the medication is helping and why are you still getting worse and then being punished by schools and parents and treatment for your “bad behaviors” such as self harm or pulling your hair out or still not paying attention no matter how much they up the stimulants. Eventually some one starts throwing relatively heavy doses of antipsychotics at them to attempt to calm them down. Meanwhile, they are still expected to function normally in school while they continue to be in a manic or mixed episode and in an extreme amount of emotional distress because they are experiencing failure in every area of life. Maybe what I am trying to say is that our mental health system doesn’t do a very good job of identifying and treating early stages of mental illness.

 

[docksan]

I kinda think the opposite, that our system doesn't really do a good job in identifying illness correctly and errs too much on worse case scenarios like "I'm worried this is bipolar so slam them with 400mg of Seroquel and worry about it later" when the later never comes and the patient keeps getting treated for something they don't have.

I think many are so keen on "catching things early" that they're catching the ocean to find a shrimp.

 

[ClosetCentrist]

The PD literature is very clear that parental behavior, and childhood experiences are the most likely etiology of PDs. The number of geographic moves in childhood is highly predictive of ASPD. The combined rate of adverse parental behaviors is predictive of development of most PDs, with some specificity of behaviors related to certain PDs.

This is the exact opposite of my reading of the literature, which I find to be rather clear that PDs have very little to do with parental behavior.

This paper from Torgersen in 2012 says it all really:

We assessed close to 2,800 twins from the Norwegian Institute of Public Health Twin Panel using a self-report questionnaire and, a few years later, the Structured Interview for DSM-IV Personality (SIDP-IV).


Whereas the heritability of Cluster B PDs assessed by interview was around .30, and around .40–. 50 when assessed by self-report questionnaire, the heritability of the convergent latent factor, including information from both interview and self-report questionnaire was .69 for APD, .67 for BPD, .71 for NPD, and .63 for HPD. As is usually found for personality, the effect of shared-in families (familial) environment was zero.

 

[Crayola227]

This is the exact opposite of my reading of the literature, which I find to be rather clear that PDs have very little to do with parental behavior.

This paper from Torgersen in 2012 says it all really:

Eh, something I read said we must be skeptical of self report of childhood by those with PDs. Something about the PD itself potentially skewing the report/recollection. Which makes sense seeing it through the eyes of a PD.

 

[ClosetCentrist]

Eh, something I read said we must be skeptical of self report of childhood by those with PDs. Something about the PD itself potentially skewing the report/recollection. Which makes sense seeing it through the eyes of a PD.

This paper's methodology doesn't rely on self-reports of childhood experiences by individuals with PDs, so that argument is a total non-sequitur. Twin-studies allow us to determine genetic effects, alongside shared and unshared environmental effects without needing to know that information. I'd recommend reading the Model Fitting section of the Torgersen paper for a more complete explanation.

 

[PsyDr]

This is the exact opposite of my reading of the literature, which I find to be rather clear that PDs have very little to do with parental behavior.

This paper from Torgersen in 2012 says it all really:

I dunno. This longitudinal study seems much more valid and reliable.

Johnson, J. G., et al. (2006). "Parenting behaviors associated with risk for offspring personality disorder during adulthood." Arch Gen Psychiatry 63(5): 579-587.

 

[whopper]

I've seen people with histrionic traits.
I'm not officially diagnosing this guy, but as a teaching tool I used to tell students to check out videos of Richard Simmons.

When I was a PGY-2, unfortunately one of the interns had the disorder. She came into work one day with a see through shirt without a bra. She literally had every single trait in the DSM for diagnosis. If she became sexually attracted towards someone within days to weeks she made an accusation the other person was trying to seduce her or sexually harass her. By about her 6th month she was removed from the program. I felt a mix of pity for her, cause I knew with her problems she'd never make it in medicine (unless something radical happened like she took a year off and focused just on therapy), but also that despite the pity I could in no way shape or form help her given her toxicity and that she was a work colleague.

 

[ClosetCentrist]

I dunno. This longitudinal study seems much more valid and reliable.

Johnson, J. G., et al. (2006). "Parenting behaviors associated with risk for offspring personality disorder during adulthood." Arch Gen Psychiatry 63(5): 579-587.

I don't think that study supports your original assertion that "parental behavior and childhood experiences are the most likely etiology of PDs"

The composite index of problematic parental behavior was significantly associated with the aggregate PD symptom total at mean ages of 22 and 33 years when the covariates were controlled (partial r = 0.28; P<.001)

So the r^2 was 0.078 which means that problematic parental behavior accounted for a meager 8% of the variance. 92% of leftover unexplained variation seems pretty in-line with the Torgersen paper's findings that parental effects are very small and it is mostly genetic and unshared environment. This also is supported by the study of personality traits in non-psychiatric populations which shows a very small effect of shared environment, with 50% accounted for by genetics and the rest to unshared environment.

 

[PsyDr]

This also is supported by the study of personality traits in non-psychiatric populations which shows a very small effect of shared environment, with 50% accounted for by genetics and the rest to unshared environment.

Which is more reliable?

1) The recall and self report of someone with a PD
2) Longitudinal observation

 

[ClosetCentrist]

Which is more reliable?

1) The recall and self report of someone with a PD
2) Longitudinal observation

Your question suggests that you didn't actually read the Torgersen paper - there was no need for the PD patients to recall anything about their childhood because they were not asked about their childhood. It seems as though you do not understand how twin studies work and why those questions do not need to be answered when you have such an ability to control for genetics.

Even if you are correct that your longitudinal study is more reliable, parental behavior only explains 8% of the variance in scoring on their PD scale. What do you think makes up the other 92%? How is this compatible with your claim that "parental behavior and childhood experiences are the most likely etiology of PDs?"

 

[PsyDr]

Your question suggests that you didn't actually read the Torgersen paper - there was no need for the PD patients to recall anything about their childhood because they were not asked about their childhood. It seems as though you do not understand how twin studies work and why those questions do not need to be answered when you have such an ability to control for genetics.

Even if you are correct that your longitudinal study is more reliable, parental behavior only explains 8% of the variance in scoring on their PD scale. What do you think makes up the other 92%? How is this compatible with your claim that "parental behavior and childhood experiences are the most likely etiology of PDs?"

Silly me, I must have made some mistake that shared in family environmental effects specific to the self report questionnaire were.... you know... based upon the individuals self report regarding shared in family environmental effects