The present chapter is concerned with methods used to establish whether social factors are involved in the etiology of personality disorders. If the social context should prove to be crucial, important clinical implications would follow. Social factors might help explain why individuals exposed to similar psychological risk factors develop or do not develop personality disorders. The social context might also help explain why certain treatment strategies for personality disorders are effective, while others are not, and why some recover from personality disorders, while others do not.

The social context of mental disorders

Social psychiatry is concerned with the effects of social factors on the causes, course, and treatment of mental illness. However, the difficulty for empirical research in this area is that social risk factors for psychiatric disorders are difficult to measure. There is no practical way to conduct controlled experiments in which the role of social influences can be isolated from other etiological factors. Research in social psychiatry uses indirect methods, and its conclusions inevitably require some degree of inference.

The standard epidemiological methods for establishing etiological relationships are prospective follow-up studies or casecontrol studies. In prospective studies, general community populations, or populations at risk, are followed over a number of years to see which individuals develop a disorder. Casecontrol studies compare patients who have already developed an illness to those without the disorder for the presence of risk factors.