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A Multivariate Twin Study

Kenneth S. Kendler, MD; Steven H. Aggen, PhD; Nikolai Czajkowski, MA, MS; Espen Røysamb, PhD; Kristian Tambs, PhD; Svenn Torgersen, PhD; Michael C. Neale, PhD; Ted Reichborn-Kjennerud, MD

Arch Gen Psychiatry. 2008;65(12):1438-1446.

Context  Although both genetic and environmental factors affect risk of individual personality disorders (PDs), we know little of how they contribute to the pattern of comorbidity between the PDs in the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV).

Objective  To clarify the structure of the genetic and environmental risk factors for the 10 DSM-IV PDs.

Design  Assessment of PDs at personal interview and multivariate twin modeling with the Mx program.

Setting  General community.

Participants  A total of 2794 young adult members of the Norwegian Institute of Public Health Twin Panel.

Main Outcome Measure  Number of endorsed criteria for the 10 DSM-IV PDs.

Results  The best-fit multivariate twin model required 3 genetic and 3 individual-specific environmental factors and genetic and individual-specific factors unique to each PD. The first genetic factor had high loadings on PDs from all 3 clusters including paranoid, histrionic, borderline, narcissistic, dependent, and obsessive-compulsive. The second genetic factor had substantial loadings only on borderline and antisocial PD. The third genetic factor had high loadings only on schizoid and avoidant PD. Several PDs had substantial disorder-specific genetic risk factors. The first, second, and third individual-specific environmental factors had high loadings on the cluster B, A, and C PDs, respectively, with 1 exception: obsessive-compulsive PD loaded with cluster B and not cluster C PDs.

Conclusions  Genetic risk factors for DSM-IV PDs do not reflect the cluster A, B, and C typology. Rather, 1 genetic factor reflects a broad vulnerability to PD pathology and/or negative emotionality. The 2 other genetic factors are more specific and reflect high impulsivity/low agreeableness and introversion. Unexpectedly, the cluster A, B, and C typology is well reflected in the structure of environmental risk factors, suggesting that environmental experiences may be responsible for the tendency of cluster A, B, and C PDs to co-occur.

Author Affiliations: Virginia Institute for Psychiatric and Behavioral Genetics (Drs Kendler, Aggen, and Neale) and Departments of Psychiatry (Drs Kendler, Aggen, and Neale) and Human and Molecular Genetics (Drs Kendler and Neale), Virginia Commonwealth University, Richmond; Division of Mental Health, Norwegian Institute of Public Health (Mr Czajkowski and Drs Røysamb, Tambs, and Reichborn-Kjennerud), Institutes of Psychology (Drs Røysamb and Torgersen) and Psychiatry (Dr Reichborn-Kjennerud), University of Oslo, Center for Child and Adolescent Mental Health of Eastern and Southern Norway (Dr Torgersen), and Nic Waal's Institute (Dr Torgersen), Oslo, Norway; and Department of Epidemiology, Columbia University, New York, New York (Dr Reichborn-Kjennerud).

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