The obstacles confronting investigators engaged either in the design, execution, or interpretation of studies of personality disorders are formidable. Numerous questions have been raised about both the methodological adequacy of earlier research and the likelihood that these studies will prove more fruitful in the future.

Since it is impossible to design an experiment in which relevant variables can systematically be controlled or manipulated, it is impossible to establish unequivocal cause-effect relationships among these variables and personality pathology. Investigators cannot arrange, no less subvert and abuse, an individual or a social group for purposes of scientific study; research in this field must, therefore, continue to be of a naturalistic and correlational nature. The problem that arises with naturalistic studies is the difficulty of inferring causality; correlations do not give us a secure base for determining which factors were cause and which were effect. For example, correlations between socioeconomic class and personality disorders may signify both that deteriorated social conditions produce mental disorders and that mental disorders result in deteriorated social conditions.

Throughout the chapter were comments indicating the lack of definitive research to support assertions about the role of pathogenic factors in personality pathology. That pathogenic factors of both a psychosocial and biologic nature are significantly involved seems axiomatic to most theorists, but science progresses not by supposition and belief but by hard facts gained through well-designed and well-executed research. This paucity of evidence does not signify neglect on the part of researchers; rather, it indicates the awesome difficulties involved in unraveling the intricate interplay of influences productive of personality pathology. Despite these apologetics, there is reason for caution in accepting the contentions of pathogenic theorists.

We have no choice but to continue to pursue the suggestive leads provided us both by plausible speculation and exploratory research; difficulties notwithstanding, we must caution against inclinations to revert to past simplifications or to abandon efforts out of dismay or cynicism. Our increasing knowledge of the multideterminant and circular character of pathogenesis, as well as the inextricable developmental sequences through which it proceeds, should prevent us from falling prey to simplifications that led early theorists to attribute personality pathology to single factors. Innumerable pathogenic roots are possible; the causal elements are so intermeshed that we must plan our research strategies to disentangle not isolated determinants but their convergencies, their interactions, and their continuities.

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