As far as recent life events are concerned, the situation is less intriguing. Table 2 shows the results of the controlled studies in this area. It may be seen that, with the exception of the earlier studies, almost all papers are consistent in finding an excess of stressful life events in the period preceding the onset of a depressive episode. However, since most of the latest studies were carried out in community sam­ples and the diagnoses were made by nopsychiatrists, there is some doubt as to whether such cases correspond to those usually described among psychiatric samples. Moreover, in some cases the results obtained in the community could
pp, patients; ss, subjects. (more…)

Basically, the relationship of early traumata to adult life depression may be studied by either prospective or retrospective studies. In the first case, the in­dependent variable is the occurrence of an early trauma, whereas the dependent variable is whether a subsequent illness occurred. The opposite position applies to retrospective studies, i.e., that the presence of an illness being the independent variable, the researcher looks for the presence of early traumata. Both methods are difficult to carry out in practice because of serious meth­odological limitations. Prospective studies are almost impossible in man, because of the length of the observation period, whereas retrospective studies are seriously biased by the fact that the events have to be recalled at a distance of several decades. In this case the researcher is caught between the lack of sensitivity of the methods that consider only those events that may be reliably recalled (e.g., death of a parent), and the lack of reliability of the methods that take into account finer, but less objective events, e.g., the quality of the upbringing patterns. In man, the prospective procedure has been followed in Sweden by studying
the prevalence of psychiatric disorder among adoptees. In this case, while a slight overrepresentation of psychiatric illnesses has been found during the adult life of adoptees (compared to nonadopted people), it was not possible to establish a precise relationship with affective disorder, except, perhaps, a dubious association with depressive neurosis (4,49). Retrospective studies may be made by the administration of specially devised questionnaires [the last one is the EMBU (39)]; the studies carried out with this method are fairly consistent in showing that depressives perceive their childhood more negatively than healthy people, although the same findings were not valid for the bipolars (36). Self-assessed inventories, however, aim to investigate the subjective perception of the events, rather than the actual occurrence of the events. The majority of studies has therefore used the method of considering only the events that can be objectively and reliably re-evoked. Table 1 summarizes the controlled studies in this area. It may be noted that after some initial discrepancies among the earlier studies, the most recent show a general tendency to find an excess of early traumatic events in depressives. In our own study (16), two distinct groups (100 and 118 cases, respectively) of patients with a DSM-III diagnosis of Major Depressive Episode were compared with two control groups, of 100 cases each, made up of mixed psychiatric patients and healthy subjects, respectively. While there was a general excess of early traumata in the affective patients, the differences were small, at a much lower degree hypothesized by the psychological model of the illness. Furthermore, it may be objected that depressives run a greater risk of experiencing childhood traumatic events because of a greater psychiatric morbidity in the family circle. In our sample, for instance, we found that some cases of separation from parents were owing to admission of either parent to a psychiatric hospital; some cases of divorce were secondary to alcoholism or sociopathy, and so on. When we tried to single out such events and repeated the comparison, the differences became much smaller, although retaining some statistical significance. Overall, therefore, it would seem that depressives suffered more traumatic events during their childhood, compared to nondepressives, but the difference is too small to support conclusively any model of the illness based on these grounds. These kinds of studies, however, are subject to a basic criticism: The psychological models of depression are concerned with the quality of events, rather than with their crude objectivity. The lack, or the smallness, of the dif­ferences would therefore result from the fact that the method is not able to reveal the actual personal psychological impact of the events, rather than from the non-validity of the theory being tested. One response could be that when a real, consistent difference does exist, it emerges clearly even with such clumsy meth­odology. When we used the same method to evaluate the life events of patients with agoraphobia (18), a clear and significant excess of early traumata was found over the healthy controls, despite a lower number of cases. In conclusion, therefore, our impression is that, at the moment, there is no conclusive evidence for a strong implication of early life events in the pathogenesis of depression, although an association between events and depression does exist. Three different hypotheses may be considered: (a) The initial hypothesis, as derived by the psychoanalytic model of depression, is only partially valid; an early trauma, although an important factor, would not be as crucial to the de­velopment of affective illness as the theory suggests, (b) The methods used to quantify early events are too clumsy to capture the emotional impact of these events on the child, (c) Other factors, apart from those considered in the psy­chological model, play an important role in the etiology of this disorder. (more…)

Analyzing the frequency distribution of the personality disorders in the study subgroups we found that the most frequent were histrionic disorders among the bipolar patients (30%) and compulsive ones among the unipolar group (32%). Paranoid and dependent disorders were the most frequent (9%) among the control group. Borderline disorders were present only in the latter (6%). Further, per­sonality disorders were differently distributed among the three groups, most strongly clustered in the group of unipolar patients—avoidant (18%), compulsive (32%), dependent (25%), and passive-aggressive (11%) personalities—overlapping cluster III reported by Pfohl et al., in 1984 (24). Unipolar patients showed higher frequency personality disorders than bipolar and controls. Schizotypal and an­tisocial personality types were not present in any of the sample groups, although schizoids were found only among the unipolar patients (11%), as was the case with avoidant disorders. Table 1 presents data on morbidity risks for first-degree relatives according to the presence or absence of personality disorders, sex of probands, and type of familial relationship for the three study subgroups.
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and Personality Disorders. Preliminary Reports
M. Gasperini and M. Provenza
Institute of Clinical Psychiatry, Milan Medical School, Ospedale S. Paolo, 20142 Milan, Italy (more…)

C. Faravelli, S. Pallanti, R. Frassine, B. Guerrini, and G. Albanesi
Institute of Nervous and Mental Diseases, Chair of Clinical Psychiatry, Florence University Medical School, 50134 Florence, Italy (more…)

Our sample was composed of 29 bipolar patients (BP), 35 unipolar patients (UP), and 34 controls (CT). The patients were selected from the population of major affective disorder outpatients of St. Paul’s Hospital in Milan. All patients were diagnosed in accordance with DSM-HI criteria (9). The controls were se-lected from among the medical in- and outpatients of the same hospital, none of them ever having had any previous psychiatric illness. The presence or absence of personality disorders was independently assessed У two senior psychiatrists, who employed a semistructured interview that in­corporated the criteria for Axis II of DSM-III. We ruled out from the analysis all patients and controls for whom accordance of diagnosis was not reached. Before beginning the interview, both the affective patients (who were symptom free) and controls were instructed to respond in the context of their "normal" state. The patients were asked not to take account of recent episodes of depression or mania. Similarly, the controls were asked not to think about unusually stressful situations. This was done in order to minimize misdiagnoses of their respective personality characteristics (26). We collected information about the presence of affective disorders in 376 first-degree relatives and in 870 second-degree relatives using Family History (7) directly from the patients and controls and when possible from the first-degree relatives themselves. Relatives who had had a diagnosis of Major Affective Dis­orders, both bipolar and unipolar, Cyclothymic and Dysthymic Disorders, and Atypical Depression (all according to DSM-III) were considered to be affected. All data about the relatives were corrected for age (14,16). Nevertheless, off­spring of first- and second-degree relatives were excluded because of their far too young mean ages. Since the aim of this preliminary study was to see whether the presence of a personality disorder, regardless of type, could differentially affect the risk of dis­orders in families, we applied different statistical analyses (19,20), carried out on the Sperry Univac 1100/80 computer of Milan University, to our data about both the first- and second-degree relatives of the whole study sample (BP, UP patients, and controls). The familial risk was tested against the presence or absence of personality disorders, sex, study subgroup classification, age at onset for pa­tients, and the type of familial relationship (parents/siblings, grandparents/aunts, uncles).

edited by G. Racagni and E. Smeraldi. Raven Press, New York © 1987.

edited by G. Racagni and E. Smeraldi. Raven Press, New York © 1987.