False Assumptions in Personality Disorder Research, Part III

Source: Flickr: PersonaIII by the Dear Ze, C.C. by 2.0

This is the third in a series of posts that discusses false and unacknowledged assumptions that are rampant in the personality disorders research literature and which lead to false or misleading conclusions. I presented this information during a panel discussion on personality research at the 2018 annual meeting of the American Psychiatric Association in New York City.

False Assumption #4: the Confusion of  Performance with Ability: Ignorance of hidden motivation, social psychology, and attachment issues.

As we all know, all things biological are not diseases, even though we can define disease in such a way that all diseases are biological.  All human psychological experience is mediated by the brain; each person only has one brain; therefore the brain will always be biologically changing as we have psychological experiences. Hearing a talk about the brain is a psychological experience as much as the delusions seen in schizophrenia. Some reflect diseases while others result from conditioned responses and neural plasticity in normal brains. If you were repeatedly abused, you will have changes in the brain, and you might also develop clinical symptoms of borderline personality. But those changes in the brain do not have the same causal role as the neuronal atrophy that occurs with Alzheimer’s disease.

Another false assumption in the psychiatric literature is that one can totally disregard the motives of research subjects as well their past experiences and the environmental context in which they live when evaluating their performance on psychological tests.  A clear-cut example is that the performance of African-Americans on IQ tests. It is, on average, slightly below that of Whites (while that of Asians is, on average, slightly above Whites).

I think this finding might just might be related to the fact that for several generations Blacks who looked too smart were labelled as “uppity” and were at high risk of being humiliated, attacked, or even lynched. Because of that history, I question whether they are – again on average – just as motivated as other folks to want to look smart on an IQ test being administered by White researchers.

Certainly, people who are trying to look smart are going to put more effort into performing well on IQ tests than people who could not care less—let alone people who are motivated not to look smart. And there is simply no way to measure this motivation.

What I have seen more and more lately, particular in the personality disorders literature, are studies that look at differences between various diagnostic groups on such behaviors as how much “impulsive aggression” they exhibit. When differences are found, either the “lower” performing groups or the “higher” performing groups are just assumed to be “impaired” or “abnormal.” (Whether it is the lower or the higher performance that is labeled abnormal is dependent on the opinion the experimenter has about desirability of the behavior in question - independent of social context).

The purveyors of these studies routinely confuse performance with ability. Without knowing anything about what the subjects in the experiments are motivated to do in their daily lives on any particular dimension for whatever reason, or what environmental contingencies they are worried about that may relate to the task at hand, it is literally impossible to say for sure whether any difference in their performance is related to what they would be able to do if those other issues were not operative.

In watching the families of origins of my patients with borderline personality disorder interact with one another, for example, I have personally and repetitively witnessed double messages about what the various family members expect from one another flying in all directions. In such an environment, they are highly likely to decide that it’s a good idea to hide certain of their thoughts and abilities from their families in order to prevent their parents from becoming even more unstable than they already are. Several studies in the attachment behavior of children have found a strong tendency in children to try to manage their parents’ emotional reactions. The attachment theorist Bowlby found that children are very good at correctly anticipating their parents reactions by the time they are two.

Another way of looking at this comes from the psychoanalysts, who, despite being wrong about many things, were also right about a few things as well. They discussed how individuals often present a false self or persona to the outside world, particularly in certain social contexts. In fact, we all present different “faces” to the outside world depending on social context. Does anyone really believe that men who cheat on their wives, for example, present themselves exactly the same way around their children, their bosses, and their mistresses? Someone with antisocial tendencies may be motivated, due to family experiences, to show more impulsive aggression than other people – on purpose – and have literally trained themselves to be like that. They may then exhibit it habitually, automatically, and without thinking. So the level of impulsive aggression they display in a study may not be a biogenetic “abnormality” at all.

False Assumption #5: relationships between parents and children are somewhat consistent, do not differ over different issues, and are usually reported honestly.

A “scientific” journal article entitled, “Which dimension of parenting predicts the change of callous unemotional traits in children with disruptive behavior disorder?” by Muratori and others in the August 2016 issue of Comprehensive Psychiatry attempted to determine whether parenting practices influenced the development of so called callous and unemotional character traits in children – or if instead they were more genetic in origin. In the study, no significant relationship was found between “negative” parenting and CU traits; these two variables were also unrelated when “positive” parenting was considered in the same model. However, using a slightly different model, higher levels of positive parenting in the study predicted lower levels of CU traits.

Although I would like to believe and tend to agree that “positivity” in parent-child relationships helps decrease acting out behavior in children, a huge problem with this type of study is: how can you precisely measure the nature of the relationship between parents and children? The biggest problems with that include the fact that these relationships are not constants but vary across time and situational contexts. Also, parents might be good disciplinarians when it comes to providing children with adequate curfews, for example, but terrible at allowing them to stay up all hours of the night. Furthermore, the disciplinary practices certainly change over time as the children get older.

Furthermore, how does a study even attempt to measure the tone of parenting practices? This study used a measure called The Alabama Parenting Questionnaire that used the mother’s own report of her own disciplinary practices! If a mother had been abusive or inconsistent, how likely do these authors think she would admit to it, even if she were very self-aware, which obviously many people are not? There is no way to be sure, of course, but the odds are very good that the amount of “negative” parenting is higher than any study results would indicate, while the amount of “positive” parenting could easily be overestimated. 

And which particular types of those parental behaviors listed in the instrument were the most relevant to the question at hand? There is no way to know! When it comes to assessing the effects of family interactions, details make a huge difference. In order to get these details, you would literally need a camera on both the parents and the children 24 hours a day over a significant time period of time. This type of study usually uses absolutely no direct observation of what is purportedly being measured.

Another example of this issues in seen in the delineation of the “shared” and “the unshared” environmental influence on heritability – which itself in a measure of phenotype (the end result of the interactions between genes and the external environment that turns genes off and  on). This means that heritability is not even roughly synonymous with “genetic.” The statistic is developed from twin studies: identical versus fraternal twins, and/or those identical twins raised together and those raised apart. 

Heretability studies divide environmental influences into “shared” (family and home) and “unshared” (peers, media, teachers, and other outside factors). The way that this is done just assumes that parents treat all of their children pretty much alike. This is often far from true. The family therapy literature is rife with references to the so-called identified patient – one child is picked out for a variety of reasons to be the family scapegoat or black sheep, and is groomed to become that. Nor does each twin have exactly the same interactions with each and every other family member from the moment they are born to the moment they die.

Interestingly, the “shared” environments in one of these studies – on suicide and self injurious behavior – came out as less important in leading to behavioral issues than the “unshared!” (Maciejewski DF, Creemers HE, Lynskey MT, Madden PA, Heath AC, Statham DJ, Martin NG, Verweij KJ. ”Overlapping genetic and environmental influences on nonsuicidal self-injury and suicidal ideation: different outcomes, same etiology?”JAMA Psychiatry. 2014 Jun; 71(6):699-705).

 This would mean that family and parental behavior is less of a factor in personality development than outside influences – something that runs counter to logic for a variety of reasons (for example: with which peer group someone chooses to hang out - when there are several different ones to choose from –  is not an accident).  Considering the way this study variable was defined, researchers had to find that family is less important that peers and media because they just ASSUME that each twin is subject to identical influences inside the home. If you make this assumption, and then if the twins turn out differently on some characteristic, then of course the home will appear to have less influence!

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