In our rejoinder to the excellent commentaries provided by Macfie, Noose, and Gorrondona (This Volume) and Davies and Thompson (This Volume), we discuss three key directions for research and clinical work that emerge from our chapter on environmental and sociocultural influences on personality disorders. First, it is critical to recognize the importance of early caregiving environments and family processes in the etiology of personality pathology. Second, identifying transactional models that integrate biological, psychological and sociocultural influences may move the field towards a more holistic and multifaceted understanding of the underpinnings of personality pathology. Third and finally, expanding the use of dimensional models of personality pathology may contextualize these transactional relationships and facilitate more rapid advances in our understanding and conceptualizations of (mal)adaptive expressions of personality traits. Dimensional models may further facilitate consideration of socioeconomic, cultural and geopolitical influences in evaluating and defining the maladaptiveness of specific traits and behaviors. Increasing our focus on contextual, environmental, and sociocultural influences in research design, assessment, and case conceptualization will improve personality research and clinical care.

In addition to identifying important biological and psychosocial correlates of personality disorders, recent research has illuminated environmental and sociocultural factors that influence the development, expression, and maintenance of personality disorders. In particular, cross-national and cross-cultural comparisons indicate that the expression, meaning, and impact of specific personality traits and behaviors differ across gender roles, historical periods, and cultural and socioeconomic groups. Moreover, whereas interpersonal and attachment theories have historically underscored the importance of parent-child relationships, emotional attunement, and early childhood adversity in the formation and continuation of personality pathology, recent behavioral genetic studies suggest that unique, non-shared environmental influences account for as much or more variance in personality disorders as shared influences among family members. Additional sources of sociocultural and environmental influence on personality disorders include peer and romantic relationships. Increasingly, integrative theories highlight the importance of considering interactions and transactions across biological, psychological, and sociocultural systems in understanding the etiology of personality disorders. These theoretical and empirical advances have important implications for personality disorder research and clinical practice, and point to the potential utility of considering cross-cultural diagnostic validity when evaluating dimensional or categorical diagnostic models.