At the urging of her husband, Nigel, Cynthia made an appointment with her doctor. Both Nigel and Cynthia, who had been married for four years wanted children but Cynthia had kept postponing the decision. Ten years ago, Cynthia's younger brother had been diagnosed as a schizoid, a personality disorder that renders its victims emotionally detached and isolated, and the young woman worried that her own child would be at risk.

The thought of raising a child who may develop a personality disorder would daunt most prospective parents. Whether the disorder manifests itself as paranoia, schizophrenia, manic depression or obsessive-compulsive personality, life will undoubtedly be difficult for both the afflicted individual as well as his or her family. Often, people with a personality disorder have little tolerance for stress or change and exhibit a diminished capacity for love and work.

The causes of personality disorder are not fully understood. Some researchers believe that genetics play a lead role. Therefore, an individual in Cynthia's position would want to take time to assess her ability or desire to raise a child with psychological challenges.

Other experts believe that the cause of personality disorder is environmental. This latter school insists that children develop both normal and disordered personalities by modeling their behavior on people around them. Thus a paranoid personality develops when a child's demonstrations of love or trust are not acknowledged and rewarded. Similarly, a child who is punished severely is likely to become withdrawn or aggressive.

However, whether the roots of the problem lie in nature or nurture, there is general agreement among theorists that with support from a loving family, education, counseling and perhaps medication, individuals with personality disorders can be greatly helped today. This too is something Cynthia and Nigel will want to consider as they make their important decision.

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