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==Historical Perspective==
==Overview==
Personality disorder is a term with a distinctly modern meaning, owing in part to its clinical usage and the institutional character of modern psychiatry. The currently accepted meaning must be understood in the context of historical changing classification systems such as DSM-IV and its predecessors. Although highly anachronistic, and ignoring radical differences in the character of subjectivity and social relations, some have suggested similarities to other concepts going back to at least the [[Ancient Greek medicine|ancient Greeks]].<ref name="millon">{{cite book
[[Personality]] defects were started to be [[recognized]] in the 18th century. Previously, all the diseases were a result of [[abnormalities]] with four [[Bodily fluids|bodily]] [[fluids]]; [[blood]], [[phlegm]], yellow [[bile]], and black [[bile]]. The changes in them were also considered responsible for [[variations]] in [[mood]]. In the 18th century [[Phillippe Pinel]] described a group of people having [[impulsive]], irrational ways and behaviors while maintaining understanding, [[perception]], judgment, and [[memory]] of the actions. This was the [[birth]] of recognition of [[personality disorders]]. In the 19th century,[[Sigmund Freud]], known as the father of [[psychology]] and his colleagues, worked on the [[psychoanalytic]] [[classification]] and [[etiology]] of [[personality]]. They related [[personality traits]] with [[childhood]] characters. He presented the [[structural theory]] that [[unconscious]] [[mental]] conflicts influence the development of [[Character (biology)|character]] and [[behavior]]. In the late 1900s, [[statistics]] was utilized to group together different definitions of [[personality]] structures. It was pioneered by [[Bernard Cattell]]. This employs a different number of dimensions to delineate [[personality]] systems. These [[Dimensional modeling|dimensional]] models lead to [[Diagnostic and statistical manual of mental disorders|DSM]] characterization of [[personality disorders]] according to [[Diagnostic and statistical manual of mental disorders|DSM]] classifications. [[DSM IV]] was established in 1994 with an [[updated version]], [[DSM IV-TR]], and uses a multiaxial approach to describe [[Psychiatric Disorders|psychiatric]] illnesses with [[axis II]] reserved for [[personality disorder]]. This multiaxial system was abolished in [[DSM 5]] and categorized the various [[disorders]] with related [[Disorder (medicine)|disorders]].
| first=Theordore
| last= Millon
| year= 1996
| title=Disorders of Personality: DSM-IV-TM and Beyond
| edition= first edition, personal disorders
| publisher=John Wiley and Sons
| location=New York
| page= 35
| isbn=  0-471-01186-X }}</ref> For example, the Greek philosopher [[Theophrastus]] described 29 'character' types that he saw as deviations from the norm, and similar views have been found in Asian, Arabic and Celtic cultures. A long-standing influence in the Western world was [[Galen]]'s concept of personality types which he linked to the [[four humours]] proposed by [[Hippocrates]].
 
Such views lasted into the 18th century, when experiments began to question the supposed biologically based humours and 'temperaments'. Psychological concepts of character and 'self' became widespread. In the 19th century, 'personality' referred to a person's conscious awareness of their behavior, a disorder of which could be linked to altered states such as [[Dissociation (psychology)|dissociation]]. This sense of the term has been compared to the use of the term 'multiple personality disorder' in the first versions of the DSM.<ref>Suryanarayan, Geetha (2002) [http://www.asia.cmpmedica.com/cmpmedica_my/disppdf.cfm?fname=suryanHistory.pdf The History of the Concept of Personality Disorder and its Classification], The Medicine Publishing Company Ltd.</ref>
 
Physicians in the early 19th century started to diagnose forms of [[insanity]] that involved disturbed emotions and behaviors but seemingly without significant intellectual impairment or [[delusions]] or [[hallucinations]]. [[Philippe Pinel]] referred to this as 'manie sans délire' – insanity without delusion – and described a number of cases mainly involving excessive or inexplicable anger or rage. [[James Cowles Prichard]] advanced a similar concept he called [[moral insanity]], which would be used to diagnose patients for some decades. 'Moral' in this sense referred to [[Affect (psychology)|affect]] (emotion or mood) rather than necessarily ethics, but it was arguably based in part on religious, social and moral beliefs, with a pessimism about medical intervention so that social control should take precedence.<ref>{{cite journal|pmid=8757717|year=1996|last1=Augstein|first1=HF|title=J C Prichard's concept of moral insanity—a medical theory of the corruption of human nature|volume=40|issue=3|pages=311–43|pmc=1037128|journal=Medical history|doi=10.1017/S0025727300061329}}</ref> These categories were much different and broader than later definitions of personality disorder, while also being developed by some into a more specific meaning of moral degeneracy akin to later ideas about 'psychopaths'. Separately, [[Richard von Krafft-Ebing]] popularized the terms [[Sadism and masochism as medical terms|sadism and masochism]], as well as [[homosexuality]], as psychiatric issues.
 
The German psychiatrist [[Julius Ludwig August Koch|Koch]] sought to make the moral insanity concept more scientific, suggesting in 1891 the phrase 'psychopathic inferiority', theorized to be a [[congenital disorder]]. This referred to continual and rigid patterns of misconduct or dysfunction in the absence of apparent mental retardation or illness, supposedly without a moral judgement. Described as deeply rooted in his Christian faith, his work has been described as a fundamental text on personality disorders that is still of use today.<ref>{{cite journal|pmid=19127839|year=2008|last1=Gutmann|first1=P|title=Julius Ludwig August Koch (1841–1908): Christian, philosopher and psychiatrist|volume=19|issue=74 Pt 2|pages=202–14|journal=History of psychiatry|doi=10.1177/0957154X07080661}}</ref>
 
=== 20th Century ===
 
In the early 20th century, another German psychiatrist, [[Emil Kraepelin]], included a chapter on psychopathic inferiority in his influential work on clinical psychiatry for students and physicians. He suggested six types – excitable, unstable, eccentric, liar, swindler and quarrelsome. The categories were essentially defined by the most disordered criminal offenders observed, distinguished between criminals by impulse, professional criminals, and morbid [[Vagabond (person)|vagabonds]] who wandered through life. Kraepelin also described three paranoid (meaning then delusional) disorders, resembling later concepts of schizophrenia, delusional disorder and paranoid personality disorder. A diagnostic term for the latter concept would be included in the DSM from 1952, and from 1980 the DSM would also include schizoid and schizotypal personality disorders; interpretations of earlier (1921) theories of [[Ernst Kretschmer]] led to a distinction between these and another type later included in the DSM, avoidant personality disorder.


In 1933 Russian psychiatrist [[Pyotr Gannushkin|Pyotr Borisovich Gannushkin]] published his book ''Manifestations of psychopathies: statics, dynamics, systematic aspects'', which was one of the first attempts to develop a detailed [[Pyotr Gannushkin#The theory of psychopathies|typology of psychopathies]]. Regarding maladaptaion, ubiquity, and stability as the three main symptoms of behavioral pathology, he distinguished 9 clusters of psychopaths: cycloids (including constitutionally depressive, constitutionally excitable, cyclothymics, and emotionally labile), asthenics (including psychasthenics), schizoids (including dreamers), paranoiacs (including fanatics), epileptoids, hysterical personalities (including pathological liars), unstable psychopaths, antisocial psychopaths, and constitutionally stupid.<ref name="Gannushkin 01">Ганнушкин П. Б. (2000). ''Клиника психопатий, их статика, динамика, систематика''. Издательство Нижегородской государственной медицинской академии. ISBN 5-86093-015-1.</ref> Some elements of Gannushkin's typology were later incorporated into the theory developed by a Russian adolescent psychiatrist, [[Andrey Yevgenyevich Lichko]], who was also interested in psychopathies along with their milder forms, the so-called [[Andrey Yevgenyevich Lichko#Accentuations of character|accentuations of character]].<ref name="Lichko 02">Личко А. Е. (2010) Психопатии и акцентуации характера у подростков. Речь, ISBN 978-5-9268-0828-6.</ref>
Psychiatrist David Henderson published in 1939 a theory of 'psychopathic states' which ended up contributing to the term becoming popularly linked to anti-social behavior. [[Hervey M. Cleckley]]’s 1941 text, [[The Mask of Sanity]], based on his personal categorization of similarities he noted in some prisoners, marked the start of the modern clinical conception of psychopathy and its popularist usage.<ref>{{cite journal|last=Arrigo|first=B. A.|title=The Confusion Over Psychopathy (I): Historical Considerations|journal=International Journal of Offender Therapy and Comparative Criminology|date=1 June 2001|volume=45|issue=3|pages=325–344|doi=10.1177/0306624X01453005|url=http://193.146.160.29/gtb/sod/usu/%24UBUG/repositorio/10281816_Arrigo.pdf}}</ref>
Towards the mid 20th century, psychoanalytic theories were coming to the fore based on work from the turn of the century being popularized by [[Sigmund Freud]] and others. This included the concept of 'character disorders', which were seen as enduring problems linked not to specific symptoms but to pervasive internal conflicts or derailments of normal childhood development. These were typically understood as weaknesses of character or willful deviance, and were distinguished from [[neurosis]] or [[psychosis]]. The term 'borderline' stems from a belief that some individuals were functioning on the edge of those two categories, and a number of the other personality disorder categories were also heavily influenced by this approach, including dependent, obsessive-compulsive and histrionic,<ref>Amy Heim & Drew Westen (2004) [http://www.psychsystems.net/Publications/2005/17.%20theories%20of%20personality%20and%20personality%20disorders_Heim_textbook%20of%20pers%20disorders%202005.pdf Theories of personality and personality disorders]</ref> the latter starting off as a conversion symptom of hysteria particularly associated with women, then a hysterical personality, then renamed histrionic personality disorder in later versions of the DSM. A passive aggressive style was defined clinically by Colonel [[William Menninger]] during World War II in the context of men's reactions to military compliance, which would later be referenced as a personality disorder in the DSM.<ref name="Lane">{{cite journal|last=Lane|first=C.|title=The Surprising History of Passive-Aggressive Personality Disorder|journal=Theory & Psychology|date=1 February 2009|volume=19|issue=1|pages=55–70|doi=10.1177/0959354308101419|url=http://www.christopherlane.org/documents/Lane.PAPDisorder.pdf}}</ref> [[Otto Kernberg]] was influential with regard to the concepts of the borderline and narcissistic personalities which were later incorporated as disorders into the DSM in 1980.
Meanwhile, a more general [[personality psychology]] had been developing in academia and to some extent clinically. [[Gordon Allport]] was publishing theories of [[personality traits]] from the 1920s, and [[Henry Murray]] advanced a theory called 'personology' which influenced a later key advocate of personality disorders, [[Theodore Millon]]. Tests were developing or being applied for personality evaluation, including [[projective test]]s such as the [[Rorschach test|Rorshach]], as well as questionnaires such as the [[Minnesota Multiphasic Personality Inventory]]. Around mid-century, [[Hans Eysenck]] was analysing traits and [[personality types]], and psychiatrist [[Kurt Schneider]] was popularising a clinical use in place of the previously more usual terms 'character', 'temperament' or 'constitution'.
American psychiatrists officially recognised concepts of enduring personality disturbances in the first [[Diagnostic and Statistical Manual of Mental Disorders]] in the 1950s, which relied heavily on psychoanalytic concepts. Somewhat more neutral language was employed in the DSM-II in 1968, though the terms and descriptions had only a slight resemblance to current definitions. The DSM-III published in 1980 made some major changes, notably putting all personality disorders onto a second separate 'axis' along with mental retardation, intended to signify more enduring patterns, distinct from what were considered axis one mental disorders. 'Inadequate' and '[[asthenic]]' personality disorder' categories were deleted, and others were unpacked into more types, or changed from being personality disorders to regular disorders. Sociopathic Personality Disorder, which had been the term for psychopathy, was renamed Antisocial Personality Disorder. Most categories were given more specific 'operationalized' definitions, with standard criteria that psychiatrists could agree on in order to conduct research and diagnose patients.<ref>Hoermann, Simone; Zupanick, Corinne E. and Dombeck, Mark (January 2011) [http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=560&cn=8 The History of the Psychiatric Diagnostic System Continued]. mentalhelp.net.</ref> In the DSM-III revision, self-defeating personality disorder and sadistic personality disorder were included as provisional diagnoses requiring further study. They were dropped in the DSM-IV, though a proposed 'depressive personality disorder' was added; in addition, the official diagnosis of passive-aggressive personality disorder was dropped, tentatively renamed 'negativistic personality disorder.'<ref>{{cite journal|author=Oldham, John M. |title=Personality Disorders|journal=FOCUS|year=2005|volume=3|pages=372–382|url=http://focus.psychiatryonline.org/article.aspx?Volume=3&page=372&journalID=21}}</ref>
International differences have been noted in how attitudes have developed towards the diagnosis of personality disorder. Kurt Schneider had argued that they were simply 'abnormal varieties of psychic life' and therefore not necessarily the domain of psychiatry, a view said to still have influence in Germany today. British psychiatrists have also been reluctant to address such disorders or consider them on a par with other mental disorders, which has been attributed partly to resource pressures within the National Health Service, as well as to negative medical attitudes towards behaviors associated with personality disorders. In the US, the prevailing healthcare system and psychanalytic tradition has been said to provide a rationale for private therapists to diagnose some personality disorders more broadly and provide ongoing treatment for them.<ref>{{cite journal|author=Kendell, RE|doi=10.1192/bjp.180.2.110|title=The distinction between personality disorder and mental illness|year=2002|journal=The British Journal of Psychiatry|volume=180|issue=2|page=110}}</ref>
==Overview==
==Historical Perspective==
==Historical Perspective==


===Discovery===
===Discovery===
* There is limited information about the historical perspective of [disease name].
[[Personality]] defects were started to be recognized in the 18th century. Previously, all the [[diseases]] were a result of [[abnormalities]] with four [[bodily fluids]]; [[blood]], [[phlegm]], yellow [[bile]], and black [[bile]]. The changes in them were also considered responsible for variations in [[mood]]. However, by the 18th century, [[Phillippe Pinel]] described a group of people having impulsive, irrational ways and behaviors while maintaining understanding, [[perception]], judgment, and [[memory]] of the actions. This was the [[birth]] of recognition of [[personality disorders]].  
OR
*[Disease name] was first discovered by [name of scientist], a [nationality + occupation], in [year]/during/following [event].
 
*The association between [important risk factor/cause] and [disease name] was made in/during [year/event].
*In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].
*In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].


===Landmark Events in the Development of Treatment Strategies===
===Phrenology===
In the 18th century, the term [['phrenology']] was used to describe [[personality]] characteristics. It was believed that the origin of [[personality traits]] is from various [[facets]] in the [[cranium]]. Despite the discontinuation of the term, it remains significant as it laid the basis for the [[origin]] of PDs from the [[cerebral cortex]].


===Impact on Cultural History===
===Personality Term===
In the 19th century and early 20th century, different [[European Centre for Disease Prevention and Control|European]] [[psychologists]] started identifying and describing different [[personality traits]] and [[Disorder (medicine)|disorders]]. The term [[personality]] is derived from [[Greek citron|Greek]] word, [['persona,']] the mask worn in theatres in ancient times to denote a [[Character (biology)|character]] or social role. It is now used to define that aspect of the person which is discerned by other individuals.


===Famous Cases===
===Freud's personality theory===  
The following are a few famous cases of [disease name]:
In the 1920s and 1930s, [[Sigmund Freud]], known as the father of [[psychology]] and his colleagues, worked on the [[psychoanalytic]] [[classification]] and [[etiology]] of [[personality]]. They related [[personality traits]] with childhood characters. He presented the [[structural theory]] that [[unconscious]] [[mental]] conflicts influence the [[development]] of [[Character (biology)|character]] and [[behavior]] <ref name="pmid25071640">{{cite journal| author=Boag S| title=Ego, drives, and the dynamics of internal objects. | journal=Front Psychol | year= 2014 | volume= 5 | issue=  | pages= 666 | pmid=25071640 | doi=10.3389/fpsyg.2014.00666 | pmc=4076885 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25071640  }} </ref>. This comprises three components of the [[brain]]; the [[id]] ([[Primitive (integral)|primitive]] urges at [[birth]]), [[ego]] (mediator that maintains a balance between id and reality), and [[superego]] (conscience and moral values). They develop at different stages in life, and the interplay among them is responsible for shaping the [[personality]] of a person. Any fixation at any stage is responsible for the improper balance of [[id]] and [[ego]] and leads to interference in the appropriate and timely [[development]] of the [[superego]]. A person is born with the [[Id, ego, and super-ego|id]] and develops [[Id, ego, and super-ego|ego]] and [[Id, ego, and super-ego|superego]] at last. This laid down the foundation for further theories and explanations of PDs; however, it lacks the interaction and influences of social, cultural, environmental, and [[genetic]] factors in posing the [[personality]] in an individual.


===Diagnostic and Statistical Manual of Mental Disorders===
In the late 1900s, [[statistics]] was utilized to group together different definitions of [[personality]] structures. It was pioneered by [[Bernard Cattell]]. This employs a different number of dimensions to delineate personality systems. These dimensional models lead to [[Diagnostic and statistical manual of mental disorders|DSM]] characterization of [[personality disorders]] according to [[Diagnostic and statistical manual of mental disorders|DSM]] classifications.


*The first [[Diagnostic and statistical manual of mental disorders|DSM]] was published in 1950 and it characterised all the personality disorders formally. It listed four categories of [[Psychiatric Disorders|psychiatric disorder]];
**Disturbances of pattern
**Disturbances of [[Trait (biology)|trait]]
**Disturbances of [[Drive theory (psychoanalysis)|drive]], [[control]], and relationships
**Sociopathic disturbances
*[[DSM II]] was established in 1968 and listed 10 PDs. It differs from [[DSM I]] due to the recognition stage in life being [[adolescence]], while the former states that these disorders exist lifelong. [[DSM II]] was based on concepts of [[psychoanalysis]] and [[neuroses]]. It included; inadequate,  [[Paranoid personality disorder|paranoid]],  [[Cyclothymic disorder|cyclothymic]],  [[Schizoid personality disorder|schizoid]],  [[Hysterical psychosis|hysterical]],  [[Passive-aggressive personality disorder|passive-aggressive]], [[Obsessive-compulsive personality disorder|obsessive-compulsive]], explosive, [[Antisocial personality disorder|antisocial]], and [[asthenic personality disorders]].
*[[DSM III]], established in 1980, described PDs scientifically and clinically. [[DSM III]] removed the [[Sigmund Freud|Freud]] concepts like [[Id, ego, and super-ego|Id]] which could not be measured and replace them with observed behaviours and [[thoughts.]] A multiaxial approach to describe [[psychiatric]] illnesses with [[axis II]] reserved for [[personality disorder]] was established. [[Schizoid personality disorder|Schizoid]] PD was split into three more sub-categories and boderline PD and [[Narcissistic personality disorder|narcissistic]] PD were added.
*[[DSM IV]] was established in 1994 with an updated version, [[DSM IV-TR]] in 2000. For the first time, general [[diagnostic criteria]] for any [[personality disorder]] was incorporated. This included the requirements of early onset in [[adolescence]], pervasive and unrelentless course, and prolonged duration of symptoms.
*This multiaxial system was abolished in [[DSM 5]] in 2013 and categorized the various disorders with related [[Disorder (medicine)|disorders]]. This abolishes the confusion of linking each [[personality disorder]] with the diagnosis of [[Axis 1]] disorder due to the presence of [[symptoms]] from there. <ref name="pmid24174889">{{cite journal| author=Crocq MA| title=Milestones in the history of personality disorders. | journal=Dialogues Clin Neurosci | year= 2013 | volume= 15 | issue= 2 | pages= 147-53 | pmid=24174889 | doi= | pmc=3811086 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24174889  }} </ref>. It classifies PDs into three clusters, with each containing 3-4 [[Disorder (medicine)|disorders]].


==References==
==References==

Latest revision as of 13:56, 13 September 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Ayesha Anwar, M.B.B.S[2]

Overview

Personality defects were started to be recognized in the 18th century. Previously, all the diseases were a result of abnormalities with four bodily fluids; blood, phlegm, yellow bile, and black bile. The changes in them were also considered responsible for variations in mood. In the 18th century Phillippe Pinel described a group of people having impulsive, irrational ways and behaviors while maintaining understanding, perception, judgment, and memory of the actions. This was the birth of recognition of personality disorders. In the 19th century,Sigmund Freud, known as the father of psychology and his colleagues, worked on the psychoanalytic classification and etiology of personality. They related personality traits with childhood characters. He presented the structural theory that unconscious mental conflicts influence the development of character and behavior. In the late 1900s, statistics was utilized to group together different definitions of personality structures. It was pioneered by Bernard Cattell. This employs a different number of dimensions to delineate personality systems. These dimensional models lead to DSM characterization of personality disorders according to DSM classifications. DSM IV was established in 1994 with an updated version, DSM IV-TR, and uses a multiaxial approach to describe psychiatric illnesses with axis II reserved for personality disorder. This multiaxial system was abolished in DSM 5 and categorized the various disorders with related disorders.

Historical Perspective

Discovery

Personality defects were started to be recognized in the 18th century. Previously, all the diseases were a result of abnormalities with four bodily fluids; blood, phlegm, yellow bile, and black bile. The changes in them were also considered responsible for variations in mood. However, by the 18th century, Phillippe Pinel described a group of people having impulsive, irrational ways and behaviors while maintaining understanding, perception, judgment, and memory of the actions. This was the birth of recognition of personality disorders.

Phrenology

In the 18th century, the term 'phrenology' was used to describe personality characteristics. It was believed that the origin of personality traits is from various facets in the cranium. Despite the discontinuation of the term, it remains significant as it laid the basis for the origin of PDs from the cerebral cortex.

Personality Term

In the 19th century and early 20th century, different European psychologists started identifying and describing different personality traits and disorders. The term personality is derived from Greek word, 'persona,' the mask worn in theatres in ancient times to denote a character or social role. It is now used to define that aspect of the person which is discerned by other individuals.

Freud's personality theory

In the 1920s and 1930s, Sigmund Freud, known as the father of psychology and his colleagues, worked on the psychoanalytic classification and etiology of personality. They related personality traits with childhood characters. He presented the structural theory that unconscious mental conflicts influence the development of character and behavior [1]. This comprises three components of the brain; the id (primitive urges at birth), ego (mediator that maintains a balance between id and reality), and superego (conscience and moral values). They develop at different stages in life, and the interplay among them is responsible for shaping the personality of a person. Any fixation at any stage is responsible for the improper balance of id and ego and leads to interference in the appropriate and timely development of the superego. A person is born with the id and develops ego and superego at last. This laid down the foundation for further theories and explanations of PDs; however, it lacks the interaction and influences of social, cultural, environmental, and genetic factors in posing the personality in an individual.

Diagnostic and Statistical Manual of Mental Disorders

In the late 1900s, statistics was utilized to group together different definitions of personality structures. It was pioneered by Bernard Cattell. This employs a different number of dimensions to delineate personality systems. These dimensional models lead to DSM characterization of personality disorders according to DSM classifications.

References

  1. ↑ Boag S (2014). "Ego, drives, and the dynamics of internal objects". Front Psychol. 5: 666. doi:10.3389/fpsyg.2014.00666. PMC 4076885. PMID 25071640.
  2. ↑ Crocq MA (2013). "Milestones in the history of personality disorders". Dialogues Clin Neurosci. 15 (2): 147–53. PMC 3811086. PMID 24174889.

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