Personality disorder historical perspective

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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 . 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.

• The first DSM was published in 1950 and it characterised all the personality disorders formally. It listed four categories of psychiatric disorder;
  • Disturbances of pattern
  • Disturbances of trait
  • Disturbances of 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, cyclothymic, schizoid, hysterical, passive-aggressive, obsessive-compulsive, explosive, antisocial, and asthenic personality disorders.
• DSM III, established in 1980, described PDs scientifically and clinically. DSM III removed the Freud concepts like 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 PD was split into three more sub-categories and boderline PD and 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 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. . It classifies PDs into three clusters, with each containing 3-4 disorders.