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| ==Historical Perspective==
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| 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
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| | first=Theordore
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| | last= Millon
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| | year= 1996
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| | title=Disorders of Personality: DSM-IV-TM and Beyond
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| | edition= first edition, personal disorders
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| | publisher=John Wiley and Sons
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| | location=New York
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| | page= 35
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| | 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]].
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| 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>
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| 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.
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| 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>
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| === 20th Century ===
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| 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.
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| 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>
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| 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>
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| 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.
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| 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'.
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| 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>
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| 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>
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| ==Overview== | | ==Overview== |
| ==Historical Perspective== | | ==Historical Perspective== |