Personality disorders: the history of an idea

In the past, most of the present categories of personality disorder were not considered to be mental illnesses. We need to explain how people with characterological problems came to be seen as meriting psychiatric diagnoses.

Personality disorders are exaggerations of normal personality traits. At some point, these exaggerations produce significant levels of dysfunction, and can therefore be considered pathological. The problem is where to draw the line between normality and pathology.

All medical illnesses lie on a continuum with normality. The determination of what is a “case” is in many respects a social construct (Eisenberg, 1986). If we consider the two examples of personality disorders presented in the introduction, these patients might be considered, in the first case, unwise or unlucky in love, or, in the second case “more bad than mad”. What justifies seeing these people as having mental disorders?

The acceptance of personality disorders as valid diagnoses reflects a change in psychiatric ideology. In order to understand this change, we need to know its historical context.

The classification of personality has a long history that can be traced back to the Greeks (Frances & Widiger, 1986; Tyrer & Ferguson, 1988; Tyrer et al., 1991). A theory describing four temperaments (choleric, sanguine, phlegmatic, and melancholic), associated with the Roman physician Galen (Kagan, 1994), dominated thinking about abnormal personality for many centuries. In fact, if one considers Galen's temperamental types as descriptions, and if one ignores his anachronistic physiological speculations, the four temperaments still have a certain validity (Frances & Widiger, 1986).