European views on personality disorders: a conceptual history

A historical account is offered of the European origins of the DSM-III-R category, personality disorder, and a differentiation is made between the history of terms, patterns of behaviors, and concepts. The concept of "disorder of character (personality)" developed in the nineteenth century, and was possible after notions such as character, constitution, temperament, and self received a psychological definition, and after the insanities became transformed into "psychoses." Terms such as "type" and "trait" were in turn ushered into the nineteenth century by faculty psychology and the phrenological tradition. Until the end of that century, "personality" referred to the subjective aspects of the self, and "personality disorder" meant alteration of consciousness (e.g., hysterical dissociation); the behavioral patterns dealt with by DSM-III-R as personality disorders were then called disorders of character and explained as states of volitional failure, or loss of coherence between cognitive, emotional, and conative functions, or of "automatism," i.e., the manifestation of lower (more primitive or animal) forms of behavior escaping the control of higher (human) ones. Character types and disorders were first considered as forms of attenuated insanity, and later on were made into a separate group whose membership could be attained via the visitation of a degeneration taint, neurological disease (e.g., encephalitis), or plain ill-breeding. The relevance of the intellectual background of the nineteenth century to these diagnostic changes is also discussed.