Milestones in the history of personality disorders

Abstract

This paper analyzes the major historical milestones in the study of normal and abnormal personality, from antiquity up until the 20th century. Special attention is paid to the interaction between dimensional and typological approaches, which was a major issue during the preparation of DSM-5. Theories of personality started with the humoral theory of Greek medicine. Pinel, and later Esquirol and Prichard, are credited with the first descriptions of abnormal personalities in textbooks of psychiatry. Between the late 19th and early 20th centuries, elaborate systems of normal and abnormal personality, associating to some degree types and dimensions, were devised by a succession of European psychologists, such as Ribot, Heymans, and Lazursky. Emil Kraepelin and Kurt Schneider proposed classifications of abnormal personality types. In parallel, psychoanalysts stressed the role of early life experiences. Towards the mid-20th century, statistical methods were applied to the scientific validation of personality dimensions with pioneers such as Cattell, anticipating the five-factor model.

Full text

147
Introduction
he objective of this article is to describe the his-
tory of the study of normal and abnormal personality.
We will review the major concepts that have emerged up
to the 20th century. The knowledge of historical
antecedents helps us put into perspective the classifica-
tion of personality disorders that has prevailed from
DSM-III through DSM-IV-TR. Also, we will pay special
attention to the interaction between dimensional and
typological classifications, since this was the focus of a
heated debate during the preparation of DSM-5, the lat-
est version of the Diagnostic and Statistical Manual of
Mental Disorders of the American Psychiatric
Association. Indeed, the DSM-5 work group on person-
ality and personality disorders debated several options:
(i) maintaining a typological classification of personality
disorders (as in DSM-IV-TR); (ii) switching to a dimen-
sional system (adapted from the Five Factor model); or
(iii) constructing a hybrid system associating both
approaches. Both approaches have their own merits and
demerits. Dimensional systems are better at depicting
the variegated nuances of normal personality; they
emphasize the continuum between normal and abnor-
mal personalities; and they usually define abnormal per-
sonalities as the cases that exceed a threshold at the
Clinical research
Copyright © 2013 AICH. All rights reserved www.dialogues-cns.org
Milestones in the history of
personality disorders
Marc-Antoine Crocq, MD
T
Keywords:
personality; temperament; character; personality disorder; personality
type; personality dimension; history of psychiatry; history of psychology; Théodule
Ribot; Gerard Heymans; Aleksandr Lazursky; Emil Kraepelin; Kurt Schneider; DSM
Author affiliations: Hospital specialist, Rouffach General Hospital, Rouffach,
France
Address for correspondence: Centre Hospitalier, 68250 Rouffach, France
(e-mail: macrocq@aol.com)
This paper analyzes the major historical milestones in the
study of normal and abnormal personality, from antiq-
uity up until the 20th century. Special attention is paid
to the interaction between dimensional and typological
approaches, which was a major issue during the prepa-
ration of DSM-5. Theories of personality started with the
humoral theory of Greek medicine. Pinel, and later
Esquirol and Prichard, are credited with the first descrip-
tions of abnormal personalities in textbooks of psychia-
try. Between the late 19th and early 20th centuries, elab-
orate systems of normal and abnormal personality,
associating to some degree types and dimensions, were
devised by a succession of European psychologists, such
as Ribot, Heymans, and Lazursky. Emil Kraepelin and
Kurt Schneider proposed classifications of abnormal per-
sonality types. In parallel, psychoanalysts stressed the role
of early life experiences. Towards the mid-20th century,
statistical methods were applied to the scientific valida-
tion of personality dimensions with pioneers such as
Cattell, anticipating the five-factor model.
© 2013, AICH
Dialogues Clin Neurosci.
2013;15:147-153.
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extreme(s) of a unipolar or bipolar dimension. On the
other hand, abnormal personality types have been
described first with literary sketches, then clinical
vignettes in psychiatric textbooks, and more recently lists
of criteria. Diagnostic categories agree with the diag-
nostic approach of traditional medicine, and they are
more convenient to use than a dimensional system in
clinical settings. However, diagnostic categories cannot
render the variety and complexity of personality,
whether normal or abnormal. Often, patients with a per-
sonality disorder are not adequately described by one
distinct category, with the result that one of the most fre-
quent personality diagnoses in DSM-IV is “not other-
wise specified.” Also, personality types were created via
the clinical intuition of gifted psychiatrists, and they are
not based on scientific methods. Finally, another objec-
tive of this paper is to describe in more detail the con-
tributions of a few key historical authors, who are often
quoted but whose original papers are seldom read. An
exhaustive report on all significant authors is beyond the
scope of this paper; thus, a few important names have
been omitted.
Personality in ancient Chinese and
Greek philosophy
Both ancient Chinese and Greek medicine offer physi-
ological and psychological explanations for the variety
of personality types. The effect of the combination of
“blood and vital essence” (Chinese: 血氣; pinyin: xuè-qì)
on temperament are mentioned in the Analects (XVI,
7), a collection of sayings attributed to Confucius (551–
479 BCE)1:
The gentleman guards against three things: when he is
young, and his blood and vital essence (xuè-qì) are still
unstable, he guards against the temptation of female
beauty; when he reaches his prime, and his blood and vital
essence have become unyielding, he guards against being
contentious; when he reaches old age, and his blood and
vital essence have begun to decline, he guards against being
acquisitive.
In this text, temperament is understood as variable, sub-
ject to variations induced by age. We might interpret
“blood and vital essence” as a physiological-psycholog-
ical theory of human temperaments.2The physiological
element is the blood (xuè) and the substances that are
contained in it, whereas the psychological element is rep-
resented by “qì,” the immaterial energy that imparts
activity and movement to the substances it penetrates,
according to traditional Chinese philosophy.
The first system of personality types in the Greco-Roman
world was expounded in a book called The Characters, by
the Greek philosopher Theophrastus (c 371 to c 287 BC).
Theophrastus joined Plato’s academy, before the latter’s
death, and he was a close follower of Aristotle, his senior
by 12 years. His book contains 30 descriptions that are all
organized along the same structure; the character type is
first named, then briefly defined in one short sentence,
and finally illustrated by a list of about ten examples
showing how the person will typically react in different
life situations. This is in line with the notion, emphasized
since DSM-III, that personality is revealed by a fixed pat-
tern of reacting to various life circumstances. For instance,
the “Suspicious Man,” (Character 18, ἀπιστία) is analo-
gous to today’s paranoid personality3; he is defined by the
sentence “he believes that everybody is fraudulent,” and
further described by typical patterns such as “The suspi-
cious man is the sort of person who sends a servant to
market and then sends another to watch him and find out
the price he pays.” The “Thankless Man” (Character 17,
μεμψιμοιρία) always sees the negative aspects and is inca-
pable of enjoying life; he is presenting traits that might be
qualified today as anhedonia, resentfulness, and nega-
tivism. For instance, “when his sweetheart kisses him, he
says ‘I wonder if you really do love me so in your heart’.”
Theophrastus’ book exerted much influence in the 17th
and 18th century in Western Europe, where it prompted
much literature on character description. There is a well-
known French translation by La Bruyère (Paris, 1688).
Because of Theophrastus, European languages have
adopted the term character. As suggested by the etymol-
ogy of the Greek χαρακτήρ (instrument for marking or
graving, impress, stamp), character refers to a permanent
or long-standing mode of functioning that is inscribed in
the fabric of the person, like a coin that has been stamped.
Long before DSM-III, the permanence of traits has been
part of the definition of a personality disorder, although
certain personality disorders may be acquired to some
degree, and are amenable to change as a result of treat-
ment.
Besides “character,” other terms such as “temperament”
and “personality” were well also defined by the 18th cen-
tury. According to the Encyclopédie, the very influential
French-language encyclopedia edited between 1751 and
1772 by Denis Diderot and Jean d’Alembert,4tempera-
ment (temperament) originates from the natural consti-
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tution of the individual. The definition goes on to men-
tion the four temperaments described by the Greco-
Roman physician Galen, on the basis of the four humors
of the Hippocratic school: phlegmatic, sanguine, melan-
cholic, and choleric. This illustrates how humoral theo-
ries of personalities remained influential well into the
18th century. According to the Oxford English
Dictionary, the term “personality” has been used since
the 18th century to designate the distinctive individual
qualities of a person. Personality traits are a continuum,
ranging from the normal to the pathological. However,
in current usage, personality tends to refer to the traits
or qualities that are strongly developed or strikingly dis-
played, rather than to usual features. This raises the issue
of defining abnormality, a task complicated by the fact
that the same terms are often used to designate both
normal personality traits and psychiatric diagnoses.
Personality and the birth of psychiatry
Psychiatry, as a medical science, began to take shape
toward the end of the 18th century. One very popular
way of describing personality characteristics at that time
was phrenology. Although this science is now discred-
ited, it was a sincere attempt to describe personality on
a neuroanatomical basis. Phrenology is associated with
Franz Joseph Gall (1758–1828) a German physician who
was active in Vienna and ultimately settled in Paris.
However, it was Johann Gaspar Spurzheim, an associate
of Gall, who coined the term phrenology. Progress in
neuroanatomy led to the hypothesis that personality
traits had their basis in the cerebral cortex, where they
could be localized with precision. Phrenology models
indicated the location of many personality facets on the
cranium. For instance, combativeness, or courage and the
tendency to fight, were located behind the ear and above
the mastoid process; self-esteem, “was placed at the top,
or crown of the head, precisely at the spot from which
the priests of the Roman Catholic Church are obliged to
shave the hair”5; cautiousness was situated nearly in the
middle of the parietal bones; and conscientiousness was
located next to cautiousness. The concept of phrenology
started losing its appeal in the middle of the 19th cen-
tury. However, it remains an important milestone in the
development of psychiatry, since it highlighted the role
of the cerebral cortex.
According to most historians of psychiatry,6,7 Philippe
Pinel (1745–1826) was the first author to include a per-
sonality disorder in psychiatric nosology. In his Traité
médico-philosophique sur l’aliénation mentale ou la manie,8
Pinel introduced a category termed “manie sans délire”
(mania without delusion). At that time, “mania” referred
to states of agitation. Pinel described a few male patients
who appeared normal to the lay observer. Indeed, “with-
out delusion” meant, in Pinel’s depiction, that the patients
did not present with abnormalities of understanding, per-
ception, judgment, imagination, memory, etc. However,
they were prone to fits of impulsive violence, sometimes
homicidal, in response to minor frustration. One such
patient grappled a woman who had insulted him, and
threw her into a well. Philippe Pinel considered that a pos-
sible etiology of such cases was “a deficient and ill-
directed upbringing of the child, or an undisciplined or
perverse nature … [for instance in] an only son, raised by
a weak and permissive mother.” Subsequent French
alienists and psychologists retained an interest in the con-
ditions that were characterized by peculiarities in the
expression of emotions and behaviors, in the absence of
delusions, hallucinations, and without disorders of the
intellect. Jean-Étienne Dominique Esquirol (1772–1840)
introduced the concept monomanie raisonnante,9which
he illustrated with a motley collection of clinical cases; a
few of those cases would still be considered personality
disorders today. Esquirol also acknowledged Prichard,
noting that monomanie raisonnante was similar to the
moral insanity described by James Cowles Prichard (1786-
1848). Prichard was born into a Quaker family and knew
many foreign languages, including French, which may
explain his interest for French psychiatry and allowed him
to reappraise Pinel’s work.10 Neither Esquirol’s mono-
manie raisonnante, nor Prichard’s moral insanity, were
well delimited; they included a heterogeneous collection
of cases that would fall under a variety of modern diag-
nostic categories today. As would be the case for
Kraepelin later, many cases that captured the interest of
both Esquirol and Prichard had forensic consequences.
This shows that the practical question was whether psy-
chiatry could explain patterns of abnormal behavior, in
subjects with a normal intellect and no acute psychiatric
symptoms who had come into contact with the law.
The period between the late 19th century and early 20th
century was marked by the emergence of several elabo-
rate systems of normal and abnormal personality, asso-
ciating to some degree types and dimensions. A succes-
sion of European psychologists, such as Ribot, Heymans,
and Lazursky, deserve mention.
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Théodule Ribot (1839-1916), a French psychologist
known for coining the term “Anhedonia,” wrote on nor-
mal and abnormal characters.11 Ribot’s treatise was
translated into English within a year (the Psychology of
Emotions, 1897), and English-speaking contemporaries
were familiar with his ideas. Like his predecessors, Ribot
stressed that character is stable, appearing in childhood
and lasting all life. Ribot’s classification had “subtypes,”
defined by the association of several “primary types.”
Ribot’s terminology is antiquated, but his system
becomes more limpid when one realizes that he is, in
fact, describing dimensions. Normal personality was
characterized by the three following primary types: (i)
the sensitive or emotional, whose nervous system was
easily impressed by pleasant or unpleasant emotions,
and whose feelings were introverted; (ii) the active, who
were extraverted, spontaneous, and courageous; (iii) and
the apathetic, corresponding to the lymphatic of the
humoral classification, who displayed little propensity to
excitation and reaction. These three primary categories
were further subdivided into various “subtypes,” accord-
ing to the association of several dimensions. For instance,
the sensitive were subdivided into: the (i) humble, with
limited intelligence and energy; (ii) the contemplative,
who showed sensitivity, a keen intellect, and little activ-
ity (Hamlet, indecisive, was given as an example); and
(iii) the emotional, stricto sensu. Among the active, the
association of high activity, high intelligence, and little
sensitivity could produce historical figures such as
empire builders (Ribot mentioned Hernan Cortez and
Pizarro). Subjects associating apathy with intelligence
were good at strategy and unemotional reasoning (eg,
Benjamin Franklin, or Philip II of Spain). It is notewor-
thy that intelligence was an important modifier of per-
sonality according to Ribot; later authors would also
stress this.
Gerard Heymans (1857–1930) was a professor of phi-
losophy and psychology at the University of Groningen
(in the Netherlands). He coauthored articles with Enno
Dirk Wiersma (1858–1940), a professor of psychiatry at
the same university. Heymans was one the first to apply
empirical methods to the study of personality. He wrote
his habilitation in Freiburg im Breisgau (Germany), and
introduced Wilhelm Wundt’s methods of experimental
psychology into the Netherlands. The “Cube of
Heymans” that constructs personality types on the basis
of dimensions represents his description of personalities.
Heymans defined three bipolar dimensions: activity
level, emotionality, and primary vs secondary function-
ing (ie, functioning immediately vs according to plans).12
These three dimensions are represented on the x-, y- and
z-axes of the Heymans cube. All possible combinations
of the three dimensions defined eight personality types,
represented at the eight extremities of the cube. The
eight types are: amorphous, sanguine, nervous, choleric,
apathetic, phlegmatic, sentimental, and passionate.
Heymans’ terminology, obviously inspired by Greek
medicine, constitutes a link between ancient schools and
modern experimental psychology.
Aleksandr Fyodorovich Lazursky (1874-1917) was a psy-
chologist in Saint Petersburg (Russia), where he studied
under Bekhterev. He developed one of the first com-
prehensive theories of personality and had very creative
intuitions.13 His work did not enjoy international recog-
nition, probably because of the author’s early death, the
fact that he published in Russian, and because historical
upheavals isolated his country from international scien-
tific contacts after his death. Like others, he described
personality as a stable and long-lasting ensemble.
Lazursky’s first original contribution was his distinction
between “endopsychic” and “exopsychic” aspects of per-
sonality. Endopsychic features comprise the traditional
psychological functions (eg, memory, representations,
attention) that are largely innate or inherited.
“Temperament” (associated with physiological
processes) and “character” (linked to the exercise of will
and reason) belong to the “endopsychic” core of per-
sonality. In contrast, exopsychic characteristics result
from the favorable or unfavorable reciprocal interac-
tions between the personality and the outside world;
they are influenced by the person’s interests and are
capable of evolving. The endopsychic sphere has to do
with the psychological and neurological constitution. In
contrast, the exopsychic interface encompasses psy-
chosocial elements, the consequences of upbringing and
education, and the individual’s adaptive capacity. The
individual acquires a few exopsychic traits—such as the
attitude toward work and property, and the vision of the
world—but they become as durable as the endopsychic
personality traits. The interaction between the endo- and
exopsychic spheres determines three levels of function-
ing (inferior, intermediate, superior). Individuals func-
tioning at an inferior level are personalities that are
weak, ungifted, poorly organized; they have difficulties
adjusting to the environment; their life is guided by exte-
rior factors and not by their endopsychic capacities.
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Individuals functioning at an intermediate level are
more able to use the environment for their purposes;
they can find an occupation that corresponds to their
inclination; they achieve higher levels of comfort and
more freedom of initiative; in the end, they are more
useful to society. Highly gifted, talented people func-
tioning at a superior level can develop their creativity
even in unfavorable circumstances; they not only adjust
to the environment, but they even actively adapt the
environment to their needs.
Personality dimensions and personality types
in contemporary psychiatry
This section reviews the key authors that have defined
the concepts of personality types and personality dimen-
sions, as we use them today. Emil Kraepelin (1856–1926)
introduced personality types into modern psychiatric
classification, under the term “psychopathic personali-
ties.” At the beginning of the 20th century, in German-
speaking psychiatry, the meaning of the term “psy-
chopathy” was limited from the broad notion of
mentally ill to the more restricted abnormal personality.
Kraepelin stressed the existence of a broad overlap
between overt pathological conditions and personal fea-
tures that are encountered in normal people. He noted
that the limit between pathological and normal is grad-
ual and arbitrary. In entering the field of personality, psy-
chiatry was taking an interest in conditions that were not
previously considered to be liable to psychiatric inter-
pretation. In the 7th edition of his textbook,14 Kraepelin
assumed that psychopathic personalities were the con-
sequence of a faulty constitution, which had previously
been approached under the ill-defined concept of degen-
eracy. Psychopathic personalities result from a psycho-
logical inborn “defect,” which explains why the symp-
toms of psychopathic personalities have always been
present in the individual and persist with little modifi-
cation during his or her whole life. Their pathological
nature is not deduced from the fact the symptoms
appear in the patient after a period of normal function-
ing, but rather from the fact that symptoms deviate from
the range of normalcy. Patients with psychopathic per-
sonalities often have good cognitive capabilities, but
their affects and emotions are problematic. In the 7th
edition of Kreapelin’s textbook, the list of pathological
personalities comprised only four types: (i) the born
criminal (der Geborene Verbrecher), modeled on earlier
description by Cesare Lombroso (l’uomo delinquente)
and James C. Prichard (moral insanity); (ii) the irresolute
or weak-willed (die Haltlosen), who are unable of apply-
ing themselves to sustained and long-term work; (iii) the
pathological liars and swindlers (die krankhaften Lügner
und Schwindler) whose disorder is due to hyperreactive
imagination, unfaithful memory, an unstability of emo-
tions and willpower; and (iv) the pseudoquerulants (die
Pseudoquerulanten) who correspond to today’s paranoid
personality. The prefix “Pseudo” was meant to differen-
tiate this personality from the delusional disorder of the
same name. In the 8th edition (1915), the list was
expanded to seven types: (i) the excitable (die
Erregbaren), possibly sharing some characteristics with
today’s borderline personality disorder; (ii) the irres-
olute; (iii) persons following their instincts
(Triebmenschen) such as periodic drinkers and pleasure-
lovers; (iv) eccentrics (Verschrobene); (v) pathological
liars and swindlers; (vi) enemies of society
(Gesellschaftsfeinde); and (vii) the quarrelsome (die
Streitsüchtige). Kraepelin studied patients whose symp-
toms had consequences on social adaptation, and for
whom a psychiatric opinion might be sought after some
problem with the law. Most of Kraepelin’s personality
types do not correspond to DSM-IV-TR categories.
Kurt Schneider (1887–1967) described several “psycho-
pathic” (ie, abnormal) personalities in the successive edi-
tions of his textbook.15 Schneider’s various types of psy-
chopaths are as follows: (i) the hyperthymic
(Hyperthymische); (ii) the depressive; (iii) the insecure
(Selbstunsichere); (iv) the fanatical (Fanatische); (v)
recognition-seeking (Geltungsbedürftige); (vi) with labile
mood (Stimmungslabile); (vii) explosive (Explosible);
(viii) emotionally-blunted (Gemütlose); (ix) the weak-
willed (Willenlose); and (x) the asthenics (Asthenische).
Kurt Schneider stated several key concepts that are still
valid. He defined “psychopathic” personalities as those
individuals who suffer, or cause society to suffer, because
of their personality traits. Abnormal personalities are
largely inborn constitutions, but they can evolve as a
result of personal development or outside influences.
Kurt Schneider made an observation that is extremely
relevant to the debate surrounding the preparation of
DSM-5. He noted that a hybrid system of personality,
associating dimensions of normal personality and patho-
logical types, was an artificial construction. One could
build a “characterological system” describing normal
human personality dimensions, but it would be mean-
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ingless to derive clinically relevant abnormal types from
the exaggerations of these normal personality dimen-
sions. He remarked that characterological systems would
produce mostly bipolar dimensions, such as “explosive—
unexcitable” or “weak-willed—strong-willed.” However,
the clinically relevant abnormal personality types could
not be accommodated at the extremities of these axes.
Sigmund Freud (1856–1939) was born in the same year
as Kraepelin, which is their only shared characteristic.
Psychoanalysts reshaped contemporary thinking by cen-
tering their attention on the impact of early life events.
In addition, they assumed that these early events
remained out of awareness, kept unconscious, owing to
their potentially troublesome character. It was Sigmund
Freud, Karl Abraham, and Wilhelm Reich who laid the
foundation of the psychoanalytic character typology. The
first model of a psychoanalytic approach to a faulty per-
sonality is Freud’s paper on “Character and anal ero-
tism,” published in 1909.16 Before this, Freud had already
associated money and miserliness with excrements in a
letter to Fliess in 1897. Freud established a connection
between character traits and childhood experiences. He
described patients who are especially “orderly, parsimo-
nious and obstinate.” These three character traits were
inter-related. When exploring the early childhood of
these patients, Freud had the impression that they had
belonged to the “class who refuse to empty their bowels
when they are put on the pot because they derive a sub-
sidiary pleasure from defecating.” He postulated that
such people were born with a sexual constitution in
which the erotogenicity of the anal zone was exception-
ally strong. This description of the compulsive personal-
ity by Freud opened the way for the subsequent psy-
choanalytic definitions of other personality types. The
classification of personality disorders in DSM-II was
influenced by psychoanalysis, at least as regards termi-
nology.
Modern dimensional systems of personality are based
on the statistical analysis of the many thousands of
adjectives that are used to describe personality in all lan-
guages. The pioneer of this approach, Raymond Bernard
Cattell (1905-1998), was a British-born psychologist who
moved to the USA. Believing that psychology should be
based on measures, he pioneered the use of statistics to
discover personality dimensions. With the help of corre-
lation and factor analyses, made possible by the first
computers, he grouped the multitude of terms usually
used to describe personality into a smaller number of
traits. Cattell discovered a variable number of “source
traits” arranged along bipolar dimensions. The number
of these source traits varied as Cattell’s work evolved;
they amounted to sixteen in the final versions of his sys-
tem. Initially, Cattell chose to name these dimensions
with letters, in alphabetical order, starting with A for the
factor accounting for the most variance, B for the next
one, etc. He reasoned that it was more prudent to use
letters to name these dimensions, in the same way as
biologists had used letters to name vitamins, since giving
names would entail a risk of erroneously interpreting
dimensions whose true nature was unknown. Cattell’s
factor B (bright, abstract thinking versus dull, concrete
thinking) is supposed to be similar to Charles
Spearman’s g factor, measuring general intelligence.
Cattell coined a few words to name his source traits. For
instance, he adopted “surgent” to designate a distinct
type characterized by resourcefulness, responsiveness,
joyfulness, and sociability. The word “surgent,” from the
Latin surgo, conveys the idea of “leaping” or “rising up”
with facility. Systems of personality have been described
with a varying number of dimensions, often with three
or five dimensions (see ref 17 for a detailed description
of the history of dimensional description of personality).
The most successful dimensional model is the five-fac-
tor model, which was adapted for the dimensional
description of personality in DSM-5 (see the paper by
Trull and Widiger in this issue).18
Conclusion
The long history of personality theories helps put DSM
classifications of personality disorders into perspective.
DSM-II (1968) was influenced by psychoanalysis19; in
DSM-II, some personality disorders had to be differen-
tiated from the neuroses of the same name (eg, hysteri-
cal, obsessive-compulsive, and [neur]asthenic personal-
ities and neuroses). In DSM-III (1980),20 and the
subsequent DSM-III-R (1987) and DSM-IV (1994), per-
sonality disorders were described as discrete types,
grouped into three clusters, placed on a separate axis
(axis II). This categorical approach was in line with the
medical model advanced by Emil Kraepelin. Borderline
and narcissistic personality disorders, which entered
DSM-III, were adapted from psychoanalytical concepts.
The preparation of DSM-5 questioned the merits of
combining typological and dimensional models of per-
sonality, reopening a century-old debate. ❏
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Hitos en la historia de los trastornos de
personalidad
Este artículo analiza los principales hitos históricos
en el estudio de la personalidad normal y anormal,
desde la Antigüedad hasta el siglo XX. Se pone
especial atención a la interacción entre las aproxi-
maciones dimensionales y tipológicas, tema que fue
importante durante la preparación del DSM-5. Las
teorías de la personalidad se iniciaron con la teoría
humoral de la medicina griega. En los textos de psi-
quiatría se reconoce a Pinel, y luego a Esquirol y
Prichard como los primeros autores en describir las
personalidades anormales. Una sucesión de psicó-
logos europeos como Ribot, Heymans y Lazursky,
entre finales del siglo XIX y comienzos del XX, ide-
aron complejos sistemas de personalidad normal y
anormal, asociando en algún grado tipos y dimen-
siones. Emil Krepelin y Kurt Schneider propusieron
clasificaciones de tipos de personalidad anormal.
Paralelamente, los psicoanalistas destacaron el
papel de las experiencias tempranas de la vida.
Hacia mediados del siglo XX se aplicaron métodos
estadísticos para la validación científica de las
dimensiones de la personalidad con pioneros como
Cattell, anticipando el modelo de cinco factores.
Les grandes étapes dans l'histoire des
troubles de la personnalité
Cet article passe en revue les étapes majeures de
l’histoire de l’étude des personnalités normales et
pathologiques, depuis l’antiquité jusqu’au XXe
siècle. Cette perspective historique permet de com-
prendre certains débats qui ont animé la prépara-
tion du DSM-5, notamment le choix entre une
approche faisant appel à des catégories diagnos-
tiques distinctes, selon un modèle kraepelinien, par
opposition à une description de la personnalité nor-
male ou pathologique par des dimensions, dans la
suite de travaux qui ont culminé dans le modèle de
la personnalité à cinq facteurs (dit Big Five).
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