IPDE - Extranet Systems - World Health Organization

4 A. A. Dahl and A. Andreoli
Psychoanalysis introduced a general theory of personality develop
ment based on the solution of phase-specific drive conflicts during childhood.
From this emerged the oral, anal, and phallic-genital personality
types. As psychoanalysis progressed from a focus on drive conflicts to
tbe study of ego functions, object relations, and self-development, a
more interpersonal view was taken to describe conflicts and defects in
personality functioning. For example, various interpersonal wishes and
fears characterize the personality types described by Smith Benjamim2
Recently, a basic separation of temperament and character was proposed
by Cloninger et al..' who stated that descriptive data about individual
behaviour were insufficient to permit strong preferences among alternative
ways of summarizing personality traits. They proposed a general
psychobiological model of personality based on three temperamental
and four character dimensions.
Deviant personalities, psychopathies, and personality disorders
The problems in describing normal personality raise the fundamental
question of what the difference is between normal and abnormal personality.
Disorders of personality were described in the nineteenth century,
along with such concepts as character, constitution, temperament, and
self.4 Pinel. in 1801, described personalities that were deviant in their
emotions. Prichard, in 1835, identified patients who violated social nonns
as having 'moral insanity'. He raised the fundamental question, still very
important in forensic psychiatry, of whether deviant personalities are mad
or bad. In 1873, Koch described personality deviance in several domains
as 'psychopathic inferiorities', thereby embracing the view of More1 that
those with deviant personalities are inferior to normal people. The moralistic
attitude towards deviant personalities was based on this assumption,
and a derogatory view of patients with PD is still quite common.
From the very beginning PD was debated as a nosological entity,
because of moral judgements about unacceptable personality traits,
problems of their delimitation with normality, and the lack of guilt and
remorse in many such patients. Because individuals with PD often did
not consider themselves mentally ill, their diagnosis was less reliable
than it was for many other mental disorders.
SchneiderJ proposed the view that personality traits are continuously
distributed, the extreme deviations of a trait being pathological, if the individual
or society suffered because of them. His 10 types of PD illustrate
the fundamental arbihariness of categorical classification of abnormal