(a) Clinical Origins

The recognition of different types of personality goes back to the earliest medical writings. Hippocrates suggested that the body contained four humours, and that excess of any one humour determined personality. Yellow bile was associated with a choleric temperament, black bile with a melancholic disposition, excess phlegm with a phlegmatic character and excess blood with a sanguine personality. Aristotle's pupil Theophrastus wondered that ‘albeit the whole of Greece lies in the same clime and all Greeks have a like upbringing, we have not the same constitution of character’. His differentiation of ‘characters’ into offensive, arrogant, unscrupulous, distrustful, avaricious and superstitious bears a remarkable similarity to the modern classifications of personality disorder. However, such individuals were not then considered to be disordered.

Personality disorder as such has its origins in the writings of early nineteenth-century psychiatrists from the French, German and Anglo-American tradition. Until then, mental disorders were always thought to include a disturbance of intellect or reasoning ability, and to be accompanied by hallucinations and delusions; they would now be termed ‘the psychoses’. Peter Tyrer and others consider that

Pinel recognised that certain individuals who showed behaviour characteristic of the mentally disturbed possessed a clear, intact reasoning ability and had no delusional ideas. This ‘central notion of bizarre behaviour in the presence of otherwise normal reasoning processes has remained one of the cornerstones of abnormal personality to this day.’ Pinel (1745-1826) indeed gave modern psychiatry a symbolic image when, ‘inspired by the Revolutionary ideals of liberty, equality, and fraternity … [he] figuratively (and perhaps literally) struck off the chains from his charges’ in the Pitié-Salpêtrière and Bicêtre Hospitals.