Personality disorders: from historical aspects to contemporary views
https://doi.org/10.31363/2313-7053-2025-4-1084
Abstract
This article presents a narrative review of the key theoretical and clinical approaches to understanding personality disorders. It traces the historical evolution of the concept, from early psychiatric descriptions to its current formulations in the DSM-5 and ICD-11 classifications. The review discusses differences in the definition of personality disorders and evaluates the advantages and disadvantages of categorical versus dimensional diagnostic systems. Special attention is given to comparing psychodynamic, cognitive-behavioral, and neurobiological models, including their influence on treatment strategies. The article provides a detailed analysis of neurobiological models of personality disorders, including data on structural and functional brain changes, neurochemical imbalances, and genetic factors, as well as their potential for the development of biomarkers and individualized therapies. Furthermore, it outlines the principles of psychotherapeutic interventions according to different theoretical frameworks—from psychoanalytically oriented therapy and schema therapy to dialectical behavior therapy. The review also examines the possibilities and limitations of pharmacotherapy, including current data on its efficacy and applicability across various types of personality pathology. This comprehensive overview aims to present the current state of the field and may be of interest to professionals in psychiatry and psychotherapy, as well as researchers exploring the development of integrative models for the diagnosis and treatment of personality disorders.
About the Authors
T. I. Shishkovskaia
Mental Health Research Center
Russian Federation
Russian Federation
Tatiana I. Shishkovskaia
Moscow
A. V. Leonova
Surgut State University
Russian Federation
Russian Federation
Alena V. Leonova
Surgut
N. N. Petrova
Saint Petersburg State University
Russian Federation
Russian Federation
Natalia N. Petrova
Saint Petersburg
References
1. Valiullina E.V. Izuchenie i issledovanie individual'no-psihologicheskih osobennostej lichnosti s pomoshch'yu metodiki R.B. Kettella. Fundamental'nye nauchnye issledovaniya: teoreticheskie i prakticheskie aspekty: Sbornik materialov V Mezhdunarodnoj nauchno-prakticheskoj konferencii, Tom II. – Kemerovo: Obshchestvo s ogranichennoj otvetstvennost'yu «Zapadno-Sibirskij nauchnyj centr»; 2017. (In Russ.).
2. Gannushkin P.B. Klinika psikhopatii: ikh statika, dinamika, sistematika. N. Novgorod: Meditsinskaya kniga, 1998. (In Russ.).
3. Leont'ev DA. A.F. Lazursky's theory of personality: from inclinations to relationships. Metodologiya i istoriya psikhologii. 2008;3:7–20. (In Russ.).
4. Abu Raya M, Ogunyemi AO, Broder J, Carstensen VR, Illanes-Manrique M, Rankin KP. The neurobiology of openness as a personality trait. Front Neurol. 2023;14. https://doi.org/10.3389/fneur.2023.1235345
5. American Psychiatric Association. Practice guideline for the treatment of patients with borderline personality disorder. American Journal of Psychiatry. 2001;158:52.
6. Asp M, Lindqvist D, Fernström J, Ambrus L, Tuninger E, Reis M et al. Recognition of personality disorder and anxiety disorder comorbidity in patients treated for depression in secondary psychiatric care. PLoS One. 2020;15:e0227364. https://doi.org/10.1371/journal.pone.0227364
7. Bach B, Mulder R. Clinical Implications of ICD-11 for Diagnosing and Treating Personality Disorders. Curr Psychiatry Rep. 2022;24:553–63. https://doi.org/10.1007/s11920-022-01364-x
8. Bach B, Sellbom M, Skjernov M, Simonsen E. ICD-11 and DSM-5 personality trait domains capture categorical personality disorders: Finding a common ground. Australian & New Zealand Journal of Psychiatry. 2018;52:425–34. https://doi.org/10.1177/0004867417727867
9. Bach B, Simonsen S. How does level of personality functioning inform clinical management and treatment? Implications for ICD-11 classification of personality disorder severity. Curr Opin Psychiatry. 2021;34:54–63. https://doi.org/10.1097/YCO.0000000000000658
10. Bamelis LLM, Evers SMAA, Spinhoven P, Arntz A. Results of a Multicenter Randomized Controlled Trial of the Clinical Effectiveness of Schema Therapy for Personality Disorders. American Journal of Psychiatry. 2014;171:305–22. https://doi.org/10.1176/appi.ajp.2013.12040518
11. Bateman A, Fonagy P. Psychotherapy for Borderline Personality Disorder. Mentalization-based Treatment. Oxford: Oxford University Press; 2004.
12. Bateman AW, Gunderson J, Mulder R. Treatment of personality disorder. The Lancet. 2015;385:735–43. https://doi.org/10.1016/S0140-6736(14)61394-5
13. Choate AM, Fatimah H, Bornovalova MA. Comorbidity in borderline personality: understanding dynamics in development. Curr Opin Psychol. 2021;37:104–8. https://doi.org/10.1016/j.copsyc.2020.09.015
14. Chumakov E, Charnaia D, Petrova N. Pharmacotherapy and psychotherapy interventions in patients with borderline personality disorder in outpatient clinical practice. European Psychiatry. 2024;67:118–118. https://doi.org/10.1192/j.eurpsy.2024.280
15. Clark LA, Watson D. The trait model of the DSM–5 alternative model of personality disorder (AMPD): A structural review. Personality Disorders: Theory, Research, and Treatment. 2022;13:328–36. https://doi.org/10.1037/per0000568
16. Crocq M-A. Milestones in the history of personality disorders. Dialogues Clin Neurosci. 2013;15:147–53. https://doi.org/10.31887/DCNS.2013.15.2/macrocq
17. Deodato M, Seeber M, Mammeri K, Michel CM, Vuilleumier P. Combined effects of neuroticism and negative emotional context on spontaneous EEG dynamics. Soc Cogn Affect Neurosci. 2024;19. https://doi.org/10.1093/scan/nsae012
18. Freud S. Character and anal erotic. London: The Hogarth Press; 1959.
19. Gauchet F, Lambert R. La caracteroiogie d’Heymans et Wiersma. Paris: Presses Universitaires de France; 1959.
20. Huprich SK. Personality Disorders in the ICD-11: Opportunities and Challenges for Advancing the Diagnosis of Personality Pathology. Curr Psychiatry Rep. 2020;22:40. https://doi.org/10.1007/s11920-020-01161-4
21. Jang KL, Livesley WJ, Vernon PA, Jackson DN. Heritability of personality disorder traits: a twin study. Acta Psychiatr Scand. 1996;94:438–44. https://doi.org/10.1111/j.1600-0447.1996.tb09887.x
22. Keefe JR, McMain SF, McCarthy KS, Zilcha-Mano S, Dinger U, Sahin Z, et al. A meta-analysis of psychodynamic treatments for borderline and cluster C personality disorders. Personality Disorders: Theory, Research, and Treatment. 2020;11:157–69. https://doi.org/10.1037/per0000382
23. Kim Y, Saunders GRB, Giannelis A, Willoughby EA, DeYoung CG, Lee JJ. Genetic and neural bases of the neuroticism general factor. Biol Psychol. 2023;184:108692. https://doi.org/10.1016/j.biopsycho.2023.108692
24. Kolla NJ, Boileau I, Bagby RM. Higher trait neuroticism is associated with greater fatty acid amide hydrolase binding in borderline and antisocial personality disorders. Sci Rep. 2022;12:1126. https://doi.org/10.1038/s41598-022-04789-9
25. Koudys JW, Traynor JM, Rodrigo AH, Carcone D, Ruocco AC. The NIMH Research Domain Criteria (RDoC) Initiative and Its Implications for Research on Personality Disorder. Curr Psychiatry Rep. 2019;21:37. https://doi.org/10.1007/s11920-019-1023-2
26. Kraepelin E. Ein Lehrbuch fur Studierende und Artzte. 7. Auflage. II. Band. Klinische Psychiatrie. Leipzig: Verlag Barth; 1904.
27. Krueger RF, Hobbs KA. An Overview of the DSM-5 Alternative Model of Personality Disorders. Psychopathology. 2020;53:126–32. https://doi.org/10.1159/000508538
28. Latzman RD, Krueger RF, DeYoung CG, Michelini G. Connecting quantitatively derived personality–psychopathology models and neuroscience. Personal Neurosci. 2021;4:e4. https://doi.org/10.1017/pen.2021.3
29. Leichsenring F, Rabung S. Long-term psychodynamic psychotherapy in complex mental disorders: update of a meta-analysis. British Journal of Psychiatry. 2011;199:15–22. https://doi.org/10.1192/bjp.bp.110.082776
30. Leigh D. James Cowles Prichard, M.D., 1786-1848. Proceedings of Royal Society of Medicine. 1955;48:586–90.
31. Livesley W, Jang K, Jackson D, Vernon P. Genetic and environmental contributions to dimensions of personality disorder. American Journal of Psychiatry. 1993;150:1826–31. https://doi.org/10.1176/ajp.150.12.1826
32. Mallard TT, Tubbs JD, Jennings M, Zhang Y, Gustavson DE, Grotzinger AD, et al. The pleiotropic architecture of human impulsivity across biological scales. 2023. https://doi.org/10.1101/2023.11.28.23299133
33. Marstrand-Joergensen MR, Madsen MK, Stenbæk DS, Ozenne B, Jensen PS, Frokjaer VG, et al. Default mode network functional connectivity negatively associated with trait openness to experience. Soc Cogn Affect Neurosci. 2021;16:950–61. https://doi.org/10.1093/scan/nsab048
34. Miller AP, Gizer IR. Dual-systems models of the genetic architecture of impulsive personality traits: neurogenetic evidence of distinct but related factors. Psychol Med. 2024;54:1533–43.
35. Mulder RT. ICD-11 Personality Disorders: Utility and Implications of the New Model. Front Psychiatry. 2021;12. https://doi.org/10.1017/S0033291723003367
36. National Collaborating Centre for Mental Health. National Institute for Health and Clinical Excellence. Personality Disorders: borderline and antisocial. [nice.org]. nice; 2015. Available at: www.nice.org.uk/guidance/qs88. 2015.
37. National Health and Medical Research Council. Australian Government. Clinical Practice guidelines for the management of borderline personalità disorder. Melbourne: National Health and Medical Research Council. [bpdfoundation.org.au]. bpdfoundation; 2012. Available at: https://bpdfoundation.org.au/images/mh25_borderline_personality_guideline.pdf
38. Ormel J, Bastiaansen A, Riese H, Bos EH, Servaas M, Ellenbogen M, et al. The biological and psychological basis of neuroticism: Current status and future directions. Neurosci Biobehav Rev. 2013;37:59–72. https://doi.org/10.1016/j.neubiorev.2012.09.004
39. Paris J. Why Patients With Severe Personality Disorders Are Overmedicated. J Clin Psychiatry. 2015;76:e521–e521. https://doi.org/10.4088/JCP.14com09441
40. Pascual JC, Arias L, Soler J. Pharmacological Management of Borderline Personality Disorder and Common Comorbidities. CNS Drugs. 2023;37:489–97. https://doi.org/10.1007/s40263-023-01015-6
41. Pinel P. Traité médico-philosophique sur I’aliénation mentale ou la manie. Paris, 1801.
42. Post RM, Leverich GS, McElroy S, Kupka R, Suppes T, Altshuler L, et al. Relationship of comorbid personality disorders to prospective outcome in bipolar disorder. J Affect Disord. 2020;276:147–51. https://doi.org/10.1016/j.jad.2020.07.031
43. Ribot T. La psychologie des sentiments. Paris; 1896.
44. Rinaldi C, Attanasio M, Valenti M, Mazza M, Keller R. Autism spectrum disorder and personality disorders: Comorbidity and differential diagnosis. World J Psychiatry. 2021;11:1366–86. https://doi.org/10.5498/wjp.v11.i12.1366
45. Ripoll LH, Triebwasser J, Siever LJ. Evidence-based pharmacotherapy for personality disorders. Int J Neuropsychopharmacol. 2011;14:1257–88. https://doi.org/10.1017/S1461145711000071
46. Schneider K. Klinische Psychopathologie. Stuttgart, 1976.
47. Siever L, Davis K. A psychobiological perspective on the personality disorders. American Journal of Psychiatry. 1991;148:1647–58. https://doi.org/10.1176/ajp.148.12.1647
48. Stoffers J, Völlm BA, Rücker G, Timmer A, Huband N, Lieb K. Pharmacological interventions for borderline personality disorder. Cochrane Database of Systematic Reviews. 2010. https://doi.org/10.1002/14651858.CD005653.pub2.
49. Stoffers-Winterling JM, Völlm BA, Rücker G, Timmer A, Huband N, Lieb K. Psychological therapies for people with borderline personality disorder. Cochrane Database of Systematic Reviews. 2012;8(8):CD005652 https://doi.org/10.1002/14651858.CD005652.pub2
50. Stoffers-Winterling J, Storebø OJ, Lieb K. Pharmacotherapy for Borderline Personality Disorder: an Update of Published, Unpublished and Ongoing Studies. Curr Psychiatry Rep. 2020;22:37. https://doi.org/10.1007/s11920-020-01164-1
51. Stoffers-Winterling J, Völlm B, Lieb K. Is pharmacotherapy useful for treating personality disorders? Expert Opin Pharmacother. 2021;22:393–5. https://doi.org/10.1080/14656566.2021.1873277
52. Svrakic D, Cloninger R. Psychobiological Model of Personality: Guidelines for Pharmacotherapy of Personality Disorder. Curr Psychopharmacol. 2013;2:190–203.
53. Swales MA. Personality disorder diagnoses in ICD-11: Transforming conceptualisations and practice. Clinical Psychology in Europe. 2022;4 Special Issue. https://doi.org/10.32872/cpe.9635
54. Tyrer P, Gunderson J, Lyons M, Tohen M. Special Feature: Extent of Comorbidity Between Mental State and Personality Disorders. J Pers Disord. 1997;11:242–59. https://doi.org/10.1521/pedi.1997.11.3.242
55. Xu Q, Liu F, Qin W, Jiang T, Yu C. Multiscale neurobiological correlates of human neuroticism. Hum Brain Mapp. 2020;41:4730–43. https://doi.org/10.1002/hbm.25153sto
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Shishkovskaia T.I., Leonova A.V., Petrova N.N. Personality disorders: from historical aspects to contemporary views. V.M. BEKHTEREV REVIEW OF PSYCHIATRY AND MEDICAL PSYCHOLOGY. (In Russ.) https://doi.org/10.31363/2313-7053-2025-4-1084
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