Character Disorder

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The conception of character reflects mankind's understanding of human nature. Plato (427-347 b.c.) and Aristotle (284-322 b.c.) recognized individual differences; Hippocrates (460-377 b.c.) and Galen (130-200 a.d.) offered humoral theories of temperament, whereas Theophrastus (372-287 b.c.) described 30 character types, some of which resemble modern personality typologies. By the early nineteenth century psychopathology became linked to character. For example, Pinel (1801/1962) described insanity without delirium, Rush (1812) wrote about moral depravity, and Prichard (1835) advanced the concept of moral insanity.

According to Pierce's (1924) The Philosophy of Character, personality and character are equivalent; both reflect the sum of attributes of the person and the agglomeration of all knowledge, innate and acquired, teleological and non-teleological, which forces action, and thus, taken with the environment, determines the conduct of individuals. Similarly, Roback's The Psychology of Character (1927) defined character as the disposition to inhibit impulse and narrow self-seeking in light of some value principle.

From this traditional definition, the concept of character disorders evolved to include four rather diverse patterns of abnormal behavior: alcoholism, drug addiction, sexual deviancy, and psychopathy. Despite their diversity, several characteristics common to individuals so categorized were cited as justification for viewing them within a single conceptual framework. The behavior patterns typically constitute a violation of the codes and conventions of society. The problem behaviors most often result in immediate positive reinforcing consequences, although the delayed effects are usually negative. Finally, these individuals do not seem to experience guilt over repeated violation of societal conventions and are rarely motivated to change their behavior.

A slightly different meaning to the term character can be found within psychoanalytic theory. Early analysts began by investigating neurotic symptoms, phenomena that do not fit within a customary mode of behavior. Realizing the importance of these customary modes of "character" in the analysis of symptoms of therapeutic resistances, analysts began describing the nature of character and the role it played within the ego (see Fenichel, 1945). The publication of Reich's Character Analysis in 1933 was an impetus for the serious study of character types. It represented a shift in psychoanalytic theory away from unconscious material and toward the characteristic behavior that is used as a defense against analytic insight and unconscious material (Reich, 1972).

The most common example of character disorder is the condition classically designated as the psychopathic or so-ciopathic personality, the history of which has been comprehensively recounted elsewhere (Millon, Simonsen, & Birket-Smith, 1998). The psychopath seems to regard others not as persons, with feelings and rights comparable to his or her own, but as things to be used, exploited, and manipulated. H. Cleckley in The Mask of Sanity (1941) describes the psychopath as having superficial charm, un-truthfulness, insincerity, poor judgment, failure to learn from experience, unresponsiveness in interpersonal relationships, and a failure to follow any life plan. Frequent involvement with criminal justice systems is common, along with participation in fraud and swindling activities. Modern assessment, such as Hare's (1991) checklist, preserves a set of core attributes: glib and superficial charm; grandiose sense of self-worth; need for stimulation or proneness to boredom; tendency toward pathological lying, conning, and manipulativeness; lack of remorse or guilt; shallow affect; callousness and lack of empathy; parasitic lifestyle; poor behavior controls; promiscuous sexual behavior; early behavior problems; lack of realistic, long-term goals; impul-sivity; irresponsibility; failure to accept responsibility for own actions; many short-term marital relationships; juvenile delinquency; revocation of conditional release; and criminal versatility. Confusingly, the term psychopath is almost absent from widely accepted modern nomenclature, replaced by the more ubiquitous Antisocial Personality Disorder, which substituted more reliable behavioral criteria of lawlessness and deviance for richer, albeit less reliable, eti-ologic and theoretic formulations.

Alcoholism and drug abuse have traditionally been included under the heading of character disorders. Individuals with these symptoms generally show many dependency-autonomy conflicts and problems in the area of impulse control, conformity to social expectations, and personal value commitments that are common to a disorder of character. Similarly, sexual behaviors including exhibitionism, trans-

vestitism, voyeurism, sadomasochism, fetishism, rape, homosexuality, pedophilia, and incest have historically been included in this category. Modern classification systems have discarded the notion of character as defining in these disorders and have separated substance abuse and sexual paraphilias into discrete diagnostic categories. Likewise, in psychology's more recent history, character disorder is used as a generic term to refer to disorders of personality. Such disorders represent any deeply ingrained inflexible, mal-adaptive patterns of relating to, perceiving, and thinking about the environment and oneself. They may cause either significant impairment in adaptive functioning or subjective distress. Thus they are pervasive personality traits and are exhibited in a wide range of social and personal contexts. The Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) is one system of describing these conditions.

Finally, it is important to recognize that character disorders need not be exclusively defined by their clinical, symptomatic, or maladaptive components. Indeed, there are examples of constellations of traits that might be considered maladaptive in one setting but adaptive, perhaps even richly rewarding, in another setting. Widom (1977), for instance, has studied the personality profiles of nonin-stitutionalized psychopaths, ones who have never been caught. Works such as Lasch's (1978) The Culture of Narcissism and Smith's (1978) The Psychopath in Society have taken an even broader view by implicating certain character "disorders" as ascendant over aspects of modern culture and commerce.

In summary, character disorders, a slightly archaic term by standards of contemporary nomenclature, have their origin in conceptions of human nature and individual difference. As a class, character disorders subsumed a number of conditions for which a moral defect was believed responsible: alcoholism, drug addiction, sexual deviancy and psychopathy. Modern conceptions of character disorders are relegated to descriptions of Antisocial Personality Disorder, personality disorders in general, or Substance Abuse and Sexual Disorders.

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