This phenomenon is made evident by the remarkably low prevalence of antisocial personality disorders in countries including Taiwan, China, and Japan, along with a significantly higher incidence of cluster C personality disorders. Cultural factors may also play a pivotal role in the development of personality disorders, as demonstrated by the varying prevalence of personality disorders in different countries. Genes of interest are those regulating neurotransmission - serotonin (5-HT), dopamine (DA), and norepinephrine(NE), which indirectly participate in affect regulation. More recently, researchers have found genetic correlations, specifically in schizotypal, borderline personality disorder (BPD), and antisocial PDs (personality disorders). Those with borderline and antisocial disorders suffer from intimacy and trust deficits, both of which may be co-related with childhood abuse and trauma. Childhood trauma is another etiologic hypothesis. For example, classic Freudian drive theory postulates fixation at different stages manifests as separate disorders dependent, obsessive-compulsive, and histrionic personality disorders are consequences of fixation at oral, anal, and phallic stages, respectively. Psychoanalysts suggest that these disturbances result from a failure to progress through proper psychosexual development. The precise etiology of personality disorders continues to elude scientists, giving rise to wide-ranging hypotheses. Patients with personality disorders suffer from distorted perceptions of reality and abnormal affective behavior, manifesting in maladaptive coping mechanisms and distress. These disorders are currently described as pervasive, maladaptive, and chronic patterns of behavior, thinking, and feeling, ultimately leading to distress and dysfunction. Cluster C includes avoidant, dependent, obsessive-compulsive. Cluster B includes antisocial, borderline, histrionic, and narcissistic. Cluster A includes paranoid, schizoid, and schizotypal. The ensuing ten disorders are classified into three clusters.
However, the catalog ultimately remained unchanged.
During the production of DSM 5 (2013), editors considered combining the novel dimensional five-factor model of behavior with psychoanalytic typological models of personality. Eleven then became ten in the more condensed DSM IV (1994). This new model was represented by the eleven personality disorders acknowledged in DSM III (1980). Psychiatric conceptualization then shifted away from the previously accepted psychoanalytic model to a categorical model strongly correlating with the medical model originally proposed by Kraepelin.
The subsequent DSM II (1968), which was heavily influenced by psychoanalysis, elaborated further to distinctly separate personality disruptions from neuroses of the same name. These, in turn, evolved into the seven personality disturbances listed by the DSM-1, in 1952. Emil Kraepelin classified manic-depressive patients as depressive, hypomanic, or irritable, which in turn correlated with melancholic, sanguine, or choleric dispositions, respectively. The postulated temperaments, consisting of sanguine, choleric, melancholic, and phlegmatic, remained in use as recently as the 20th century. Temperament classification dates back as far as ancient Greece when Hippocrates proposed his humoral theory regarding the classifications of behavior.
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