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Being deeply rooted in a Christian faith and having much interest in moral and ethical issues, Koch published some philosophical works Die Wirklichkeit und ihre Erkenntnis (Reality and its knowledge; Koch, 1886), in which he tried to bring together critical Kantian philosophy and Christian conviction. In 1888 he published Kurzgefasster Leitfaden der Psychiatrie (Short Textbook of Psychiatry). The next work, entitled Die psychopathischen Minderwertigkeiten (Psychopathic Inferiority; Koch, 1891-93) became one of his fundamental texts on the concept of personality disorders, a concept still used today. Although psychiatric disorders are nowadays classified differently, Koch's work still has great importance for the concept of personality disorders; furthermore, he provides very exact and detailed descriptions of a multitude of psychopathological symptoms.

This article reviews the history and evolution of the diagnosis of personality disorders according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) from its first edition in 1952 through its fourth edition in 1994. The article also traces the earliest origins of personality disorders (e.g., Hippocrates) through the modern foundational works of Pritchard, Schneider, and Horney. Analysis of the changes across the editions of the DSM suggest slow but steady progress in the clarification and classification of personality disorders, although formidable challenges remain. A call for future research as to reliability and validity of personality disorders is made, and suggestions for research are offered.

The empirical research in premorbid personality of psychiatric patients has markedly advanced in German speaking countries since adequate research methods were introduced in the middle of the sixties. Among the various results are the following: Kretschmer's typological conception of human constitution were largely refuted and replaced by other conceptions on a methodologically more solid ground; Tellenbach's concept of the "melancholic type" as the premorbid structure of the majority of patients suffering from a unipolar affective disorder with melancholic features could be convincingly validated; this concept was supplemented by that of the "manic type" of personality as the premorbid correlate of the amount of a predisposition to manic episodes within the course of an affective disorder; the premorbid deviations of personality in schizophrenics and neurotics were shown to possess little nosological specificity; furthermore, similar deviations could be demonstrated in the personality of (still healthy) relatives of patients with severe mental disorders; the complex relationships of (premorbid) personality, personality disorders and mental disorders were partly clarified.

Any theoretical direction in psychiatry takes into account a definition of the illness, and of the state of health and their limits, as well as the relationships between these two different states in their psychobehavioral expressiveness and within the relational system of personality. The states which are taken as deviations from what is generally considered and accepted as normal state, have always been identified and form the so-called major mental pathology, but one cannot ascertain the same thing about the so-called borderline states, and the representation of normality. It is also true that within the two international systems of classification, WHO and DSM-III one can find the difficulty and even the hesitation of using the term "mental illnesses" instead to use "mental disorders". These are the reasons that made the author consider useful the illustration of the diagnostic criterion through the classification of the concepts on mental illness--an evolution illustrated by the contribution of syndrome concepts, i.e. an anatomoclinical state according to the evolution of the symptoms, psychopathological criteria and generally the dimensional and categorical criteria. Thus, the criteriological investigation remains a theoretical actual approach and at the same time applicable for the psychiatric care.