Patricianship, the quality of belonging to a patriciate, began in the ancient world, where cities such as Ancient Rome had a social class of patrician families, whose members were initially the only people allowed to exercise many political functions. In the rise of European towns in the 12th and 13th centuries, the patriciate, a limited group of families with a special constitutional position, in Henri Pirenne's view, was the motive force. In 19th century Central Europe, the term had become synonymous with the upper Bourgeoisie and cannot be interchanged with the medieval patriciate in Central Europe. In the maritime republics of the Italian Peninsula as well as in German-speaking parts of Europe, the patricians were as a matter of fact the ruling body of the medieval town. Particularly in Italy, they were part of the nobility.

With the establishment of the medieval towns, Italian city-states and maritime republics, the patriciate was a formally-defined social class of governing wealthy families. They were found in the Italian city-states and maritime republics, particularly in Venice, Genoa, Pisa and Amalfi. They were also found in many of the free imperial cities of the Holy Roman Empire, such as Nuremberg, Ravensburg, Augsburg, Konstanz, Lindau, Bern, Basel, Zurich and many more.

As in Ancient Rome, patrician status could generally only be inherited. However, membership in the patriciate could be passed on through the female line. For example, if the union was approved by her parents, the husband of a patrician daughter was granted membership in the patrician society Zum Sünfzen of the Imperial Free City of Lindau as a matter of right, on the same terms as the younger son of a patrician male (i.e., upon payment of a nominal fee), even if the husband was otherwise deemed socially ineligible. Accession to a patriciate through this mechanism was referred to as "erweibern."

In any case, only male patricians could hold, or participate in elections for, most political offices. Often, as in Venice, non-patricians had almost no political rights. Lists were maintained of who had the status, of which the most famous is the Libro d'Oro (Golden Book) of the Venetian Republic.

From the fall of the Hohenstaufen (1268), city-republics increasingly became principalities, like the Duchy of Milan and the Lordship of Verona. The smaller ones were swallowed up by monarchical states or sometimes other republics, like Pisa and Siena by Florence. Following these developments, any special role for the local patricians was restricted to municipal affairs.

The few remaining patrician constitutions, notably those of Venice and Genoa, were swept away by the conquering French armies of the period after the French Revolution, although many patrician families remained socially and politically important, as some do to this day.

In the modern era the term "patrician" is also used broadly for the higher bourgeoisie (not to be equated with aristocracy) in many countries; in some countries it vaguely refers to the non-noble upper class, especially before the 20th century.