Histrionic Personality Disorder 2010

Histrionic Personality Disorder 2010 by Yunjin

Classification of the Disorder
Histrionic Personality Disorder is from the group of dramatic personality disorder where people are characterized as being excessively emotional and attention-seeking. 1

Description of the Disorder
Histrionic personality disorder is one of a group of conditions called dramatic personality disorders. People who have this personality disorder depends on the approval of others and does not feel worthy of themselves. They always have a low self-esteem and have an overwhelming desire to be noticed, thus, behaving dramatically or inappropriately to get attention from others (the word histrionic means "dramatic or theatrical"). 3

List of Symptoms
  • Are uncomfortable unless the person is in the center of attention
  • Dress provocatively or behave inappropriately
  • Shift emotions rapidly (Ups and Downs)
  • Act very dramatically as though performing before an audience
  • Are overly concerned with physical appearance (physical looks and values)
  • Constantly seek reassurance or approval from others (need to belong)
  • Are gullible and easily influenced by others
  • Are extremely sensitive to criticism by others
  • Do not think before they act
  • Make rash and quick decisions
  • Be self-centered and rarely show concern for others
  • Have difficulty maintaining relationships, often seeming fake or shallow in their dealings with others
  • Threaten or attempt suicide to get attention. 3
Any known Causes (Why do people get it)
There is a lack of research and causes of the HPD. However, although the exact cause is not known, many psychologists believe that both learned and inherited factors play a great role in this development because the tendency for HPD to run in families suggest that there might be a genetic susceptibility to be inherited (but the child of a parent with this disorder may be just repeating a learned behavior). It is thought that HPD may be caused by biological, developmental, cognitive, and social factors during their early adolescents years. Other environmental factors that might be connected include a lack of criticism or punishment during young childhood, positive reinforcement that is given when a child completes appropriate behaviors, and unpredictable attention given to a child by his guardians all could lead to this personality disorder. According to Freud's theory, all people use defense mechanisms, but different people use different types of defense mechanisms. Individuals with HPD differ in the severity of the maladaptive defense mechanisms they use. Patients with more severe cases of Histrionic Personality Disorder may utilize the defense mechanisms of repression, also known as denial. 3

Biosocial Causes
Biosocial learning models of HPD suggest that individuals may acquire HPD from inconsistent interpersonal reinforcement offered by parents.

Sociocultural Causes

Studies of specific cultures with high rates of HPD suggest social and cultural causes of HPD. For example, some researchers would expect to find this disorder more often among cultures that tend to value uninhibited displays of emotion.

Personal Variables
Researchers have found some connections between the age of individuals with HPD and the behavior displayed by these individuals. For example, research suggests that seductiveness may be employed more often by a young adult than by an older one. To impress others, older adults with HPD may shift their strategy from sexual seductiveness to a paternal or maternal seductiveness. 6

Description of the therapies and treatments used to help people with the disorder
Individuals who suffer from HPD are usually difficult to treat of many reasons.However, they are much quicker to seek treatment and exaggerate their symptoms and difficulties during treatments. Thus, Psychotherapy is the treatment of choice. Group and family therapy approaches are not recommended because the individual will draw attention to themselves and exaggerate every action and reaction during the therapy. Because of the nature to be dramatic, therapists should be more attuned to their own feelings within the therapy to ensure the treatment.

As with most HPD patients, medications are not indicated except for the specific diagnoses. There should be a large amount of care given when prescribing medications to someone who suffers this because the medication might contribute to self-destructive behavior.

Self Help
Such approaches such as the self-help support groups would likely not be very effective because a person with this personality disorder is likely to be dramatic with a large group of interactions. 7

Case Study
(Notes of first therapy session with Marsha, female, 56, diagnosed with Histrionic Personality Disorder)
Marsha visibly resents the fact that I have had to pay attention to another patient (an emergency) "at her expense" as she puts it. She pouts and bats suspiciously long eyelashes at me: "Has any of your female patients fallen in love with you?" - she suddenly changes tack. I explain to her what is transference and countertransference in therapy. She laughs throatily and shakes loose an acid blond mane: "You may call it what you want, doctor, but the simple truth is that you are irresistibly cute." I steer away from these treacherous waters by asking her about her marriage. She sighs and her face contort, on the verge of tears: "I hate what's been happening to Doug and me. He has had such a stretch of bad luck - my heart goes out to him. I really love him you know. I miss what we used to be. But his rage attacks and jealousy are driving me away. I feel that I am suffocating."
Is he a possessive paranoid? She shifts uneasily in her seat: "I like to flirt. A little flirting never hurt nobody is what I say." Does Doug share her insouciance? He accuses her of being too provocative and seductive. Well, is she? "A woman can never be too much of either" - she protests mockingly.

Has she ever cheated on her husband? Never. So, why his jealous tantrums? Because she has been pretty direct with men she fancied, told them what she would do with them and to them if circumstances were different. Was this a wise thing to do in public? Maybe not the wisest, but it sure was fun, she laughs.
How did men react to her advances? "Usually, with an enormous erection." - she chuckles - "How did you react, doctor?" I was embarrassed, I admit, even annoyed. She doesn't believe me, she says. No red-blooded male has ever been put off by the lure of an attractive female and "from where I sit, you sure look as red-blooded as they come." Doug has been her fourth serious relationship this year. How can such a short-lived liaison be meaningful? "Depth and intimacy can be created overnight" - she assures me, they are not a function of the length of acquaintance. But surely they depend on the amount of time spent together? "Is this your wife?' - she points at a silver-framed picture on my desk - "I bet you are hitting it off in the sack!" Actually, I tell her, that's my daughter. She shrugs off her faux-pas and sprawls across my duvet, long legs exposed to the hip and crossed at the ankles.
She sighs theatrically and shields her eyes with her hand: "I wish it was all over." Does she mean her relationship with Doug? "No, silly", she was referring to her tumultuous life and its vagaries. Does she really mean it? Of course not. She rolls to one side, leaning on her elbow, face supported by an open palm: "I just wish people were more lighthearted, you know? I wish they knew how to enjoy life to the maximum, give and take with joy. Isn't this what psychotherapy is all about? Aren't these the skills you, as a psychiatrist, are trying to instil in your patients?" 5

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