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Histrionic Personality Disorder


Neurotic Solution: Histrionic Type
Dramatic Personality Type



Perspectives q.v.





The Disease Perspective



The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (American Psychiatric Association, 1994, pp. 657-658) describes Histrionic Personality Disorder as a pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
  • is uncomfortable in situations in which he or she is not the center of attention;

  • interaction with others is often characterized by inappropriate sexually seductive or provocative behavior;

  • displays rapidly shifting and shallow expression of emotions;

  • consistently uses physical appearance to draw attention to self;

  • has a style of speech that is excessively impressionistic and lacking in detail;

  • shows self-dramatization, theatricality, and exaggerated expression of emotion;

  • is suggestible, i.e., easily influenced by others or circumstances;

  • considers relationships to be more intimate than they actually are.




The Dimensional Perspective



Dimensions

Here is a hypothetical profile, in terms of the five-factor model of personality, for Histrionic Personality Disorder (speculatively constructed from McCrae, 1994, pg. 306):



High Neuroticism
Chronic negative affects, including anxiety, fearfulness, tension, irritability, anger, dejection, hopelessness, guilt, shame; difficulty in inhibiting impulses: for example, to eat, drink, or spend money; irrational beliefs: for example, unrealistic expectations, perfectionistic demands on self, unwarranted pessimism; unfounded somatic concerns; helplessness and dependence on others for emotional support and decision making.

Low Extraversion
Social isolation, interpersonal detachment, and lack of support networks; flattened affect; lack of joy and zest for life; reluctance to assert self or assume leadership roles, even when qualified; social inhibition and shyness.

High Openness
Preoccupation with fantasy and daydreaming; lack of practicality; eccentric thinking (e.g., belief in ghosts, reincarnation, UFOs); diffuse identity and changing goals: for example, joining religious cult; susceptibility to nightmares and states of altered consciousness; social rebelliousness and nonconformity that can interfere with social or vocational advancement.

High Agreeableness
Gullibility: indiscriminate trust of others; excessive candor and generosity, to detriment of self-interest; inability to stand up to others and fight back; easily taken advantage of.

Low Conscientiousness
Underachievement: not fulfilling intellectual or artistic potential; poor academic performance relative to ability; disregard of rules and responsibilities can lead to trouble with the law; unable to discipline self (e.g., stick to diet, exercise plan) even when required for medical reasons; personal and occupational aimlessness.



Specific Affects

Exaggerated, shallow emotions; enthusiasm, anger, boredom (Millon, pg. 158).

Hysteria; sadness, jealousy, disappointment, fear, boredom (Stone [Briquet], pg. 318).



Character Weaknesses and Vices*

  • praise-hungry
  • seductive
  • over-dramatic
  • shallow
  • self-centered
  • impressionistic
  • attention-seeking


Know Your Major Weaknesses


* Derived from Michael Stone's (pg. 22) list of the "personality traits" of DSM-III-R Histrionic Personality Disorder.





The Behavior Perspective



Motivations

Desire to coerce, manipulate, and deceive others into giving help and to establish and maintain dependency.

"The inordinate and demanding dependency displayed by many of these patients plays so important a role in hysterical psychopathology as to constitute a kind of organizing principle for many of the other features, which can be seen as distorted efforts to gratify dependency or as defensive reactions to its presence" (Chodoff, pg. 2727).



Behaviors

Overly dramatic, reactive, and intensely expressed behavior; strident and superficial emotionality, emotional storms, constant attention-seeking, sexually seductive behavior, histrionics, submissiveness, eagerness to please, ruthless willfulness (Chodoff, pp. 2727-2728).

Affectation, overreaction, stimulus-seeking, intolerance of inactivity, impulsiveness, theatricality, flirtatiousness, demandingness, attention-seeking, exhibitionism (Millon, pp. 138, 140).

Emotional manipulation, seductiveness; demands for constant attention; cravings for novelty, stimulation, and excitement; suicide gestures and threats (American Psychiatric Association, pg. 656).

Bombast.



Associated Disorders

Somatization Disorder, Conversion Disorder, Major Depressive Disorder (American Psychiatric Association, pg. 656).

Depression, Hysteroid Dysphoria (Chodoff, pp. 2735-2736).







The Life Story Perspective



Childhood

Inconsistent parenting style: alternation between insensitive non-involvement and rewards for exhibitionist behavior.
 

Universal Character Disorder   Sadistic


A Christian Approach to Character Disorder

Histrionic character disorder is a type of "solution" to the problem of anxiety; that is, it is a strategy to alleviate anxiety. The objects of desire and pleasure listed below (derived mostly from Beck, Freeman, and associates, 1990, pp. 50-51) are limited goods pridefully turned to for security when we fail to trust God. They are analogous to Karen Horney's "neurotic needs."

Karen Horney: Intrapsychic Strategies of Defense

The Self-Effacing Solution

"Even when we deeply value ourselves, the anxiety built into finitude will tempt us to find our source of security in some strategy rather than a trust in God" (Cooper, pg. 163).


Idols

"According to Ellis, emotional and behavioral difficulties occur when humans take simple preferences (desire for love, approval, success) and turn them into dire needs" (Source).

Compulsive Attachments

 Compulsive Aversions
  • attention
  • expressiveness
  • emotionalism
  • romanticism
  • impressing others
  • captivating others
  • glamor
  • amusement
  • affection
  • alliances
  • an audience
  • appreciation
  • being entertaining
  • admiration
  • feelings
  • dramatics
  • demonstrativeness
  • being ignored
  • being unattractive
  • being unlovable
  • being uninteresting
  • being abandoned
  • being helpless
  • frustration
  • not getting their own way
  • not getting compliance from others
  • being treated unfairly



Cognitive Effects

Basic Belief: I need to impress. [Strategy]: Dramatics (Beck, Freeman & associates, pg. 26).

The "idealized self is made up of beliefs about how we should feel, think, or act" (Tamney, pg. 32).

Compulsive beliefs and attitudes are idols, too.

In Cognitive Therapy of Personality Disorders, Aaron T. Beck, Arthur Freeman, and associates (1990) list typical beliefs associated with each specific personality disorder. According to my view, the beliefs and attitudes rationalize and reinforce the idealized image and the compulsive attachments and aversions. They are analogous to Karen Horney's "shoulds" and "neurotic claims." Here are the typical beliefs that they have listed (pg. 362) for Histrionic Personality Disorder:

  • I am an interesting, exciting person.
  • In order to be happy I need other people to pay attention to me.
  • Unless I entertain or impress people, I am nothing.
  • If I don't keep others engaged with me, they won't like me.
  • The way to get what I want is to dazzle or amuse people.
  • If people don't respond very positively to me, they are rotten.
  • It is awful for people to ignore me.
  • I should be the center of attention.
  • I don't have to bother to think things through—I can go by my "gut" feeling.
  • If I entertain people, they will not notice my weaknesses.
  • I cannot tolerate boredom.
  • If I feel like doing something, I should go ahead and do it.
  • People will pay attention only if I act in extreme ways.
  • Feelings and intuition are much more important that rational thinking and planning (362).


Beck's Cognitive Therapy for Personality Disorders







American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. 4th ed. Washington: Author.

Beck, Aaron T. and Freeman, Arthur M. and Associates (1990). Cognitive Therapy of Personality Disorders. New York : Guilford Press.

Beck, Aaron T. and Freeman, Arthur M. and Associates (2003). Cognitive Therapy of Personality Disorders, 2nd ed. New York : Guilford Press.

Chodoff, Paul (1989). Personality Disorders: Histrionic Personality Disorder. Treatments of Psychiatric Disorders, Vol. 3. American Psychiatric Association. Task Force on Treatments of Psychiatric Disorders. Washington, DC : American Psychiatric Association.

Cooper, Terry D. (2003). Sin, Pride, and Self-Acceptance: The Problem of Identity in Theology and Psychology. Downers Grove, IL: InterVarsity Press.

McCrae, Robert R. (1994). "A Reformulation of Axis II: Personality and Personality-Related Problems." Costa, Paul T., Jr., Widiger, Thomas A., editors. Personality Disorders and the Five-Factor Model of Personality. Washington, D.C.: The American Psychological Association.

Millon, Theodore (1990). Toward a new personology : an evolutionary model. New York : Wiley.

Stone, Michael H. (1993). Abnormalities of personality: within and beyond the realm of treatment. New York: W.W. Norton.

Tamney, Joseph B. (2002). The Resilience of Conservative Religion. New York: Cambridge UP.



Histrionic Personality Disorder: links

 Personality Disorders





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