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Histrionic Personality Disorder

 

Personality disorder is a matter of false judgments of value. Listed below are the false value judgments that are at the root of Histrionic Personality Disorder.


False Good

False Bad

Personality Disorder
attention being ignored uncomfortable in situations in which they are not the center of attention
to be sexually attractive interaction with others often characterized by inappropriate sexually seductive or provocative behavior
to react emotionally to events rapidly shifting and shallow expression of emotion
to present an attractive physical appearance consistently uses physical appearance to draw attention to self
to have a dramatic, stimulating style of speech has a style of speech that is excessively impressionistic and lacking in detail
to dramatically express emotion shows self-dramatization, theatricality, and exaggerated expression of emotion
others' guidance, help, and considered opinions is suggestible, easily influenced by others or circumstances
intimate relationships consider relationships to be more intimate than they actually are



Perspectives q.v.





The Disease Perspective

Proposed Revision | APA DSM-5 New!



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


* 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.



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).

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).








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.



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