HISTRIONIC PERSONALITY.pdf

H ISTRIONIC P ERSONALITY

S TYLE AND D ISORDER

T HE H ISTRIONIC P ERSONALITY T YPE I N A N UTSHELL

“The essential feature of H ISTRIONIC P ERSONALITY D ISORDER is pervasive and excessive

emotionality and attention-seeking behavior.” 1

Individuals who have a H ISTRIONIC P ERSONALITY T YPE may engage in relationships that

contain heightened emotions. They typically pull people in through emotionality (including

overt seductive behaviors) and then blow up the relationship in overly dramatic emotional

outbursts. After the explosion, they will reel the person back in for another round on their

emotional roller coaster. The cycle continues over and over with close or intimate contacts.

A C LOSER L OOK

Sometimes therapists have a hard time differentiating between B ORDERLINE P ERSONALITY

D ISORDER and H ISTRIONIC P ERSONALITY D ISORDER . There is a possibility that the two can

co-exist. The combination of both conditions is usually considered as the decomposition of

the histrionic personality structure.

In one respect, the differences between the two are a matter of degree. Both include a

fear of being alone and a fear of abandonment – with the borderline being frantic in their

efforts to avoid those conditions. Both are also impulsive – again, with the borderline

being potentially dangerous in their impulsive actions.

In another respect, however, there is a very significant difference in self-image. The

histrionic individual has a higher level of functioning in the respect that they are interactive

with their interpersonal environment. They openly use attention-seeking efforts to seek and

maintain relationships. 2 The borderline is much more frantic in their relationship efforts.

Also, the borderline individual has a propensity toward paranoid ideations and severe

dissociative symptoms. These are usually not present with the histrionic individual.

1 American Psychiatric Association: D IAGNOSTIC AND S TATISTICAL M ANUAL OF M ENTAL D ISORDERS , F OURTH E DITION ,

T EXT R EVISION . Washington D.C., American Psychiatric Association. 2000, p. 711.

2 In both disorders, the individuals fear being alone. The histrionic individual, however, believes that they

can do something to avoid abandonment. Thus, they use whatever assets they have (including overt

sexuality, attractiveness, and other flamboyant measures) to secure relationships so that they can avert

being alone. The borderline individual has either forfeited those efforts or they see those efforts as largely a

failure.

T HE B OTTOM L INE

Although securing lasting relationships with significant people is the primary need of these

individuals, they have not learned enough about their own self image to secure a lasting

and stable relationship. Thus, all of their efforts are simply attention-seeking behaviors.

Without a thorough understanding of self these individuals cannot differentiate themselves

from others enough to maintain the relationships that they seek.

There is often a confusion between feeling and fact with these individuals. What they

feel is often what they believe. Thus, if they “feel” stupid, then they are stupid. If they

“feel” ugly, then they are ugly. They cannot differentiate between feeling and fact. In a

relationship, this inability to differentiate results in their abandonment terror. If, for

example, they have some “feeling” of abandonment in a relationship, then certainly the

relationship must be over! Facts regarding commitment and the history of the relationship

are not considered.

T ECHNICAL DSM-IV-TR C RITERIA

F OR D IAGNOSIS OF A F ULL P ERSONALITY D ISORDER

The official DSM-IV-TR diagnostic criteria for H ISTRIONIC P ERSONALITY D ISORDER are: 3

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:

1. Is uncomfortable in situations in which he or she is not the center of attention.

2. Interaction with others is often characterized by inappropriate sexually seductive or

provocative behavior.

3. Displays rapidly shifting and shallow expression of emotions.

4. Consistently uses physical appearance to draw attention to self.

5. Has a style of speech that is excessively impressionistic and lacking in detail.

6. Shows self-dramatization, theatricality, and exaggerated expression of emotion.

7. Is suggestible, i.e., easily influenced by others or circumstances.

8. Considers relationships to be more intimate than they actually are.

[The therapist is reminded that the above criteria must be (1) a pervasive pattern, (2) and

must begin by early adulthood. If those main criteria cannot be met, a personality disorder

cannot be diagnosed (technically). If many of the other criteria are present, the therapist

should understand that the personality style has drifted toward undesirable and maladaptive

behaviors associated with the disorder. Treatment techniques described below should be

used to move the personality toward style rather than disorder.]

3 DSM-IV-TR , p. 714.

D IFFERENTIAL D IAGNOSIS

There are a number of other disorders that contain similar characteristics to H ISTRIONIC

P ERSONALITY D ISORDER . This list contains some of those disorders . The therapist is

encouraged to research these similar disorders using the DSM-IV-TR.

B ORDERLINE P ERSONALITY D ISORDER . Dual diagnosis can be made, if appropriate

criteria are met for both disorders.

A NTISOCIAL P ERSONALITY D ISORDER . A NTISOCIAL P ERSONALITY D ISORDER engages in

manipulation to gain power and profit while H ISTRIONIC P ERSONALITY D ISORDER engages in

manipulation to gain nurturance.

N ARCISSISTIC P ERSONALITY D ISORDER . Both disorders involve attention seeking.

N ARCISSISTIC P ERSONALITY D ISORDER uses attention seeking to gain superiority over others

and H ISTRIONIC P ERSONALITY D ISORDER uses attention seeking because the individuals are

willing to be viewed as fragile.

D EPENDENT P ERSONALITY D ISORDER . D EPENDENT P ERSONALITY D ISORDER is not

characterized by flamboyant, exaggerated emotional features while H ISTRIONIC

P ERSONALITY D ISORDER contains those elements.

P ERSONALITY C HANGE D UE T O M EDICAL C ONDITION . Dual diagnosis can be made.

H ISTRIONIC P ERSONALITY D ISORDER must exist prior to the onset of the medical condition.

C HRONIC S UBSTANCE A BUSE . Dual diagnosis can be made. H ISTRIONIC P ERSONALITY

D ISORDER must exist prior to the onset of chronic substance abuse.

C OMMONLY A SSOCIATED A XIS I D ISORDERS

There are a number of DSM-IV Axis I Disorders that are commonly associated with the

H ISTRIONIC P ERSONALITY T YPE . The therapist should be aware of each of these Axis I

Disorders and screen for them, if such screening seems appropriate.

S OMATIZATION D ISORDER . Somatization Disorder may be present in the H ISTRIONIC

P ERSONALITY T YPE . This disorder results in significant physical complains that involve

repeated visits to a medical doctor. In order to meet criteria for the disorder, the physical

complaints must be from four categories: pain symptoms , gastrointestinal symptoms ,

sexual symptoms , and pseudoneurological symptoms . These physical manifestations may

be a result of the attention-seeking behavior of this personality type.

C ONVERSION D ISORDER . Conversion Disorder is the presence of physical symptomology

related to motor or sensory function. Symptoms vary widely including paralysis , difficulty

swallowing , lump in the throat , urinary issues , loss of touch or pain sensation , double

vision , blindness , and deafness . 4 These symptoms usually simulate neurological or other

medical conditions quite closely. Conversion Disorder may only be diagnosed when a

medical doctor has completely ruled out a medical source for the seemingly medical issues.

Conversion Disorder among individuals with the H ISTRIONIC P ERSONALITY T YPE may be

associated with attention-seeking behaviors and the excessive emotionality .

M AJOR D EPRESSIVE D ISORDER . Relationships associated with the H ISTRIONIC

P ERSONALITY T YPE are often roller coasters. When relationships fail, there is a possibility of

a Major Depressive Disorder . The general emotionality of this disorder may also

precipitate depression.

D YSTHYMIC D ISORDER . Dysthymic Disorder contains many of the same elements as

Major Depression . One of the main differences is the prolonged nature of the depressive

symptomology (existing over at least a two-year period). Although the symptoms may be

less severe, they include a depressed or “blue” mood. The tendency of the H ISTRIONIC

P ERSONALITY T YPE toward Dysthymic Disorder may be related to their consistent

interpersonal conflicts.

S OCIAL P HOBIA . Due to the potential for consistent interpersonal conflict experienced by

the individual with a H ISTRIONIC P ERSONALITY T YPE , the prospect of a Social Phobia is a

distinct possibility.

A NXIETY D ISORDERS . Again, due to the prospect of consistent interpersonal conflict, this

individual may experience various anxiety disorders.

T HE H ISTRIONIC P ERSONALITY C ONTINUUM

All personality flows on a continuum from order to disorder – from function to

dysfunction. Internal and external stressing events are the “triggers” that motivate a

personality that is functioning in an orderly fashion to move toward disorder. Since each

personality is different, not all stressing events hold the same impacting “value” for each

person. A stressor that might cause significant personality disruption in one person might

not effect another at all.

Each clinically recognizable Personality Disorder has its corresponding Personality

Style . The goal of the therapist should be to move a disordered personality from a state of

disorder to a state of homeostasis – the corresponding Personality Style .

According to Sperry, 5 the optimally functioning H ISTRIONIC P ERSONALITY S TYLE contains

seven elements. Correspondingly, there are seven elements that indicate the breakdown of

each of those seven optimally functioning elements. As an individual “trades off” each of

the optimally functioning elements for a maladaptation, they are moving closer to a clinical

assessment of full H ISTRIONIC P ERSONALITY D ISORDER . The effort, therefore, must be to

establish and maintain the optimally functioning elements of the H ISTRIONIC P ERSONALITY

S TYLE without allowing for diminution toward more maladaptive traits.

4 DSM-IV-TR , pp. 492-498.

5 Sperry, Len, M.D., Ph.D. H ANDBOOK OF D IAGNOSIS AND T REATMENT OF DSM-IV-TR P ERSONALITY D ISORDERS

(Second Edition). Brunner-Routledge. New York, NY. 2003. P. 133.

Sperry’s continuum includes the following seven elements:

Optimal Functioning

Maladaptation

•

This person enjoys compliments and

praise.

•

This individual constantly seeks or

demands reassurance, approval, or

praise.

•

This individual is charming, engaging,

and

•

This individual is inappropriately

sexually seductive in appearance and

behavior.

appropriately

seductive

appearance and behavior.

•

This person is attentive to their

appearance and grooming.

•

This person is overly concerned with

physical attractiveness.

•

This individual is lively and fun-

loving, often impulsive but can delay

gratification.

•

This person expresses emotion with

inappropriate exaggeration, is self-

centered.

•

This individual enjoys being the center

of attention and can rise to the

occasion when all eyes are on them.

•

This person is uncomfortable in

situations where they cannot be the

center of attention.

•

This person is sensation oriented,

emotionally

•

This person displays rapidly shifting

and shallow expression of emotion.

demonstrative,

and

physically affectionate.

•

This individual uses a style of speech

that is appropriately global and

specific.

This individual uses a style of speech

that is excessively impressionistic and

lacking in detail.

T HE H ISTRIONIC P ERSONALITY S TYLE U NDER S TRESS

The following behaviors will likely manifest when an individual with a H ISTRIONIC

P ERSONALITY T YPE faces a triggering event. In the case of the H ISTRIONIC P ERSONALITY

T YPE , triggering events will be those events that are associated with relationships involving

the opposite sex – especially relationships that become emotionally volatile. Simple

participation in relationships with the opposite sex is likely to involve at least some

stressing symptoms.

•

Constant need for reassurance, approval and praise.

•

Extreme attention-seeking behaviors (including seduction and use of emotionality).

•

Over concern with physical appearance (and attractiveness in females).

•

Exaggerated emotional displays including irrational outbursts and temper tantrums.

•

Extreme impulsiveness.

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