Histrionic personality disorder - Wikipedia

Histrionic personality disorder (HPD) is defined by the American Psychiatric Association as a personality disorder characterized by a pattern of excessive attention-seeking behaviors, usually beginning in early childhood, including inappropriate seduction and an excessive desire for approval. People diagnosed with the disorder are said to be lively, dramatic, vivacious, enthusiastic, and flirtatious. HPD is diagnosed four times as frequently in women as men.[1] It affects 2–3% of the general population and 10–15% in inpatient and outpatient mental health institutions.[2]

HPD lies in the dramatic cluster of personality disorders.[3] People with HPD have a high desire for attention, make loud and inappropriate appearances, exaggerate their behaviors and emotions, and crave stimulation.[3] They may exhibit sexually provocative behavior, express strong emotions with an impressionistic style, and can be easily influenced by others. Associated features include egocentrism, self-indulgence, continuous longing for appreciation, and persistent manipulative behavior to achieve their own needs.

Signs and symptoms Edit

People with HPD are usually high-functioning, both socially and professionally. They usually have good social skills, despite tending to use them to manipulate others into making them the center of attention.[4] HPD may also affect a person's social and romantic relationships, as well as their ability to cope with losses or failures. They may seek treatment for clinical depression when romantic (or other close personal) relationships end.[5][citation needed ]

Individuals with HPD often fail to see their own personal situation realistically, instead dramatizing and exaggerating their difficulties. They may go through frequent job changes, as they become easily bored and may prefer withdrawing from frustration (instead of facing it). Because they tend to crave novelty and excitement, they may place themselves in risky situations. All of these factors may lead to greater risk of developing clinical depression.[6]

Additional characteristics may include:

Some people with histrionic traits or personality disorder change their seduction technique into a more maternal or paternal style as they age.[8]

Mnemonic Edit

A mnemonic that can be used to remember the characteristics of histrionic personality disorder is shortened as "PRAISE ME":[9][10]

Causes Edit

Little research has been done to find evidence of what causes histrionic personality disorder and from where it stems. Although direct causes are inconclusive, there are a few theories and studies conducted that suggests there are multiple possible causes. There are neurochemical, genetic, psychoanalytical, and environmental causes contributing to histrionic personality disorder. Traits such as extravagance, vanity, and seductiveness of hysteria have similar qualities to women diagnosed with HPD.[11] HPD symptoms do not fully develop until the age of 15 with treatment only beginning at approximately 40 years of age.[12][13]

Neurochemical/physiological Edit

Studies have shown that there is a strong correlation between the function of neurotransmitters and the Cluster B personality disorders such as HPD. Individuals diagnosed with HPD have highly responsive noradrenergic systems which is responsible for the synthesis, storage, and release of the neurotransmitter, norepinephrine. High levels of norepinephrine leads to anxiety-proneness, dependency, and high sociability.[14]

Genetic Edit

Twin studies have aided in breaking down the genetic vs. environment debate. A twin study conducted by the Department of Psychology at Oslo University attempted to establish a correlation between genetic and Cluster B personality disorders. With a test sample of 221 twins, 92 monozygotic and 129 dizygotic, researchers interviewed the subjects using the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and concluded that there was a correlation of 0.67 that histrionic personality disorder is hereditary.[15]

Psychoanalytic theory Edit

Though criticised as being unsupported by scientific evidence, psychoanalytic theories incriminate authoritarian or distant attitudes by one (mainly the mother) or both parents, along with conditional love based on expectations the child can never fully meet.[3] Using psychoanalysis, Freud believed that lustfulness was a projection of the patient's lack of ability to love unconditionally and develop cognitively to maturity, and that such patients were overall emotionally shallow.[16] He believed the reason for being unable to love could have resulted from a traumatic experience, such as the death of a close relative during childhood or divorce of one's parents, which gave the wrong impression of committed relationships. Exposure to one or multiple traumatic occurrences of a close friend or family member's leaving (via abandonment or mortality) would make the person unable to form true and affectionate attachments towards other people.[17]

HPD and antisocial personality disorder Edit

Another theory suggests a possible relationship between histrionic personality disorder and antisocial personality disorder. Research has found 2/3 of patients diagnosed with histrionic personality disorder also meet criteria similar to those of the antisocial personality disorder,[11] which suggests both disorders based towards sex-type expressions may have the same underlying cause. Women are hypersexualized in the media consistently, ingraining thoughts that the only way women are to get attention is by exploiting themselves, and when seductiveness isn't enough, theatrics are the next step in achieving attention.[18] Men can just as well be flirtatious towards multiple women yet feel no empathy or sense of compassion towards them.[11] They may also become the center of attention by exhibiting the "Don Juan" macho figure as a role-play.[18]

Some family history studies have found that histrionic personality disorder, as well as borderline and antisocial personality disorders, tend to run in families, but it is unclear if this is due to genetic or environmental factors.[19] Both examples suggest that predisposition could be a factor as to why certain people are diagnosed with histrionic personality disorder, however little is known about whether or not the disorder is influenced by any biological compound or is genetically inheritable.[19] Little research has been conducted to determine the biological sources, if any, of this disorder.

Diagnosis Edit

The person's appearance, behavior and history, along with a psychological evaluation, are usually sufficient to establish a diagnosis. There is no test to confirm this diagnosis. Because the criteria are subjective, some people may be wrongly diagnosed.[20]

DSM 5 Edit

The current edition of the Diagnostic and Statistical Manual of Mental Disorders, DSM 5, defines histrionic personality disorder (in Cluster B) as:[2]

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 DSM 5 requires that a diagnosis for any specific personality disorder also satisfies a set of general personality disorder criteria.

ICD-10 Edit

The World Health Organization's ICD-10 lists histrionic personality disorder as:[21]

A personality disorder characterized by:

  • shallow and labile affectivity,
  • self-dramatization,
  • theatricality,
  • exaggerated expression of emotions,
  • suggestibility,
  • egocentricity,
  • self-indulgence,
  • lack of consideration for others,
  • easily hurt feelings, and
  • continuous seeking for appreciation, excitement and attention.

It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

Comorbidity Edit

Most histrionics also have other mental disorders. Comorbid conditions include: antisocial, dependent, borderline, and narcissistic personality disorders,[22] as well as depression, anxiety disorders, panic disorder, somatoform disorders, anorexia nervosa, substance use disorder[23] and attachment disorders, including reactive attachment disorder.[citation needed ]

Millon's subtypes Edit

Theodore Millon identified six subtypes of histrionic personality disorder. Any individual histrionic may exhibit none or one of the following:[24]

Subtype Description Personality Traits
Appeasing histrionic Including dependent and compulsive features Seeks to placate, mend, patch up, smooth over troubles; knack for settling differences, moderating tempers by yielding, compromising, conceding; sacrifices self for commendation; fruitlessly placates the unplacatable.
Vivacious histrionic The seductiveness of the histrionic mixed with the energy typical of hypomania. Some narcissistic features can also be present Vigorous, charming, bubbly, brisk, spirited, flippant, impulsive; seeks momentary cheerfulness and playful adventures; animated, energetic, ebullient.
Tempestuous histrionic Including negativistic features Impulsive, out of control; moody complaints, sulking; precipitous emotion, stormy, impassioned, easily wrought-up, periodically inflamed, turbulent.
Disingenuous histrionic Including antisocial features Underhanded, double-dealing, scheming, contriving, plotting, crafty, false-hearted; egocentric, insincere, deceitful, calculating, guileful.
Theatrical histrionic Variant of “pure” pattern Affected, mannered, put-on; postures are striking, eyecatching, graphic; markets self-appearance; is synthesized, stagy; simulates desirable/dramatic poses.
Infantile histrionic Including borderline features Labile, high-strung, volatile emotions; childlike hysteria and nascent pouting; demanding, overwrought; fastens and clutches to another; is excessively attached, hangs on, stays fused to and clinging.

Treatment Edit

Treatment is often prompted by depression associated with dissolved romantic relationships. Medication does little to affect the personality disorder, but may be helpful with symptoms such as depression. The only successful method studied and proven to succeed is to fully break contact with their lovers in order to gain a sense of stability and independence once again.[20][failed verification ] Treatment for HPD itself involves psychotherapy, including cognitive therapy.[3]

Interviews and self-report methods Edit

In general clinical practice with assessment of personality disorders, one form of interview is the most popular; an unstructured interview.[25] The actual preferred method is a semi-structured interview but there is reluctance to use this type of interview because they can seem impractical or superficial.[25] The reason that a semi-structured interview is preferred over an unstructured interview is that semi-structured interviews tend to be more objective, systematic, replicable, and comprehensive.[25] Unstructured interviews, despite their popularity, tend to have problems with unreliability and are susceptible to errors leading to false assumptions of the client.[25]

One of the single most successful methods for assessing personality disorders by researchers of normal personality functioning is the self-report inventory following up with a semi-structured interview.[25] There are some disadvantages with the self-report inventory method that with histrionic personality disorder there is a distortion in character, self-presentation, and self-image.[25] This cannot be assessed simply by asking most clients if they match the criteria for the disorder.[25] Most projective testing depend less on the ability or willingness of the person to provide an accurate description of the self, but there is currently limited empirical evidence on projective testing to assess histrionic personality disorder.[25]

Functional analytic psychotherapy Edit

Another way to treat histrionic personality disorder after identification is through functional analytic psychotherapy.[26] The job of a Functional Analytic Psychotherapist is to identify the interpersonal problems with the patient as they happen in session or out of session.[26] Initial goals of functional analytic psychotherapy are set by the therapist and include behaviors that fit the client's needs for improvement.[26] Functional analytic psychotherapy differs from the traditional psychotherapy due to the fact that the therapist directly addresses the patterns of behavior as they occur in-session.[26]

The in-session behaviors of the patient or client are considered to be examples of their patterns of poor interpersonal communication and to adjust their neurotic defenses.[26] To do this, the therapist must act on the client's behavior as it happens in real time and give feedback on how the client's behavior is affecting their relationship during therapy.[26] The therapist also helps the client with histrionic personality disorder by denoting behaviors that happen outside of treatment; these behaviors are termed "Outside Problems" and "Outside Improvements".[26] This allows the therapist to assist in problems and improvements outside of session and to verbally support the client and condition optimal patterns of behavior".[26] This then can reflect on how they are advancing in-session and outside of session by generalizing their behaviors over time for changes or improvement".[26]

Coding client and therapist behaviors Edit

This is called coding client and therapist behavior.[26] In these sessions there is a certain set of dialogue or script that can be forced by the therapist for the client to give insight on their behaviors and reasoning".[26] Here is an example from"[26] the conversation is hypothetical. T = therapist C = Client This coded dialogue can be transcribed as:

Functional ideographic assessment template Edit

Another example of treatment besides coding is functional ideographic assessment template.[26] The functional ideographic assessment template, also known as FIAT, was used as a way to generalize the clinical processes of functional analytic psychotherapy.[26] The template was made by a combined effort of therapists and can be used to represent the behaviors that are a focus for this treatment.[26] Using the FIAT therapists can create a common language to get stable and accurate communication results through functional analytic psychotherapy at the ease of the client; as well as the therapist.[26]

Epidemiology Edit

The survey data from the National epidemiological survey from 2001–2002 suggests a prevalence of HPD of 1.84 percent.[27][medical citation needed ] Major character traits may be inherited, while other traits may be due to a combination of genetics and environment, including childhood experiences.[8] This personality is seen more often in women than in men.[28] Approximately 65% of HPD diagnoses are women while 35% are men. In Marcie Kaplan's A Women's View of DSM-III, she argues that women are overdiagnosed due to potential biases and expresses that even healthy women are often automatically diagnosed with HPD.[29]

Many symptoms representing HPD in the DSM are exaggerations of traditional feminine behaviors. In a peer and self-review study, it showed that femininity was correlated with histrionic, dependent and narcissistic personality disorders.[30] Although two thirds of HPD diagnoses are female, there have been a few exceptions.[31] Whether or not the rate will be significantly higher than the rate of women within a particular clinical setting depends upon many factors that are mostly independent of the differential sex prevalence for HPD.[32] Those with HPD are more likely to look for multiple people for attention, which leads to marital problems due to jealousy and lack of trust from the other party. This makes them more likely to become divorced or separated once married.[33] With few studies done to find direct causations between HPD and culture, cultural and social aspects play a role in inhibiting and exhibiting HPD behaviors.

History Edit

Although it is said that the history of histrionic personality disorder stems from the word hysteria,[34] actually it comes from Etruscan histrio which means an actor. Hysteria can be described as an exaggerated or uncontrollable emotion that people, especially in groups, experience. Beliefs about hysteria have varied throughout time. It wasn’t until Sigmund Freud who studied histrionic personality disorder in a psychological manner.[34] “The roots of histrionic personality can be traced to cases of hysterical neurosis described by Freud.”[16] He developed the psychoanalytic theory in the late 19th century and the results from his development led to split concepts of hysteria. One concept labeled as hysterical neurosis (also known as conversion disorder)[35] and the other concept labeled as hysterical character (currently known as histrionic personality disorder).[34] These two concepts must not be confused with each other, as they are two separate and different ideas.[16]

Histrionic personality disorder is also known as hysterical personality. Hysterical personality has evolved in the past 400 years[36] and it first appeared in the DSM II (Diagnostic and Statistical Manual of Mental Disorders, 2nd edition) under the name hysterical personality disorder. The name we know today as histrionic personality disorder is due to the name change in DSM III, third edition. Renaming hysterical personality to histrionic personality disorder is believed to be because of possible negative connotations to the roots of hysteria, such as intense sexual expressions, demon possessions, etc.[37]

Histrionic personality disorder has gone through many changes. From hysteria, to hysterical character, to hysterical personality disorder, to what it is listed as in the most current DSM, DSM-5.[clarification needed ] "Hysteria is one of the oldest documented medical disorders.”[34] Hysteria dates back to both ancient Greek and Egyptian writings.[34] Most of the writings related hysteria and women together, similar to today where the epidemiology of histrionic personality disorder is generally more prevalent in women and also frequently diagnosed in women.[25]

Ancient times Edit

Middle Ages Edit

Renaissance Edit

Modern age Edit

Contemporary age Edit

Edit

The prevalence of histrionic personality disorder in women is apparent and urges a re-evaluation of cultural notions of normal emotional behaviour. The diagnostic approach classifies histrionic personality disorder behaviour as “excessive”, considering it in reference to a social understanding of normal emotionality.[40]

See also Edit

References Edit

  1. ^ Seligman, Martin E.P. (1984). "Chapter 11". Abnormal Psychology. W.W. Norton & Company. ISBN 978-0-393-94459-4.
  2. ^ a b "Chapter 16: Personality Disorders". DSM-IV-TR Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Publishing. 2000.
  3. ^ a b c d Bienenfeld, David (2006). "Personality Disorders". Medscape Reference. WebMD. Archived from the original on 2007-02-08 . Retrieved 10 January 2007 .
  4. ^ a b "Histrionic Personality Disorder". The Cleveland Clinic. Archived from the original on 2011-10-03 . Retrieved 23 November 2011 .
  5. ^ Tartakovsky, M (9 January 2020). "Histrionic Personality Disorder Treatment". PsychCentral . Retrieved 10 May 2020 .
  6. ^ a b "Histrionic personality disorder". A.D.A.M. Medical Encyclopedia. PubMed Health. Archived from the original on 2012-08-29 . Retrieved 17 June 2012 .
  7. ^ "Histrionic Personality Disorder | Psychology Today". Psychology Today . Retrieved 2018-04-24 .
  8. ^ a b Arthur, Melissa (2006). "Histrionic Personality Disorder". Histrionic Personality Disorder: Description, Incidence, Prevalence, Risk Factors, Causes, Associated Conditions, Diagnosis, Signs and symptoms and treatment. Armenian Medical Network. Archived from the original on 2007-02-12 . Retrieved 10 January 2007 .
  9. ^ Pinkofsky, HB (September 1997). "Mnemonics for DSM-IV personality disorders". Psychiatric Services. 48 (9): 1197–1198. doi:10.1176/ps.48.9.1197 . PMID 9285984.
  10. ^ "Personality Disorders". March 2001. Archived from the original on 2006-04-24 . Retrieved May 2, 2006 .
  11. ^ a b c Barlow, H.D. & Durand, V.M. (2005). Personality Disorders. (pp. 443–444). Abnormal Psychology: An Integrative Approach (4th ed.). Belmont, CA: Thomas Wadsworth.
  12. ^ Lumen Learning. "Histrionic Personality Disorder". Lumen Learning. Archived from the original on 2018-03-16 . Retrieved 2018-03-13 .
  13. ^ Fancher, R.E. & Rutherford, A. (2012). Pioneers of psychology. New York, NY: W.W. Norton & Company.
  14. ^ "Histrionic Personality Disorder". Courses Lumen. Archived from the original on 2018-03-16.
  15. ^ Torgersen, Lygren, Øien, Skre, Onstad, Edvardsen, Tambs, Kringlen, Svenn, Sissel, Per Anders, Ingunn, Sidsel, Jack, Kristian, Einar (November 2000). "A Twin Studies of Personality Disorders". Comprehensive Psychiatry. 41 (6): 416–425. doi:10.1053/comp.2000.16560. PMID 11086146. CS1 maint: multiple names: authors list (link)
  16. ^ a b c Pfohl, B. (1995). Histrionic personality disorder. The DSM IV Personality Disorders, 173–192.
  17. ^ Nickert, J. (n.d.) Histrionic Personality Disorder.
  18. ^ a b Bornstein, R.F. & Widiger, T.A. (2001). Comprehensive Handbook of Psychopathology. Adams, H.E. & Sutker, P.B. (Ed.) New York, NY.
  19. ^ a b Nolen-Hoeksema, S. (2014). Personality Disorders. (pp. 266–267). Abnormal Psychology (6th ed.). New York, NY: McGraw-Hill.
  20. ^ a b "Psych Central: Histrionic Personality Disorder Treatment". Psych Central. 2017-12-17. Archived from the original on 2008-08-29 . Retrieved 2008-07-09 .
  21. ^ "Chapter V: Mental and behavioural disorders (F00-F99)". International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10). World Health Organization. 2010. Archived from the original on 2014-11-02 . Retrieved 2012-06-05 . (F60.4)
  22. ^ Hales E and Yudofsky JA, eds, The American Psychiatric Press Textbook of Psychiatry, Washington, DC: American Psychiatric Publishing, Inc., 2003
  23. ^ "Armenian Medical Network". Archived from the original on 2007-02-12 . Retrieved 2007-01-11 .
  24. ^ Millon, Theodore (2004). Personality Disorders in Modern Life. John Wiley & Sons, Inc., Hoboken, New Jersey. ISBN 0-471-23734-5.
  25. ^ a b c d e f g h i Sutker, P.B. (2002). Histrionic, Narcissistic, and Dependent Personality Disorders. Comprehensive handbook of psychopathology (3rd ed., pp. 513–514). New York: Kluwer Academic.
  26. ^ a b c d e f g h i j k l m n o p q Callaghan G.M.; Summers C.J.; Weidman M. (2003). "The treatment of histrionic and narcissistic personality disorder behaviors: A single-subject demonstration of clinical improvement using functional analytic psychotherapy". Journal of Contemporary Psychotherapy. 33 (4): 321–339. doi:10.1023/b:jocp.0000004502.55597.81.
  27. ^ Grant, Bridget F.; Hasin, Deborah S.; Stinson, Frederick S.; Dawson, Deborah A.; Chou, S. Patricia; Ruan, W. June; Pickering, Roger P. (2004-07-15). "Prevalence, Correlates, and Disability of Personality Disorders in the United States". The Journal of Clinical Psychiatry. 65 (7): 948–958. doi:10.4088/jcp.v65n0711. ISSN 0160-6689. PMID 15291684.
  28. ^ Suinn, Richard M. (1984). Fundamentals of abnormal psychology (Updated ed.). Chicago: Nelson-Hall. pp. 335–336. ISBN 978-0-8304-1071-2.
  29. ^ Kaplan, Marcie (July 1983). "A Women's View on DSM-III" (PDF) . American Psychologist. 38 (7): 786–792. doi:10.1037/0003-066x.38.7.786. Archived (PDF) from the original on 2018-03-16 . Retrieved 2018-03-16 .
  30. ^ Klonsky, Jane, Turkheimer, Oltmanns, E. David, J. Serrita, Eric, Thomas (2002). "Gender Role and Personality Disorders". J Pers Disord. 16 (5): 464–76. doi:10.1521/pedi.16.5.464.22121. PMC 4364134 . PMID 12489312. CS1 maint: multiple names: authors list (link)
  31. ^ Corbitt, E., Widiger, T. (1995). "Sex differences among the personality disorders: An exploration of the data". Clinical Psychology: Science and Practice. 2 (3): 225–238. doi:10.1111/j.1468-2850.1995.tb00041.x. CS1 maint: multiple names: authors list (link)
  32. ^ Widiger, T. (1998). "Sex biases in the diagnosis of personality disorders". Journal of Personality Disorders. 12 (2): 95–118. doi:10.1521/pedi.1998.12.2.95. PMID 9661097.
  33. ^ Disney, K.L., Weinstein, Y., & Oltmanns, T.F. (2012). "Personality disorder symptoms are differentially related to divorce frequency". Journal of Family Psychology. 26 (6): 959–965. doi:10.1037/a0030446. PMC 3569846 . PMID 23244459. CS1 maint: multiple names: authors list (link)
  34. ^ a b c d e Blais M.A.; Hilsenroth M.; Fowler C. (1998). "Rorschach correlates of the DSM-IV histrionic personality disorder". Journal of Personality Assessment. 70 (2): 355–365. doi:10.1207/s15327752jpa7002_12. PMID 9697335.
  35. ^ Crimlisk H.; Ron M. (1999). "Conversion hysteria: history, diagnostic issues, and clinical practice". Cognitive Neuropsychiatry. 4 (3): 165–180. doi:10.1080/135468099395909.
  36. ^ Alam C.M.; Merskey H. (1992). "The development of hysterical personality". History of Psychiatry. 3 (10): 135–165. doi:10.1177/0957154x9200301001. PMID 11623028.
  37. ^ Bakkevig J.F.; Sigmund K. (2010). "Is the diagnostic and statistical manual of mental disorders, fourth edition, histrionic personality disorder category a valid construct?". Comprehensive Psychiatry. 51 (5): 462–470. doi:10.1016/j.comppsych.2009.11.009. PMID 20728002.
  38. ^ a b c d e f g h i j Tasca C.; Rapetti M.; Carta M.G.; Fadda B. (2012). "Women and hysteria in the history of mental health". Clinical Practice & Epidemiology in Mental Health. 8: 110–119. doi:10.2174/1745017901208010110. PMC 3480686 . PMID 23115576.
  39. ^ "Cable on the Ancients - Pagans". Archived from the original on 2017-06-27 . Retrieved 2016-10-07 .
  40. ^ ‘Histrionic Personality Disorder’, in American Psychiatric Association, The Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association, Arlington, VA, pp. 667.

External links Edit

https://en.m.wikipedia.org/wiki/Histrionic_personality_disorder