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Histrionic personality disorder is the grandchild of the diagnosis of hysteria. Hysterical people are typically imaginative, often with well-developed emotional intuition. They tend to look at the world in over impressionistic terms rather than focusing on details, so they tend to be headline readers. They gravitate toward activities that don’t necessarily involve concentration for long hours on facts and details, but they are often very creative and colorful. Histrionic personality disorder is really hysteria run amok. It’s hysterical personality traits carried to an extreme that is histrionic personality disorder.
Histrionic individuals can be quite colorful and outgoing. They are highly excitable. They have difficulty maintaining deep and lasting relationships and they often use displays of emotion to control other people, so that the emotion is not necessarily genuine but used to get attention, to avoid unwanted responsibilities. Histrionic individuals often have temper tantrums, they are often quite fickle in their affections. So someone can be their closest friend one day and then be of no importance the next. They can often be quite seductive. The appearance is that this is for sexual purposes but often this is to seduce lovers into situations.
Diagnostic criteria involve a pattern of excessive emotionality and attention-seeking, with demands for reassurance, inappropriate sexual seductiveness. In terms of defense mechanisms, the primary defense mechanisms used by the histrionic are repression. For example, repression of ideational contents so that all that is left over is affect. A histrionic individual will feel flooded by affect but not know why. Histrionic individuals have quite a bit more non-specific somatic complaints.
In terms of the etiology, psychodynamic theorists again point to the disturbances in the parent-child relationship that underlie this disorder. But there is also a possible association between histrionic personality disorder and antisocial personality disorder. Perhaps both represent a manifestation of the same temperamental style. Histrionic personality disorder is much more frequently diagnosed in women. Antisocial personality disorder is more frequently diagnosed in men. There is little information on the prevalence of this disorder because many people with this disorder.
Course and prognosis. This disorder is thought to improve with advancing age. That continually people’s defenses become somewhat more adaptive as they begin to see that the dramatic displays.
In terms of differential diagnosis, the main differential is between histrionic personality disorder and borderline personality disorder. They are quite similar in their overt manifestations, dramatizations, seductiveness, attention-seeking. But the borderline individuals generally feel chronically empty. They have profound identity disturbance. They are more likely to experience brief psychotic episodes and particularly - this is the hallmark - they are more likely to engage in overtly self-destructive acts. Again, there is tremendous overlap. Whether we call someone histrionic or borderline may have a lot to do with just the extent of their history of self-destructiveness. Somatization disorder is another thing to think about in the differential but people with somatization disorder often don’t have the emotional interests.
In terms of treatment, insight-oriented psychotherapy seems to be the treatment of choice for histrionic individuals. Both individual and group therapy have been found to be useful. Essentially the therapist works on helping histrionic individuals clarify what they genuinely feel, clarify ways in which they lose functioning, in which they lose cognitive capacity as a way to seek help and avoid responsibility. And help individuals take more responsibility for the consequences.
Narcissistic personality disorder. Narcissus was by legend a beautiful Grecian youth who fell madly in love with his own reflection when he happened to see it reflected in a pool one day. Narcissism refers to self-love, and loving self regard is something that is both desirable and necessary in ones inner world. It is only when the absorption of the self impairs one’s ability to form lasting relationships do we call it pathological. And crippling self-doubt and insecurity that is involved in pathological narcissism is a far cry from what we would consider simple self-regard. People with narcissistic personality disorder have severe problems in maintaining a
The narcissistic person struggles with a tenuous balance between the intensity to be admired by other people and the rage that he or she feels when people are disappointing and don’t provide the admiration that is needed. The narcissistic individual often starts out by idealizing other people only to come to devalue them when they reveal themselves to have feet of clay. Of course, this is something you have all experienced if you work with these people long-term. Narcissistic individuals, as you know, have great difficulty recognizing how other people feel. They feel entitled to special favors, to special treatment. They are more concerned about how they