Click here to view next page of this article New Treatments for Histrionic Personality DisorderHPD is a pervasive pattern of excessive emotionality and attention seeking. HPD is indicated by the presence of five or more of the eight diagnostic criteria presented in the DSM-IV. Histrionic persons also tend to be emotionially manipulative and intolerant of delayed gratification. Approximately 1% to 3% of the general population may be diagnosed with HPD. A controversial issue is its differential sex prevalence. It is stated in DSM-IV that the sex ratio for HPD is "not significantly different than the sex ratio of females. However, this should not be interpreted to suggest that the prevalence is the same for men and women. Among studies that have reported the differential prevalence across the PDs, it has typically been found that at least two thirds of persons with HPD are women, although there have been a few exceptions. Whether the rate is significantly higher than the rate of women. EtiologyThere has been little research on the etiology of HPD. It has been suggested that HPD may share a genetic disposition toward impulsivity or sensation seeking with ASPD. It has also been suggested that HPD is (in part) a severe, maladaptive variant of the personality dimensions of extraversion and neuroticism. Extraversion includes the facets of excitement seeking, gregariousness, and positive emotionality, and neuroticism includes the facets of angry hostility. Environmental and sociocultural factors, however, may also play a significant role in the development of HPD. Kernberg, for example, speculated that the fathers of women with HPD combine early sexual seductiveness with subsequent authoritarian puritanical attitudes,. Course and Natural HistoryLittle is known about the premorbid behavior pattern of persons with HPD. During adolescence they are likely to have been flamboyant, flirtatious, and attention seeking. As adults, persons with HPD readily form new relationships but have difficulty sustaining them. They may fall in love quite quickly but just as rapidly become attracted to another person. They are unlikely to be reliable or responsible. Relationships with persons of the same sexual orientation. TreatmentThe presence of HPD can complicate the treatment of an Axis I mental disorder. Persons with HPD readily develop a rapport, but it is often superficial and unreliable. Psychiatrists might also fail to appreciate the extent of influence they can have on the highly suggestible patient. Persons with HPD can readily become converts to whatever the psychiatrist. A key task in treating patients with HPD is countering their global and diffuse cognitive style by insisting on attending to structure and detail within sessions and to the practical, immediate problems of daily life. It is also important to explore within treatment the historical source for their needs for attention and involvement. Persons with HPD are prone to superficial. Many psychiatrists recommend the use of group therapy for persons with HPD. It is quite easy for them to become involved in a group, which may then be useful in helping them recognize and However, it is also important to closely monitor their involvements within the group, as they are prone to dominate and control sessions and they may escalate their attention seeking to the point of suicidal gestures. |