Histrionic Personality Disorder PDF

Histrionic Personality Disorder Histrionic Personality Disorder Have you ever known anyone who invariably would become the center of attention? – Someone whose interactions are reframed to revolve around them? Someone who was easily influenced by whoever they sought to interact with? Someone who, wh...

Histrionic Personality Disorder Histrionic Personality Disorder Have you ever known anyone who invariably would become the center of attention? – Someone whose interactions are reframed to revolve around them? Someone who was easily influenced by whoever they sought to interact with? Someone who, when conversation comes up, is more about flamboyant headlines than substantive details? Someone who’s bold pattern of expression is substantiated by their physical appearance Someone who is always the “life of the party”? Histrionic Personality Disorder Normal Range Histrionic Personality Disorder Histrionic Personality Disorder – Case Example Yvonne is a 23-year old, single female referred for psychological assessment by her gynecologist. She is outgoing and effusive, “dressed to kill,” and yet coquettishly reluctant to disclose the nature of her difficulties. When directly asked, she avoids open discussion and seems to free associate to any number of topics, some happy, some sad, but all tangential to the clinical interview. She talks a lot, but doesn’t really say much. She states, for example, that she is on a firstname basis with her physician, that she has been a dancer since she was a little girl, and that she is “blessed” with countless good friends. Histrionic Personality Disorder – Case Example After a period of direct questioning, Yvonne reveals that she has been experiencing debilitating pain continually for over half a year. “I just lay in bed and feel like I will absolutely expire!” she exclaims, closing her eyes and dropping her head forward to feign death. Extensive medical testing reveals no sufficient basis for her complaint. Histrionic Personality Disorder – Case Example During the clinical interview, Yvonne’s nonverbal affectations are numerous. Her head is cocked slightly down, eyes wide with invitation. Her facial expressions, intended to underscore the meaning of her words, are exaggerated far beyond those of normal persons. She skips quickly from one topic to another. Apparently theatrical by nature, she measures the reaction of her audience and adjusts her performance accordingly. She periodically throws out double entendres, but retreats to the safer, more demure meaning if others begin to act on her suggestions. At times, she seems to parade through a succession of persons to find the one that best fits the role of therapy client. Histrionic Personality Disorder – Case Example Despite Yvonne’s interpersonal intensity, her history seems mostly unremarkable. She describes a happy and well-adjusted family, through she admits some conflict with her mother. Her two brothers, much older than she, still treat her like a baby. She remains very close to her parents, especially her father, and calls home on a daily basis. At present, she is not involved in a serious relationship, but notes with a giggle that “most boys find me very attractive.” Histrionic Personality Disorder – Case Example Nevertheless, she feels that she has been unlucky in love, and openly admits that most guys “just want me for my body.” “I think I find it easy to get to know others,” she says, “and that’s why I get so bored with people so fast.” Instead, she prefers the excitement of new experiences, including occasional episodes of intoxication and substance abuse. Histrionic Personality Disorder – Case Example Currently, Yvonne works as a dancer at an adult club, but asserts forcefully that she is different from the other girls, an artist plying her trade. When asked what drew her to this mode of expression, she says she likes the attention and the money, “two things I can’t do without.” She expresses disgust with both the after-hours practices of the other dancers and the clientele. Her family believes that she is teaching ballet. The source of her pain remains uncertain. Histrionic Personality Disorder - Definition 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… Histrionic Personality Disorder – Diagnostic Criteria (1) is uncomfortable in situations in which he or she is not the center of attention – Attention is like a drug Something she “can’t do without” – Thoughts and behaviors depend on attention With attention – Can readily interact with others and esteem is bolstered Without attention – Feels subpar and scrambles to redirect all interest back to her – Over time, they often become very adept at eliciting attention by exhibiting interesting and attractive behaviors Histrionic Personality Disorder – Diagnostic Criteria (2) interaction with others is often characterized by inappropriate sexually seductive or provocative behavior – Most strategies used to attract and keep attention are seductive or sexually provocative – In case example, these behaviors Contribute to her success as an exotic dancer and not considered pathological in this environment Inappropriate and ill-suited outside of work Histrionic Personality Disorder – Diagnostic Criteria (3) displays rapidly shifting and shallow expression of emotions – Tendency to hyper-emotionalize – Exhibits an ever-changing stream of consciousness Leads to sequences of uncensored emotional expressions Histrionic Personality Disorder – Diagnostic Criteria (4) consistently uses physical appearance to draw attention to self – This can include gestures, speech, and dress – Can be either overt or covert Case example’s job as an exotic dancer can be seen as an exaggeration of this characteristic – Goal is to look flashier, sexier, and more colorful than everyone else These are the qualities that she believes will win friends and influence people Histrionic Personality Disorder – Diagnostic Criteria Histrionic Personality Disorder – Diagnostic Criteria (5) has a style of speech that is excessively impressionistic and lacking in detail – Often seem too concerned with their own universe Personal experiences are embellished – Speech Often talk freely Conversations tends to avoid serious matters, causing words to lack detail and substance Histrionic Personality Disorder – Diagnostic Criteria Histrionic Personality Disorder – Diagnostic Criteria (6) shows self-dramatization, theatricality, and exaggerated expression of emotion – Apparently rapid and overplayed emotional shifts Others left to wonder – Whether feelings are genuine – What conflicts and insecurities may lie underneath the actual drama Histrionic Personality Disorder – Diagnostic Criteria (7) is suggestible, i.e., easily influenced by others or circumstances – Attention is the goal As a result, behaviors are dependent on the level of attention that is given at any moment Histrionic Personality Disorder – Diagnostic Criteria (8) considers relationships to be more intimate than they actually are – Individuals often confuse attraction and intimacy Many interactions are as superficial as the dramatizations that the histrionic creates – Also exists a decreased interest in details and an increased interest in headlines Often times, a boredom results from this lack of substance – Includes the lack of substance in the patient and in their relationships Histrionic Personality Disorder Clinically most frequently diagnosed in women – When diagnosed in men, is often associated with homosexuality – This sex differential could be a product of societal expectations rather than true occurrences Histrionic personality disorder may be characterized as an extreme of either gender role – Extreme femininity – Overly “macho” male who is dramatic, sensation seeking, shallow, vain, and egocentric Histrionic Personality Disorder Male Histrionics? From Normality to Abnormality: Normal Range The dramatic style – Emphasis on feeling, color, and attention – Individuals Process their world effectively Value the impact of emotion Display their emotions easily and openly – Experience life through sensation and romance Deliberately make themselves physically attractive Consciously dress with the opposite sex in mind Become engaging, charming, or even seductive when “on stage” – Many are highly intuitive Quickly sense what to talk about and how others wish to be regarded – Many trust others easily and readily involve themselves in relationships Swiftly… moving from one boyfriend to the next From Normality to Abnormality: Normal Range The outgoing style – Focus is more on sociability than on theatrics – Individuals possess great confidence in their influence and charm Often go out of their way to be popular Naturally know how to make others like them – Often described as Warm Lively Dramatic Energizing Provocative – Joy in life is infectious – Often open to new possibilities and find tremendous joy in new experiences Cognitive Conceptualization Cognitive Conceptualization: Histrionic Personality Disorder Underlying Assumption – “I am inadequate and unable to handle life on my own” – This underlying assumption is common. The coping method is what distinguishes disorders Depressives – Dwell on the negative aspects of themselves, feel hopeless Dependents – Emphasize helplessness and (more) passively hope someone will care for them Cognitive Conceptualization: Histrionic Personality Disorder Underlying Assumption – “I am inadequate and unable to handle life on my own” – Conclusion of the Histrionic: “Because I am incapable of caring for myself, I will need to find a way to get others to take care of me” – Behavior of the Histrionic: To actively set about seeking attention and approval – Ensures that their needs are sufficiently met by others Cognitive Conceptualization: Histrionic Personality Disorder Two basic beliefs: – Other people hold the key to survival in the world – It is necessary to be loved by everyone for everything one does These beliefs lead to a very strong fear of rejection – Any indication of rejection is devastating Even if the rejecting person isn’t important to the patient* Two feelings – Inadequacy – Desperation for approval as their only salvation Leaves the Histrionic unable to relax – Can’t tolerate leaving the acquisition of approval to chance – Will not tolerate it Cognitive Conceptualization: Histrionic Personality Disorder Feel constant pressure to seek attention – Often by fulfilling the extreme of their sex-role stereotype – Females often have been rewarded at an early age for Cuteness, physical attractiveness, and charm – “Macho” male histrionics have learned to play an extreme masculine role Rewarded for virility, toughness, and power – Both sexes play a role of “performing” for others Cognitive Conceptualization: Histrionic Personality Disorder Great concern with eliciting external approval – Often external events are valued over their own internal experience – Results Leaves the patient without a clear sense of identity apart from other people See themselves primarily in relation to others – Because they have paid little attention to their own internal resources, they have no idea how to respond with depth Often aren’t in touch with their own depth Relationships are very shallow, superficial, and based on role playing