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Psychopathology: Histrionic Personality Disorder

I. Definition

The word personality describes deeply ingrained patterns of behavior and the manner in which
individuals perceive, relate to, and think about themselves and their world. Personality traits are
conspicuous features of personality and are not necessarily pathological, although certain styles of
personality may cause interpersonal problems.

Personality disorders are rigid, inflexible and maladaptive, causing impairment in functioning or
internal distress. A personality disorder is an enduring pattern of inner experience and behavior
that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible,
has an onset in adolescence or early adulthood, is stable over time and leads to distress or

Individuals with histrionic personality disorder exhibit excessive emotionalitya tendency to

regard things in an emotional mannerand are attention seekers. People with this disorder are
uncomfortable or feel unappreciated when they are not the center of attention. Behaviors may
include constant seeking of approval or attention, self-dramatization, theatricality, and striking
self-centeredness or sexual seductiveness in inappropriate situations, including social,
occupational, and professional relationships, beyond what is appropriate for the social context.
They may be lively and dramatic and initially charm new acquaintances with their enthusiasm,
apparent openness, or flirtatiousness. They may also, however, embarrass friends and
acquaintances with excessive public displays of emotion, such as embracing casual acquaintances
with passion, sobbing uncontrollably over minor setbacks, or having temper tantrums.

People with histrionic personality disorder commandeer the role of "life of the party." Interests
and conversation will be self-focused. They use physical appearance to draw attention to
themselves. Emotional expression may be shallow and rapidly shifting. Their style of speech is
excessively impressionistic and lacking in detail. They may do well with jobs that value and require
imagination and creativity but will probably have difficulty with tasks that demand logical or
analytical thinking.

The disorder occurs more frequently in women, although this may be because it is more often
diagnosed in women than men. Data from the 2001-2002 National Epidemiologic Survey on
Alcohol and Related Conditions estimate that the prevalence of histrionic personality disorder is
1.84 percent.

II. Kinds of Psychotherapy

Cognitive behavioral therapy (CBT)

CBT is a type of psychotherapy that helps people identify thoughts, feelings, and experiences that
influence their behaviors. It's usually a short-term treatment approach, making it more affordable
than other therapies, such as psychoanalytic therapy. For individuals with histrionic personality
disorder, identifying thought patterns and their origins could help them make the connection
between these thoughts and their behaviors. This, in turn, allows them to see how they can work
to change their thoughts to successfully change their behavior.

In order to combat these destructive thoughts and behaviors, a cognitive-behavioral therapist

begins by helping the client to identify the problematic beliefs. This stage, known as functional
analysis, is important for learning how thoughts, feelings, and situations can contribute to
maladaptive behaviors. The process can be difficult, especially for patients who struggle with
introspection, but it can ultimately lead to self-discovery and insights that are an essential part of
the treatment process.

The second part of cognitive behavior therapy focuses on the actual behaviors that are contributing
to the problem. The client begins to learn and practice new skills that can then be put in to use in
real-world situations.

In most cases, CBT is a gradual process that helps a person take incremental steps towards a
behavior change.

Talk therapy

Talk therapy is really a catchall term that refers to the various types of interactions between a
therapist and a client. Talk therapy sessions use conversation as the primary way to move forward
in treatment. Practitioners can incorporate talk therapy into almost any treatment approach,
including CBT. Talk therapy is an effective treatment for histrionic personality disorder because
people with the condition like to talk. Speaking candidly and aloud about their feelings and
experiences can bring clarity about distorted thoughts and beliefs that negatively influence
behavior. The therapist can capitalize on this clarity and teach the client new ways to cope with
various situations and challenges, especially in social situations where someone else is the center
of attention.

Group therapy

Most therapists don't use group therapy in treatment for histrionic personality disorder because
individuals with the condition often try to draw attention to themselves. They may exaggerate their
difficulties and experiences in an emotionally charged way that isn't conducive to an effective
session for others in the group. However, sometimes, when a patient has made good progress
toward recovery, group therapy can help her practice appropriate behavior in a group setting. With
the therapist present, the client will still feel safe and free to try the give-and-take most people
practice in social situations.

Mental health professionals should tailor histrionic personality disorder therapy to fit the needs of
individual patients. Some have found success using a combination of approaches and others find
using a single approach works best.

III. Diagnostic Criteria

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:

1Is 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


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.

IV. Etiology

The exact cause of histrionic personality disorder is unknown. Scientists believe it is an outcome
of both:

Genetic factors.

Some families have a history of HPD, which lends credit to the theory that the condition may be
explained in part by genetics. On the other hand, children of parents with HPD may simply exhibit
behavior they learned from their parents. It is also possible that a lack of discipline or positive
reinforcement of dramatic behaviors in childhood can cause HPD. A child may learn HPD
behaviors as a way to get attention from their parents.

No matter the cause, HPD usually presents itself by early adulthood..

Kraus and Reynolds (2001) state that histrionic personality disorder is associated with increased
risk for an array of other disorders, including depression and anxiety, suggesting that HPD may be
an important clinical syndrome for investigation. Histrionic personality has been found to be
associated with a number of potential negative outcomes including decreased marital satisfaction
and success (Disney, Weinstein, & Oltmanns, 2012), increased rates of hypochondriacal concerns
(Demopulos et al., 1996), and increased rates of depressive disorders (Bockian, 2006)

HPD is part of the category of 'cluster B' (or 'dramatic, emotional, or erratic') personality disorders
that are linked by theory and phenomenology to Axis I mood and impulse control disorders (APA
2000). These disorders have been found to show high rates of comorbid depressive and other mood
disorders, substance use disorders and eating disorders (Skodol 2005). Furthermore, people with
HPD may be especially prone to somatoform disorders, such as a somatisation disorder, conversion
disorder, pain disorder, hypochondriasis or body dysmorphic disorder (Skodol 2005). In general,
a co-occurring personality disorder in a patient with an Axis I disorder often indicates higher levels
of impairment (Jackson 2002) and a poorer treatment response (Grilo 2005; Newton-Howes 2006),
including a higher probability of withdrawal from treatment (Percudani 2002).
Theories of Personality

Psychodynamic Theories:

Psychodynamic theorists believe that HPD develops as a result of deep dependency needs
and repression of emotions, stemming from poor resolution of either the oral stage or the Oedipal
state. In addition, they believe attention-seeking results from the need for approval from
others. Psychodynamic theorists believe that repression of the histrionic person's feelings and
needs results in shallowness of thought and emotional involvement with others (Nolen-Hoeksema,

Cognitive Theorists

Cognitive theorists such as Aaron Beck assume that the histrionic person's behavior is driven
by a belief that says "I am inadequate and unable to handle life on my own". They say to deal with
this assumption people the histrionic will work to get other people to care for them by seeking
their attention and approval (Nolen-Hoeksema, 2001). The cognitive theory gives schemas and
pre-programmed patterns a central role. According to cognitive theorists, schemas arise from an
interaction between the childhood environment and predispositional factors. The information
about self or the environment is affected by cognitive, affective, arousal, and motivational patterns
(Davidson, 2000).

VI. General Goal and Objectives

1. Teach the clients to about histrionic personality disorder

a. To increase their knowledge about the disorder

2. Teach the clients to challenge their negative thoughts.

a. To identify and be aware of negative and distorted thoughts that affect your relationship

3. Teach clients on replacing negative thoughts and replacing it with healthier, more realistic ones.

a. To change negative or damaging thought patterns.

VII. Case Termination

The best reason to terminate psychotherapy would be that you have come to understand
your life and its unconscious motivations to such an extent that you no longer need a
psychotherapist to guide you. If you began psychotherapy feeling as if your psychotherapist were
almost a god, you end psychotherapy realizingas the psychoanalyst Jacques Lacan taughtthat
your psychotherapist is no more necessary to you than a scrap of paper in the gutter. This isnt an
insult; it just means that you have more or less dissolved all your illusions about finding your
identity in other persons.

VIII. Prognosis

Lots of people with HPD lead normal lives and are able to work and be a part of society. In fact,
many people with HPD do very well in casual settings. Many of them only encounter problems in
more intimate relationships. Depending on your case, your HPD may affect your ability to hold a
job, maintain a relationship, or stay focused on life goals. It may also cause you to constantly seek
adventure, putting you into risky situations.

You are also at a higher risk for depression if you have HPD. The disorder can affect how you
handle failure and loss. It can also leave you feeling more frustrated when you dont get what you
want. You should talk to your primary care provider if you have symptoms of HPD, especially if
they are interfering with your everyday life and work or your ability to lead a happy, fulfilling life.