PHINMA-Cagayan de Oro College

College of Allied Health Science

Max Y. Suniel Street Carmen, Cagayan de Oro City 9000

A Case Presentation On:

HISTRIONIC PERSONALITY DISORDER

In Partial Fulfillment of the Requirements of the

Course for the Subject Psychiatric Mental Health Nursing
NUR 198 & NUR 199
For the Degree of Bachelor of Science in Nursing

Submitted by:

DATUHARUN

DUMPA

FABORES

GAMPONG

GASTALA

Instructors:
Mitzi Lou Arboleras, RN
Phoebe Jaenn Tan, RN
Regine Villanueva, RN

Date Submitted:
June 16,2021
 I. INTRODUCTION

 HISTRIONIC PERSONALITY DISORDER (HPD) is characterized by a

pervasive pattern of excessive emotionality and attention seeking.
 People with HPD continually demand to be the center of attention
and often become depressed when they are not. They are often
lively, dramatic, enthusiastic, and flirtatious and sometimes charm
new acquaintances.
 HPD is diagnosed more often in women but some studies show
prevalence in women and men was similar.
 People with HPD use their physical appearance, acting in
inappropriately seductive or provocative ways, to gain attention.
 Expression of emotion may be shallow and exaggerated. They speak
dramatically, expressing strong opinions, but with few facts or details
to support their opinions.

II. EPIDEMIOLOGY

It has 1 to 3% of general US population but in as much as 10 to 15 % of

inpatient population are estimated to have a histrionic personality disorder.
It is diagnosed more often in women, but in some studies, prevalence in
men and women was similar.
 III. PSYCHODYNAMICS

Histrionic 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. Women are diagnosed with HPD roughly 4 times as often
as men. 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
 IV. ANAMNESIS

 SIGMUND FREUD (ID, EGO, SUPEREGO) & (ORAL STAGE)

The patient wasn't able to met his needs during childhood (oral stage),
like when she was a child he didn't satisfy herself on her demands, that's
why she developed a behavior (disruptive and socially) unacceptable when
the patient acts sad, angry, and vulgar. Although the patient will eventually
learn to control the id, this part of personality remains the same infantile,
primal force throughout life. It is the development of the ego and the
superego that allows the patient to control the id's basic instincts and act in
ways that are both realistic and socially acceptable.
 ERIK ERIKSON (IDENTITY vs. ROLE CONFUSION)
The patient's ability to live by the society's standards and expectations
exceeds that it didn't met the normal standards of being a teenager during
her teenage life, then later on the patient sense of self and feelings of
independence of control emerges. It is evident that the patient is self-
absorbed and only focuses on her own thinking that she doesn’t need the
thoughts of other people that's around her. The patient is Indeed not aware
of her personal identity, interactions, and mostly on her experiences
towards to other people.
  JEAN PIAGET (PREOPERATIONAL STAGE)
Vouge and lack of details about the client's physical appearance
(exaggerated jewelries and overdress ) is where she lacks off egocentricsm
that she struggled to see things from the perspective of herself, the patient
didn't know how to represent herself that's why the patient exaggerates
everything just to fulfill herself and to be the center of attraction. The way
the patient talk she didn't think thoroughly the words and fiercely spill it
out from her mouth.

 SULLIVAN (PRE ADOLESCENCE) & (GOOD ME)

The patient is uncomfortable of being alone and will seek for attention if
she's not validated, it somehow shows that the patient is seeking for
affection and respect in way that the patient wants all the attention of her
boyfriend is on her and the respect of her peers is incomparable with
others, "bad me" will follow, the patient will develop sense of discomfort
and displeasure if bad me creates anxiety because of the patients not good
experiences in her external surrounding.

 Hildegard Peplau’s Theory of Interpersonal Relations - PHASES OF

INTERPERSONAL RELATIONSHIP

Orientation - Trust and respect, honesty and effective communication

was established
Working Identification - During this phase problems and issues with the
clients are identified and plans to address are put into action. The nurse in
charge validates thoughts, feelings, and behaviors. The nurse continues her
assessment throughout all phases of development.
Resolution - During the resolution or ending phase, the final stage of the
nurse-client relationship. After the client’s problems or issues are
addressed, the relationship needs to be completed before it can be
terminated. The ending of the nurse-client relationship is based on mutual
understanding and a celebration of goals that have been met.

V. MILLIEU/NCP
NCP 1
ASSESSMENT
SUBJECTIVE:
I think there is something unusual to her” as stated by Jema’s sister
OBJECTIVE CUES:
Wants to be the center of attention.
Wear seductive clothes.
Preoccupied on how she looks like.
NURSING DIAGNOSIS:
Impaired social interactions related to unappropriate behaviour as
evidenced by: wearing seductive clothes and use body to keep people
focused in herself.

SHORT TERM GOALS

After 8 hours of nursing intervention the patient will be able to:
will be free of self-inflicted injury.
Will participate in coping skills training.

LONG TERM GOALS

After 1 week/months/year of nursing intervention the patient will be able
to:
Fully Acknowledge what is really happening to her and
Learn coping skills

INDEPENDENT INTERVENTION and RATIONALE:

Assess vital signs ( to still have determine if there are any abnormalities to
her vital sign including pain)
Maintain the area clean and free from harm( to avoid getting sick and
unexpected circumstances.)
Gives client feedback about their social interactions with others including
manner of dress and non verbal communication( to give an idea on what is
happening to her and can do something to cope up with this personality
disorder)
Gives feedback but should focus on appropriate alternatives not merely
criticism( to avoid arguing with the client and help to participate in the
therapeutic therapy.)
Teaching social skills and role playing. (to slowly help to recognize what is
the appropriate behaviors during interacting with others.

DEPENDENT INTERVENTION and RATIONALE:

Administer medication as prescribed by the physician( to control her
conditions)
Assist her during the treatment with the physician like Cognitive behavioral
therapy and psychotherapy ( to know what is the appropriate to do.)
EVALUATION

SHORT TERM GOALS

After 8 hours of nursing intervention the patient was able to: free or self
reflected injury and participated in coping skills training.

LONG TERM GOALS

After 1 week/month/year of nursing intervention the patient was able
to:fully acknowledged on what is really happening to her and learned
coping skills.

NCP 2
ASSESSMENT
Subjective data:
The patient verbalized of inability to control his behavior

Objective data:
Inability to meet role expectations/basic needs
Poor concentration
Lack of goal-directed behavior/resolution of problem, including inability to
attend to and difficulty with organizing information;

NURSING DIAGNOSIS
Ineffective coping related failure to intend to change behavior and
emotional state as evidence by intense emotional dysregulation and failure
to achieve optimal sense of control.
PLANNING
SHORT TERM GOAL:
At the end of 1-2 hrs. of nursing interventions the patient will be able to:
Verbalize awareness of own coping abilities.
Verbalize feelings congruent with behavior.

LONG TERM GOAL:

At the end of 4-6 hrs. of nursing interventions the patient will be able to:
Identify ineffective coping behaviors and consequences
Meet psychologic needs as evidenced by appropriate expression of feelings,
identification of options, and use of resources.

NURSING INTERVENTIONS
Independent
Evaluate ability to understand events, provide realistic appraisal of
situation.
Assess level of anxiety and coping on an ongoing basis.
Note speech and communication patterns.
Observe and describe behavior in objective terms. Validate observations.
Evaluate client’s decision-making ability.
Ascertain client’s understanding of current situation and its impact.
Active-listen and identify client’s perceptions of what is happening.
Dependent
Allow client to react in own way without judgment by staff. Provide support
and diversion as indicated.
Give information about purposes and side effects of
medications/treatments.
Stress importance of follow-up care.
Encourage and support client in evaluating lifestyle, occupation, and leisure
activities.
VI: DISCHARGE PLANNING
MEDICATION
Take medication as prescribed by the physician
EXERCISES
Patient can perform all activities that will refrain from thingking negativity .
Tolerated range of motions and exercises such as:
1.Running.
2.Walking
3.Biking.
4.Yoga
5.swimming
6. Gardening
7.cycling

TREATMENT
Psychodynamic theraphy- it helps patient become aware of their own
feelings. ( require several years of therapy and it may affect the patuent
throughout their life.)
Cognitive therapy- will help patients with reducing the dysfunctional
thoughts of patient with HPD.
Group therapy- allow the patient to work on interpersonal relatuonship
Family therapy- family member help to avoid supporting histrionic behavior
but knowing hiw to support the patient in a positive way.
HEALTH TEACHINGS
1.Encouraging clients to use assertive communication, such as "I"
statements, may promote self-esteem and help her to get their needs met
more appropriately.
2.Teaching self- management through cognitive restructuring.
3. Teach the patient to be patient and realistic.
4.Teach the patient learn to relate to relate to others in a more positive
way.
5.Teach patient on how to maintain safety environments.
6.Take home medications properly.
7. Patient treatment to be continued collaborate with other healthcare
practitioners in their barangay’s.
8. Teach the patient to make sure you keep yourself out of situation that
may cause you to act in a way wich you could regret or in ways which can
hurt other people.
OUTPATIENT FOLLOW UP
Explained jema follow-up checkup for impact and drug adherence for
recovery development.
DIAGNOSTIC TEST
Expect diagnostic test on the follow up check-ups.
SEXUAL SPIRITUAL
Living with HPD is not always easy, but with your focus and the right
support system and following God’s direction, it is possible to live a life
without having to deal with a disorder lurking over your shoulder.
Encourage the patient to become a member of a team that provides
spiritual services to people with personality disorders.
Tell the patuent that being willing to put effort into changing your behavior
will make all the difference along with making sure you have the right
group of people around to support you and making sure you take the
necessary time to be with the Lord.