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Journal of Psychopathology and Behavioral Assessment, Vol. 21, No.

1, 1999

Histrionic Personality Disorder, Physical Attractiveness, and Social Adjustment

Robert F. Bornstein1
Accepted: December 14, 1998

Histrionic personality disorder (HPD) is the only DSM-IVpersonality disorder (PD) explicitly linked to a person's physical appearance. This study examined the HPD-attractiveness link in a mixed-sex sample of college students. Consistent with expectations, HPD women were rated higher in attractiveness than women with other PDs or no PD. However, a parallel HPD-attractiveness link was not found in men. Subsequent analyses indicated that, relative to less attractive HPD women, more attractive HPD women (a) had a more varied and supportive social network, (b) exhibited more negative behaviors in important relationships, and (c) showed greater use of immature defenses, and less reliance on image-distorting, self-sacrificing, and mature defenses. Similar attractiveness-defense relationships were found in HPD men, but parallel results did not emerge for men in the other two domains. Implications of these findings are discussed, and suggestions for future studies are offered.
KEY WORDS: attractiveness; DMS-IV; histrionic personality disorder; social network; defense style.

INTRODUCTION Histrionic personality disorder (HPD) has a long history in psychology and psychiatry. More than 2000 years ago Hippocrates speculated that hysterical behaviors in women were caused by a "wandering womb" that

Department of Psychology, Gettysburg College, Gettysburg, Pennsylvania 17325. e-mail:

0882-2689/99/0300-0079$16.00/0 1999 Plenum Publishing Corporation



moved too close to the brain and contaminated reason with emotion. More recently, Kretschmer's (1926) formulations regarding the interpersonal dynamics of hysteria set the stage for contemporary conceptualizations of histrionic traits. Kretschmer (1926, p. 26) argued that hysterical persons show "a preference for what is loud and lively, a theatrical pathos, an inclination for brilliant roles. . . . [and] a naive, sulky egotism." Approaching the topic from a psychodynamic perspective, Reich (1933, pp. 204-205) agreed, adding that in hysterical individuals, "we find fickleness of reactions . . . [and] strong suggestibility, which never appears alone but is coupled with a strong tendency to reactions of disappointment. An attitude of compliance is usually followed by its opposite, swift deprecation and groundless disparagement."2 Modern formulations of HPD bear a striking resemblance to the earlier speculations of Kretschmer, Reich, and others. The core components of HPD include egocentricity, seductiveness, theatrical emotionality, denial of anger and hostility, and a diffuse (or global) cognitive style (Horowitz, 1991; Pfohl, 1991). Among the other traits frequently associated with HPD are gregariousness, manipulativeness, low frustration tolerance, pseudohypersexuality (i.e., superficial flirtatiousness coupled with an underlying fear of sexual intimacy), suggestibility, and somatizing tendencies (Andrews & Moore, 1991; Millon, 1996). These traits and behaviors are captured nicely in the eight DSM-IV HPD symptoms [American Psychiatric Association (APA), 1994]. According to the DSM-IV, the central feature of HPD is a pervasive pattern of excessive emotionality and attention-seeking, as indicated by five or more of the following: (a) discomfort in situations wherein he or she is not the center of attention; (b) sexually seductive or provocative behavior; (c) rapidly shifting and shallow expression of emotions; (d) use of physical appearance to draw attention to him- or herself; (e) an overly impressionistic style of speech; (f) self-dramatization, theatricality, and exaggerated emotional expression; (g) suggestibility; and (h) perception of greater intimacy in relationships than actually exists. The symptoms of HPD overlap those associated with several other DSM-IV personality disorders (PDs), most notably borderline, narcissistic, and dependent (Bornstein, 1995a; Horowitz, 1991; Kernberg, 1984). How2

The link between hysteria and HPD was first formalized in the DSM-II (APA, 1968), when the diagnostic category of Hysterical Personality was followed in parentheses by the term Histrionic Personality Disorder. Beginning with the DSM-III (APA, 1980), no mention of "hysterical" personality traits has appeared in any version of the DSM. It has now been replaced completely by HPD. Most clinicians and researchers today use the term histrionic in lieu of hysterical to describe individuals who fulfill the DSM-IV HPD criteria (Kernberg, 1986; Merskey, 1995).

HPD and Attractiveness


ever, HPD is unique among the DSM-IV PDs in at least one respect: it is the only Axis II PD explicitly tied to physical characteristics of the individual. According to the DSM-IV, persons with HPD "consistently use physical appearance to draw attention to themselves. . . are overly concerned with impressing others by their appearance, and expend an excessive amount of time, energy, and money on clothes and grooming" (APA, 1994, p. 655). In this context, several researchers have conjectured that HPD appears primarily in women and men who are above average in physical attractiveness (Apt & Hurlbert, 1994; Beck & Freeman, 1990; Char, 1985; Millon, 1996). For example, Millon (1996, p. 384) noted that a common characteristic among histrionics was their "esthetically appealing" appearance. Char (1985, p. 123) was even more direct, asserting that "the typical [histrionic] women is physically attractive, stylishly dressed, and appears younger than her chronologic age."3 Although clinicians and theoreticians have long speculated regarding the link between physical attractiveness and HPD, this relationship has never been tested empirically. The purpose of this study was to examine the relationship between physical appearance and HPD traits and symptoms. There were two parts to this investigation. First, the physical appearance of college students who reported significant HPD symptoms was compared to that of students with other PDs or no PD, using attractiveness ratings made by raters unaware of each participant's PD status. Based on the contentions of Char (1985), Millon (1996), and others, and on the DSM-IV assertion that HPD persons "consistently use physical appearance to draw attention to themselves . . . [and] are overly concerned with impressing others by their appearance" (APA, 1994, p. 655), I hypothesized that attractiveness ratings of persons with HPD would be significantly than those of persons with other PDs or no PD.4 The second part of the study explored the relationships between attractiveness ratings and several domains of coping and interpersonal functioning within the HPD group, including (a) breadth and quality of the social network, (b) behaviors commonly exhibited in important relationships, (c) frequency and severity of minor stressful life events (i.e., "hassles"), and (d) defense style. The four hypotheses tested in the second part of the study were as follows.
The hypothesized HPD-attractiveness link is unusual, but given the interpersonal dynamics of HPD, it is not surprising. Clinicians and researchers agree that seductiveness is a key component of the histrionic person's interpersonal style, and physical attractiveness facilitates seductiveness. 4 Because a central purpose of this investigation was to assess physical attractiveness and coping in HPD persons relative to those with other PDs or no PD, Axis I psychopathology was not assessed in this study.



Hypothesis 1. Relative to less attractive histrionics, more attractive histrionics should have a more varied and supportive social network. This hypothesis is based on theoreticians' assertion that HPD individuals use flirtatious behavior and pseudo-sexual influence strategies to develop and maintain supportive interpersonal relationships. Physical attractiveness should enhance the effectiveness of these influence strategies, resulting in a more varied and supportive social network. Hypothesis 2. Relative to less attractive histrionics, more attractive histrionics should exhibit more negative behaviors and fewer positive behaviors in interpersonal relationships. Because physical appearance plays a key role in social influence in HPD persons, highly attractive HPD students should be able to maintain supportive relationships with fewer positive behaviors (e.g., with less flexibility in interpersonal negotiations) and may also display a greater number of negative behaviors (e.g., disrespectful acts) in these relationships. Hypothesis 3. Relative to less attractive histrionics, more attractive histrionics should experience fewer stressful life events involving interpersonal conflict and relationship disruption. Highly attractive HPD students should experience fewer stressful life events in these areas because their attractiveness-based social influence strategies (e.g., pseudo-sexuality) will be particularly effective in minimizing relationship difficulties. Hypothesis 4. Relative to less attractive histrionics, more attractive histrionics should describe a defense style characterized by greater reliance on immature defenses (e.g., regression, projection), and less reliance on mature/adaptive defenses (e.g., sublimation). Because attractive HPD students have had a history of maintaining supportive relationships through attractiveness-based influence strategies, they should have experienced less interpersonal conflict and relationship disruption and, consequently, will have implemented fewer mature defenses such as sublimation to minimize interpersonal stress. METHOD Participants Participants in the PD prescreening sessions were 668 students (345 women and 323 men) enrolled in General Psychology classes at Gettysburg College. Participants were predominantly Caucasian and ranged in age from 18 to 22 years (M = 19.80 years, SD = 1.16). Thirty-two students with significant HPD symptomatology (18 women and 14 men) took part in follow-up sessions where measures of coping and interpersonal functioning

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were obtained. Participants received course credit for taking part in the prescreening, and $10 for taking part in the follow-up session.5

Measures Personality Disorders. Personality disorders (PDs) were assessed using the Personality Diagnostic QuestionnaireRevised (PDQ-R; Hyler et al., 1988). The PDQ-R is a 163-item self-report measure that assesses the 10 Axis II PDs included in the DSM-IV, along with 3 putative DSM-III-R PDs (passive-aggressive, sadistic, and self-defeating) that were dropped from the most recent version of the manual. All PDQ-R items are in true/false format; several items also include follow-up checklists wherein participants note specific behaviors associated with a particular PD screening item. The PDQ-R also includes two validity scales: (a) the Too Good (TG) scale and (b) the Suspect Questionnaire (SQ) scale. In addition to yielding a raw score for each PD dimension, the PDQ-R provides a series of threshold scores that enable the researcher to make a presence/absence classification for each PD category. Detailed information regarding the construct validity of the PDQ-R as a measure of PD symptomatology is provided by Hyler, Skodol, Kellman, Oldham, and Rosnick (1990). Information regarding the utility of the PDQ-R in nonclinical samples is provided by Johnson and Bornstein (1992). As these and other studies show, PDQ-R scores are positively correlated with interview- and questionnaire-based measures of personality disorders (Hyler et al., 1988, 1990), show adequate retest reliability in a variety of participant groups (Johnson & Bornstein, 1991, 1992), and predict overall level of psychopathology in psychiatric inpatients and outpatients (Hyler et al., 1990). Social Network. The Social Network Scale (SNS; Kaplan, 1975) assesses the density and quality of a person's social network. The first section of the scale includes 10 questions focusing on the breadth of the social network. Participants are then asked to list four persons with whom they have discussed personal problems during the past 6 months. Each person is rated by the participant for (a) frequency of contact, (b) accessibility, (c) time spent discussing the individual's problems, (d) time spent discussing the other person's problems, (e) range of topics discussed, (f) importance of the relationship, and (g) helpfulness of the other person. The social network

Nineteen of 32 HPD participants (11 women and 8 men) did not score above the threshold on any other PDQ-R dimension. The remaining HPD participants scored above the PDQ-R threshold for borderline (3 women and 2 men), narcissistic (2 women and 2 men), dependent (2 women and 0 men), or antisocial PD (0 women and 2 men).



as a whole is rated on these seven dimensions by pooling the participant's ratings of each individual within the network. In addition, separate family support and peer support scores are derived from participants' ratings of social support obtained from family members and friends. Evidence regarding the construct validity of the SNS as a measure of the density and quality of an individual's social network is provided by Lin, Dean, and Ensel (1981, 1986). Studies show that SNS scores predict overall satisfaction with social support in college students (Heppner, Walther & Good, 1995) and community participants (Stokes, 1984). SNS scores also predict depression levels in community participants undergoing high levels of job-related stress and disruption (Jones, 1991) and predict changes in ego identity status in college students (Caldwell, Bogat, & Cruise, 1989). Social Behaviors. The Social Performance Survey Schedule (SPSS; Lowe & Cautela, 1978) is a measure of social behaviors commonly performed by an individual. The SPSS lists 100 social behaviors and asks the participant to rate how often they perform each behavior on a 5-point scale anchored with the terms "not at all" (1) and "very much" (5). Typical SPSS items include "I seek others out too often," "I am able to accept other people despite their faults," "I am sarcastic," and "I stand up for my friends." The SPSS yields separate scores for positive behaviors and negative behaviors. It also includes three subscales that assess (a) external focus behaviors (i.e., attempts to solicit positive feedback from others), (b) disrespectful acts (i.e., acts of hostility and disrespect in interpersonal relationships), and (c) maintenance behaviors (i.e., attempts to strengthen ties to others through affiliative and relationship-promoting acts). The construct validity of the SPSS as a measure of social behavior in nonclinical participants is provided by Lowe (1982). SPSS scores predict performance on behavioral measures of verbal and nonverbal sensitivity (Fingeret, Monti, & Paxson, 1986) and show the expected patterns of relationships with observers' ratings of an individual's social skills (D'llio & Karnes, 1992). Factor-analytic data confirm the utility of the SPSS dimensions in predicting interpersonal behavior in college students (Lowe & D'llio, 1985). Daily Hassles. The Revised Hassles Scale (HS-R; DeLongis, Folkman, & Lazarus, 1988) is a measure of minor stressful life events. On the HS-R, participants (a) report which of 53 common "hassles" (e.g., familyrelated obligations) they experienced during the past month and (b) rate the severity of each hassle on a 4-point scale anchored with the terms "none" (1) and "a great deal" (4). Separate scores were derived for three types of hassles assessed by the HS-R: (a) interpersonal, (b) achievementrelated, and (c) financial. HS-R scores show good retest reliability and

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adequate concurrent and predictive validity in clinical and nonclinical samples (DeLongis et al., 1988; Monroe, 1983). Detailed information regarding the construct validity of the HS-R is provided by Bornstein (1995b). Defense Style. The Defense Style Questionnaire (DSQ; Bond, Gardner, Christian, & Sigal, 1983) is a widely used measure of defense style in clinical and nonclinical populations. The DSQ yields four subscale scores corresponding to the four defense styles originally described by Vaillant (1971, 1977): (a) immature (e.g., projection, regression), (b) image-distorting (e.g., primitive idealization, splitting), (c) self-sacrificing (e.g., reaction formation), and (d) adaptive (e.g., sublimation). Information regarding the construct validity of the DSQ is provided by Bond et al. (1989). DSQderived defense style scores covary as expected with clinically derived ratings of defense style, with various measures of ego strength, and with questionnaire- and interview-based indices of overall level of pathology and adjustment (Bond et al., 1989; Johnson, Bornstein, & Krukonis, 1992, Vaillant, Bond, & Vaillant, 1986). Procedure When participants arrived at the laboratory they were told that they were taking part in a study of personality and self-perception. Groups of 10 to 12 participants individually completed copies of the PDQ-R (Hyler et al., 1988) under standard conditions. Participants who received a score greater than 0 on the PDQ-R TG or SQ scale were dropped from the study. This resulted in 11 participants being excluded (7 who obtained scores greater than 0 on the TG scale and 4 who obtained scores greater than 0 on the SQ scale). Thus, the final sample consisted of 657 participants (340 women and 317 men). During the prescreening sessions, attractiveness ratings of each participant were made on 9-point scales (1 = not at all attractive; 9 = very attractive) by two independent raters (one female, one male), unaware of each others' ratings, and unaware of participants' PDQ-R scores. Attractiveness ratings were made based on participants' facial features, body type, and dress (see Feingold, 1992). Interrater reliability in attractiveness ratings was determined by calculating the Pearson correlation coefficient between the two ratings of each participant. These correlations were .89 for female participants and .87 for male participants. A combined (average) attractiveness rating was calculated for each participant using the two scorers' independent evaluations. Approximately two months after completing the PDQ-R, participants who scored above the PDQ-R HPD threshold were contacted by phone



and asked to take part in a follow-up session where SNS, SPSS, HS-R, and DSQ data were obtained. Thirty-two of 35 participants (91%) agreed to take part in the follow-up session (2 men and 1 woman declined). Order of measures was counterbalanced across participants during the Time 2 session.

RESULTS Relationships of Gender and PD Status to Attractiveness Ratings To assess the relationships of gender and PD status to attractiveness ratings, comparison groups of Other PD and No PD participants were constructed using a two-step process. First, after HPD participants were removed from the pool, all participants who scored above at least one other PD threshold were placed in the Other PD group (N of Other PD participants = 80, 45 women and 35 men). Next, 80 No PD participants (45 women and 35 men) were selected at random from the pool of 545 women and men who did not score above the threshold on any PDQ-R scale.6 Table I summarizes the attractiveness ratings of participants in the HPD, Other PD, and No PD groups. A 2 x 3 between-participants analysis of variance (ANOVA) revealed a main effect of PD status on attractiveness ratings [F(2,188) = 3.17, p < .05]. There was also a Gender X PD Group interaction [F(2,188) = 4.11, p < .05]. A follow-up one-way ANOVA confirmed that attractiveness ratings differed across the six groups [F(5,186) = 4.19, p < .01]. A Tukey test indicated thatas the data in Table I suggestwomen in the HPD group received significantly higher attractiveness ratings than participants in any other group (p < .05). To examine the possibility that observed PD group differences in attractiveness might have been due to a small number of highly attractive outliers in the female HPD group, the skewness and kurtosis of the HPD, Other PD, and No PD attractiveness score distributions were calculated separately for women and men. This analysis revealed that for women, the skewness of the score distribution in HPD participants (0.11) did not differ from the skewness of the distributions in Other PD (0.12) and No PD
The number of participants in the No PD group was limited to 80 to minimize heteroscedasticity problems that often result from ANOV As involving markedly different cell N's. Reanalyses of these data with all 545 available participants included in the No PD group produced virtually identical results. Highly similar results were also obtained when data were reanalyzed with passive-aggressive, self-defeating, and sadistic PD participants excluded from the Other PD group and dropped from the analysis.

HPD and Attractiveness Table I. Relationships of Gender and PD Status to Attractiveness Ratings PD group Gender Women Men


6.69 (1.67) 5.50 (1.91)

Other PD 5.04 (1.41) 5.00 (1.63)


5.48 (1.65) 5.12 (1.29)

Note. N of HPD group = 32 (18 women and 14 men); N of Other PD group = 80 (45 women and 35 men); N of No PD group = 80 (45 women and 35 men). Only participants who obtained a score of 0 on the PDQ-R TG and SQ scales were included in this analysis. Attractiveness ratings were made on 9-point scales, with higher scores reflecting greater attractiveness. Standard deviations are in parentheses.

participants (0.11). All three distributions showed similar degrees of kurtosis: kurtosis estimates were 1.09, 1.01, and 1.10, respectively, for the HPD, Other PD, and No PD groups. Virtually identical results were obtained for skewness and kurtosis estimates of the attractiveness score distributions in HPD, Other PD, and No PD men.
Attractiveness and the Social Network in HPD Participants

Table II summarizes the correlations between attractiveness ratings and aspects of HPD participants' social networks. As this table shows, there was a significant positive relationship between attractiveness and number of friends in HPD women (r = .50) but not in HPD men (r = .28). In addition, attractive HPD women rated members of their social network as more accessible (r = .45) and helpful (r = .54) than did less attractive HPD women. There was also a positive relationship between attractiveness ratings and HPD women's reports of peer support (r = .46).
Attractiveness and Social Behavior in HPD Participants

Table HI summarizes the correlations between attractiveness ratings and HPD participants' reports of social behaviors exhibited in important interpersonal relationships. In women, high attractiveness ratings were associated with fewer positive behaviors (r = -.59), fewer maintenance behaviors (r = -.53), and a greater number of disrespectful acts (r = .67). As was the case for social network scores, parallel relationships between attractiveness and social behavior were not found in HPD men.

Table II. Correlations Between Attractiveness Ratings and SNS Scores Participant gender SNS dimension Women


Number of friends .50* .28 Number of clubs/organizations .00 .19 .21 .23 Frequency of social contact .11 .45* Social support accessibility .39 .30 Time discussing your problems -.41 -.29 Time discussing their problems -.19 .04 Range of topics discussed -.12 -.10 Relationship importance .26 Helpfulness of the person .54* .01 Family support .19 .30 .46* Peer support Note. N of women = 18; N of men = 14. SNS, Social Network Scale (Kaplan, 1975). Only participants who scored above the PDQ-R HPD threshold are included in this table. Attractiveness ratings were made on 9-point scales, with higher ratings reflecting greater attractiveness. *p < .05.

Attractiveness Ratings and Daily Hassles in HPD Participants Table IV summarizes the correlations between attractiveness ratings and the frequency and severity of daily hassles in HPD participants. As Table IV shows, attractiveness ratings were unrelated to the frequency
Table III. Correlations Between Attractiveness Ratings and SPSS Scores Participant gender SPSS dimension Women

Positive behaviors -.59** -.34 Negative behaviors .41 .20 .10 External focus behaviors .05 .67** Disrespectful acts .34 -.53* -.07 Maintenance behaviors Note. N of women = 18; N of men = 14. SPSS, Social Performance Survey Schedule (Lowe & Cautela, 1978). Only participants who scored above the PDQ-R HPD threshold are included in this table. Attractiveness ratings were made on 9-point scales, with higher ratings reflecting greater attractiveness. *p < .05. **p < .01.

HPD and Attractiveness Table IV. Correlations Between Attractiveness Ratings and HS-R Scores Participant gender HS-R dimension Interpersonal Number of events Severity of disruption Achievement-related Number of events Severity of disruption Financial Number of events Severity of disruption Women
-.19 .21
.34 .10


-.28 .18
.25 -.00 .13 .07

-.12 -.34

Note. N of women = 18; N of men = 14. HS-R, Revised Hassles Scale (DeLongis et al., 1988). Only participants who scored above the PDQ-R HPD threshold are included in this table. Attractiveness ratings were made on 9-point scales, with higher ratings reflecting greater attractiveness. HS-R severity ratings were made on 4-point scales, with higher scores reflecting greater disruption.

and severity of interpersonal, achievement-related, and financial hassles in women and men. Attractiveness Ratings and Defense Style in HPD Participants Table V summarizes the correlations between attractivess ratings and four indices of defense style assessed by the DSQ. In participants of both
Table V. Correlations Between Attractiveness Ratings and DSQ Scores Participant gender DSQ dimension Immature Image-distorting Self-sacrificing Adaptive Women .63** -.71** -.49* -.50*

.59* -.66** -.44 -.72**

Note. N of women = 18; N of men = 14. DSQ, Defense Styles Questionnaire (Bond et al., 1983). Higher DSQ scores reflect greater reliance on a particular cluster of defenses. Only participants who scored above the PDQ-R HPD threshold are included in this table. Attractiveness ratings were made on 9-point scales, with higher ratings reflecting greater attractiveness. *p < .05. **p < .01.



genders, higher attractiveness ratings were associated with greater reliance on immature defenses and with less reliance on image-distorting and adaptive defenses. In addition, there was a significant negative correlation between attractiveness and reliance on self-sacrificing defenses in HPD women (r = .49). A parallel relationship was obtained in men, but this correlation was only marginally significant (r = .44, p = .10). DISCUSSION The present results indicate that the widely discussed HPDattractiveness link holds for women but not for men. The fact that PD diagnoses were based on a self-report (questionnaire) measure might be seen as a potential limitation of this study, because structured interviews allow the diagnostician to obtain more precise and detailed information regarding PD symptomatology (Oldham, 1991). This limitation aside, the use of a self-report test of PD symptoms actually represents an important strength of the present investigation: several researchers have pointed out that HPD diagnoses are to some degree influenced by a person's physical appearance, with highly attractive persons being more likely to receive an HPD diagnosis than less attractive persons with similar symptom profiles (see Ford & Widiger, 1989; Stone, 1993). Use of a self-report test of PD symptoms eliminated the potential for diagnostician bias to influence these results. Several interpretations of the gender differences obtained in this study are plausible. It may be that physical attractiveness plays a stronger role in the etiology and dynamics of histrionic traits in women than in men. Alternatively, it is possible that the most salient physical correlates of HPD in men (e.g., tattoos, body piercings) are not captured in a global measure of physical attractiveness. Whatever the explanation, if future studies confirm that the HPD-attractiveness link is in fact limited to women, it may be necessary to qualify discussions of histrionicity and physical appearance in future versions of the DSM and in extant theoretical models of HPD symptomatology (e.g., Beck & Freeman, 1990; Horowitz, 1991). Within the HPD sample, attractiveness ratings were generally more strongly predictive of social behaviors and aspects of the social network in women than in men. This suggests that physical attractiveness per se may be more central to the interpersonal dynamics of HPD in women than in men. Perhaps histrionic men use alternative social influence strategies to obtain gratification from others (e.g., verbal intimidation rather than pseudo-sexual seduction). In fact, several theoreticians have suggested that in men, histrionic tendencies are often expressed indirectly, taking the

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form of antisocial traits rather than overt histrionic behaviors (Hamburger, Lilienfeld, & Hogben, 1996; Hart & Hare, 1989; Jordan, Swartz, George, Woodbury, & Blazer, 1989). The only domain wherein histrionic women and men produced highly similar results was in the area of defense style. In both genders, higher attractiveness ratings were associated with greater reliance on immature defenses and less use of image-distorting, self-sacrificing, and adaptive defenses. Future studies should investigate whether similar results are obtained in histrionic persons who show lower levels of adaptation and functioning (e.g., HPD patients with significant Axis I symptomatology), to assess the generalizability of these results. The prevalence rates of HPD in the present sample (6% in women and 5% in men) were generally in line with those obtained in epidemiological studies of PD symptomatology in college student and community participants. Although there is some variability in HPD prevalence rates in these investigations, base rates of HPD in young adults are generally in the range of 2-8%, with women showing slightly higher HPD prevalence rates than men (Maier, Lichtermann, Klingler, Heun, & Hallmeyer, 1992; Nestadt et al., 1990). HPD prevalence rates in psychiatric inpatient and outpatient samples are typically somewhat higher, but are associated with similar patterns of gender differences (Millon, 1996; Pfohl, 1991). Although the present results provide important preliminary information regarding the HPD-attractiveness relationship, several limitations of this investigation warrant brief discussion. First, because these data were obtained with nonclinical participants, the extent to which similar findings would be obtained in clinical participants remains open to question. Replication of this investigation in psychiatric inpatients or outpatients would strengthen and extend the present results. In addition, because a relatively small sample of HPD participants was included in this study, replication of these findings on a larger, more heterogeneous nonclinical sample may be warranted. Another limitation of this study has to do with the assessment of social behavior. Information regarding participants' social networks and interaction patterns were obtained by self-report, rather than by observation of actual behaviors exhibited in the laboratory or field. The possibility that self-presentation effects influenced the present results cannot be ruled out. Thus, the most conservative interpretation of these findings is that physical attractiveness predicts the way that histrionic women describe their social networks and behaviors. Whether their actions mirror their perceptions and self-reports is a question for further study. Because the relationships between attractiveness ratings and various indices of social behavior and defense style were only assessed in HPD



participants, the degree to which similar relationships might be found in non-HPD individuals remains open to question. As noted earlier, HPD is the only DSM-IV PD that has been theoretically linked to an individual's physical appearance, both in the official diagnostic nomenclature (APA, 1994) and in extant models of personality pathology (Millon, 1996). Thus, there is a priori reason to expect that attractiveness will be a particularly salient moderating variable in the social adjustment of HPD persons. Nonetheless, future studies should assess directly the specificity of the present findings by examining whether similar attractiveness-adjustment relationships are obtained in individuals with other PDs, or no PD. Finally, the observed HPD-attractiveness relationship might well hold for youngerbut not olderpersons. In this context, it is important to recognize that the behavior of histrionic adolescents and young adults is closest to the HPD prototype as described in the DSM-IV (Ford & Widiger, 1989; Wiggins & Pincus, 1989). In older adults overt sexual seductiveness may be a less effective means of obtaining gratification from others. Thus, the primary interpersonal strategy of an older adult with HPD may shift to a kind of maternal or paternal "seductiveness"social influence and manipulation based on presentation of the self as a powerful, guilt-inducing maternal or paternal figure. Comparison of social influence strategies used by older and younger histrionic participants would address this question directly.

ACKNOWLEDGMENTS I would like to thank Donielle H. Balstra, Susannah Bonner, Anna M. Kildow, Angela E. Misluk, Meagan Power, and Krisann M. Steneken for their help in collecting data for this project.

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