Histrionic Personality Disorder

Some people tend to express themselves in very dramatic ways. When carried to an extreme, these tendencies form the basis for histrionic personality disorder. The term histrionic is derived from a Latin word meaning “actor.” People with this disorder display dramatic qualities in their everyday behaviour. For example, someone with this disorder may put on a show of being overwhelmed with tears and sentimentality at the wedding of a distant relative or may greet an acquaintance at a party with flamboyant and attention-getting hugs and exclamations of affection.

What differentiates people with this disorder from those who show appropriate emotionality is the fleeting nature of their emotional states and their use of excessive emotions to manipulate others rather than to express their genuine feelings. This disorder is more commonly diagnosed in women, though it is not clear whether this is because the disorder is more common in women or because those who are assigning the label regard histrionic behaviours as stereotypically feminine.

People with histrionic personality disorder enjoy being the centre of attention and behave in whatever way necessary to ensure that this happens. They are excessively concerned with their physical appearance, often trying to draw attention to themselves in such extreme ways that their behaviour seems preposterous. Furthermore, they are likely to be seen as flirtatious and seductive, demanding the reassurance, praise, and approval of others and becoming furious if they don’t get it. They want immediate gratification of their wishes and overreact to even minor provocations, usually in an exaggerated way, such as by weeping or fainting. Although their relationships are superficial, they assume them to be intimate and refer to acquaintances as “dear friends.” They are easily influenced by others, lack analytical ability, and see the world in broad, impressionistic terms.

Histrionic behaviours would cause others to keep their distance; being in a relationship with a person with a histrionic personality disorder can be exasperating and unsatisfying. The result, of course, is that people with this disorder have few, if any, close and reciprocal relationships. In keeping with this clinical picture, individuals with histrionic personality disorder are likely to have an insecure attachment type. They constantly seek support and approval from their partners (Lopez & Brennan, 2000).

Cognitive-behavioural theorists propose that people with this personality disorder suffer from mistaken assumptions underlying their approach to life (Freeman, Pretzer, Fleming, & Simon, 1990). These individuals seek attention and approval by acting in ways that are stereotypes of hyper-femininity or hyper-masculinity, believing that this will elicit admiration and support from others. Given the cognitive behavioural position that emotions are a product of one’s thoughts, it follows that the global nature of the histrionic individual’s thinking style leads also to diffuse, exaggerated, and rapidly changing emotional states. The way these individuals evaluate people and situations is equally imprecise and subject to distortion; therefore, their opinions can change on a daily basis from one extreme to another.

Characteristics

• This diagnosis is given to people who show a pervasive pattern of excessive emotionality and attention seeking, as indicated by five or more of the following:
• Discomfort when not the centre of attention
• Interactions characterized by inappropriate sexually seductive or provocative behaviour
• Rapid shifts and shallow expression of emotions
• Use of physical appearance to draw attention
• Speech that is excessively impressionistic and lacking in detail
• Self-dramatization, theatricality, and exaggerated expression of emotion
• High suggestibility
• Misinterpretation of relationships as being more intimate than they are

A therapist using cognitive-behavioural techniques would help the client develop more effective ways of approaching problems and situations, would work with the client to focus on goals, and would teach the client how to think more precisely and objectively. By taking this approach, the therapist models good problem-solving behaviour and gives the client practical help in dealing with various life issues. Clients also learn self-monitoring strategies to keep their impulsive tendencies in check, as well as assertiveness skills to improve interpersonal relationships.

Originally published at blog.mindsolace.com on June 18, 2017.