psychology

Histrionic Personality Disorder

Generality

Histrionic disorder is an alteration of the personality characterized by a continuous search for attention and exaggerated emotionality . The latter manifests itself through theatrical methods and constant attempts to obtain reassurance, approval and support from others.

Moreover, people with histrionic disorder have a strongly seductive and manipulative attitude, tend to somatization and are constantly looking for stimuli that are able to keep them in a constant excitatory state.

These characteristic personality traits appear between adolescence and early adulthood, and invest numerous contexts in the subject's life (relational, professional and family), creating discomfort and suffering. Indeed, the tendency of this personality to excessive dramatization can compromise relationships and, over time, lead to depression.

The diagnosis of histrionic disorder involves a clinical evaluation by a specialist. With regards to treatment, an often useful approach is psychodynamic psychotherapy.

Causes

This personality disorder is part of cluster B (being characterized by dramatic or eccentric behaviors): individuals with these traits appear to be amplifying, emotional or unpredictable.

Histrionics have a poor sense of personal identity, which leads them to focus a lot on the outside world: theatricality in emotional expression is not synonymous with intensity, but with a great distance with one's emotional and emotional inner world .

The causes of histrionic disorder are not yet well understood, but the opinion is shared that this condition may represent the result of the complex combination of several social, psychological, biological and genetic factors . These would intervene during the development of the individual, influencing their behavior and thinking.

The clinical picture can be fostered by growth in a family environment that is incapable of providing the child with the necessary care, the instinctive desire to gain social acceptance among peers and the inability to deal with stressful situations.

Symptoms

The histrionic personality disorder appears within the first adult age and manifests itself in a variety of contexts (relational, professional and family).

The most common symptoms are:

  • Unstable emotion : subjects suffering from histrionic personality disorder have exaggerated emotional reactions, tend to dramatize everything about them and are often superficial in the construction of emotional relationships;
  • Egocentrism : people affected by this condition tend to live in a state of discomfort when they are not the center of attention;
  • Inappropriate sexuality : the histrionic tends to resort to sensual or seductive behaviors to continually place himself at the center of attention;
  • Suggestibility : Histrionics are particularly impressionable, give too much importance to others' opinions and frequently tend to consider personal relationships more intimate than they really are.

The histrionic subject feels the need to be the center of attention and, when he fails to focus this on himself, he experiences a strong sense of discomfort and tends to become depressed. The histrionic does not like the idea of ​​being excluded, abandoned or another person is preferred. He is also inclined to express his feelings in a dramatic and theatrical way and manifests rapidly changing and superficial emotions.

The histrionic subject has an extremely seductive or provocative but inappropriate sexual behavior, since he does not know how to position himself adequately in the relationship; he uses his physicality in order to attract the attention of others and considers relationships more intimate than they really are.

The histrionic subject appears suggestible, easily influenced by the external environment, by circumstances and by people. His speech is structured to impress the listener, but it has no details. In the histrionic, relationships are characterized by adhesiveness and where there is this aspect there cannot be a third person (the boundary between self and the other is missing).

The condition is frequently associated with other personality disorders (especially antisocial, borderline and narcissistic), suggesting that they share a biological vulnerability. Some patients also have a somatoform disorder at the same time, which may be the reason for medical consultation. Histrionic disorder can also coexist with major depression, dysthymia and conversion disorder.

Histrionic personality disorder has significant repercussions: if not properly treated, it can end up compromising the social and working life of the people who are affected. Possible attempts at suicide by the histrionic are connected to the strong anxiety that grips the subject, as he does not tolerate separation, so he wants to communicate to the other, in the only way it is possible, his inability to tolerate the situation; however, an underlying manipulative goal of attracting attention is always present.

Diagnosis

The diagnosis of histrionic disorder is formulated by a specialist through some evaluation interviews, to understand the overall functioning of the person and to examine the patient's personal and medical history accurately. This in-depth psychological analysis makes it possible to search for repetitive and maladaptive patterns of thought and behavior during the patient's evolutionary history.

The conflictuality of the histrionic emerges above all in the relational dimension. In particular, it is opportune to explore the themes of dependence in the affective-sexual field, the adhesiveness and anguish induced by abandonment and the difficulty in facing the oedipal conflict (sense of exclusion and rejection).

The superficiality and the sudden change in the theatrical mood could indicate a difficulty in processing intra-psychic conflicts and a massive use of repression as a defense mechanism. Therefore, what the histrionic protects himself through superficiality would be investigated.

The diagnostic test can also use a physical exam to make sure that the problem is not favored by organic causes .

Diagnostic criteria

For the diagnostic definition of histrionic personality disorder - according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association - patients must present at least five symptoms of the following:

  • Discomfort in contexts where they are not the center of attention;
  • Interaction with others often characterized by seductive and / or provocative behavior;
  • Extremely inappropriate, unstable and superficial emotionality;
  • Use of physical appearance as a means of drawing attention to oneself;
  • An impressionistic speech, vague and lacking in details;
  • High suggestibility (they are easily influenced by others and by circumstances);
  • Tendency to consider relationships more intimate than they really are.

Furthermore, the symptoms must have started in early adulthood.

Differential diagnosis

The differential diagnosis is placed, in particular, against:

  • Narcissistic personality disorder : narcissistic patients desire the attention of others and, usually, they claim praise for their "superiority"; however, unlike those with histrionic personality disorder, they want to feel admired or consider themselves better. Histrionic patients are not so demanding and are willing to appear fragile if this serves to obtain the desired consideration.
  • Borderline personality disorder : borderline patients are in search of attention, take on manipulative behavior and present rapidly changing emotions; these subjects manifest chronic feelings of profound emptiness and pervasive ideas of being evil. Histrionic patients do not have such a negative humoral state, but low self-esteem with devaluation and disappointment may depend on the emotional reaction of other people. Histrionic personality disorder shares borderline inconstancy and emotional instability in relationships.
  • Dependent personality disorder : patients with dependent personality disorder, such as histrionics, try to be close to others for approval or support, but are more anxious, inhibited and submissive (because they are worried about rejection). Conversely, individuals with histrionic personality disorder seek attention through theatrical behavior and are uninhibited and emotionally showy.

The differential diagnosis for histrionic personality disorder also includes somatoform disorder and anxiety.

Treatment

The treatment of histrionic disorder is similar to that of other personality dysfunctions. The condition must not be underestimated and should be adequately treated from the first symptoms (which usually appear from youth).

A useful approach can be psychodynamic psychotherapy, which focuses on fundamental conflicts. Despite its relational inadequacy, the histrionic maintains, in fact, a good relationship with reality and a process of elaboration of the terms of the conflict is possible.

Psychotherapy interventions are aimed at helping:

  • Reduce subjective discomfort;
  • Re-elaborating the terms of intrinsic conflict;
  • Modify the traits of problematic personalities, significantly reducing maladaptive and socially unwelcome behaviors;
  • Foster the separation-individuation process, thus strengthening the internal boundaries between oneself and the other;
  • Re-elaborate the issues related to dependence, adhesiveness, abandonment anxiety, corporeality and the need for attention.

A medium-long term cognitive-behavioral psychotherapeutic interventions (from 1 to 2 years) can also be effective.

However, specific drug therapies are not available to treat histrionic personality disorder. However, if you have manifestations of depression or other related conditions, medications such as antidepressants or anxiolytics may be helpful.