Histrionic Personality Disorder

Basic Information

Histrionic personality disorder is marked by an insatiable attention-seeking, a great emotionality, a provocative and flirtatious behavior and a false sense of intimacy in relationships when in reality there is very little. Most histrionic personality types are women who have not gone beyond the infantile stage and thus enact the role of both child and woman. Often the histrionic personality has great social skills and a hyper alertness to others so that she can decide how to manipulate them in order that she can be the center of attention, outside of which she is very uncomfortable. By being seductive, often exhibiting overt sexual behavior or flirtatious skills, her goal of making the object of her focus dependent on her is secured through histrionic exaggeration.

This personality type is always on the lookout for the new and the trendy. The same old routine is boring and suffocating. Turning her back on reality, the histrionic personality enters a fantasy world in which she becomes a commodity, rarely acting from her own inner feelings and impulses (of which she is acutely unaware) and performing before an audience in a dramatic, excitable way. However, these dramatic displays have no longevity and are done only to get praise, attention and approval from others. She perceives herself as quite charming, with an active social life but as quickly as she is excited she becomes bored and her impulsivity can result in quick, unplanned bouts of hedonism and a fixation on constant activity that leaves no room for self-reflection or self-examination. Affection and attention are the main goals and to get these goals met the histrionic exhibits behaviors that our society admires or at least gives lip service to -- extroversion, popularity, sociability and attractiveness. But underneath there is the driving need to be the center of attraction or attention at any cost, even if this means repetitive, self-distracting behavior in which the histrionic's sense of self or worthiness comes solely from others and cannot be met by anyone who is not in the outside world because inside there is an emptiness, confusion and lack of a core identity. Thus external stimuli is all and an insatiable skipping from one transient event to another in an attempt to manipulate attention often becomes inappropriate behavior, getting the attention of unsuitable persons in situations that are not meaningful or which do not hold any genuine affection.

Like the dependent personality the histrionic personality exhibits anxiety towards becoming separate but is more active in that she pushes herself as a recognizable commodity that others will gravitate towards by her exhibitionistic behavior. But her tendency to become easily bored propels her into periods of being alone without any real friends and during these times she becomes restless, anxious and the mistress of overdramatization in order to get the attention she feels is suddenly missing.

Hypochondria is a tool of the histrionic personality because not only does it generate sympathy and satisfy the need for attention-getting but it can stop inner reflection and unease by focusing on yet another external albeit bogus preoccupation.

Symptoms

Besides the above symptoms, histrionic personality types will often have a flair for the dramatic or indeed an overflair for the dramatic, making grand gestures that are sure to catch the eye. Inactivity is a great fear and the sense of not belonging socially can create agitation. This personality will have difficulty in delaying gratification and will become quite attached and dependent upon one person or object of affection. There is usually an inability to sustain a relationship and this personalty type goes from one partner to another, fearful of not being the center of attention. It is between periods where she goes from one partner to another that agitation and depression are likely to set in -- that is, until the next man is on the scene and fear of abandonment is lost and the quite recognizable coquettish behavior returns at full force.

Diagnosis/Treatment

The health care provider and/or therapist can make diagnosis by observed behavior and by evaluating the pattern of parental and romantic relationships.

There may be a genetic susceptibility to this personality disorder. Both neurological and chemical influences may affect the senses and emotions of the patient. Heredity may play a part in that one of the parents may also have histrionic personality disorder. However childhood psychological experiences often provide a clearer indication of the disposition for this disorder. It is thought that histrionic behaviors are the result of:

• a lack of criticism or punishment as a child
• comments that are favorable or bring positive reinforcement only upon completion of approved behaviors (i.e., if the child is lovely or completes a task well)
• parental favor given irregularly so that the child is confused about how to receive parental attention and approval consistently.

Unlike the dependent personality, the histrionic personality actively rather than passively seeks attention. But her goals are the same: to get approval from sources outside of themselves. The child who will develop a histrionic personality as an adult feels the need to perform for and please others to feel adequate attention. Thus approval comes from others' judgements, not a feeling of self-worth or inner self-esteem. Because of gaps in parental approval during performance and attention-getting behaviors the child is never certain of the adequacy of her own behaviors and as an adult will continue to seek approval, acceptance and a status of dependency upon others, most notably those about whom she romantically obsesses or pedestalizes. The exhibitionism and flirtatious behavior continues as do preoccupations with the external and the constant attention-demanding and superficial social relationships.

Therapy can be successful in treating this personality disorder, though histrionics usually do not feel they need therapy and usually seek therapy only when boredom, dissatisfaction, loss of sexual interest, possible frigidity and fear of rejection from a partner spurs them to view life as suddenly hopeless. Often when the patient's external world changes for the better therapy is ended.

A goal for treatment is for the therapist to lessen the dramatic affects of the patient so that she may try to uncover true feelings and help improve the patient's self-reliance. Group therapy is often a good way to strengthen the patient's ability to relate to others in a more meaningful way and learn that not being the center of attention is not necessarily a fearful or anxiety-provoking position to find herself in. The use of antidepressant or anti-anxiety medication is not usually indicated and like behavior modification techniques usually proves of limited value. Supportive therapy usually has better results in allowing the patient to explore her inner life and help change old images and erode the obsessive search for approval and stimulation.

If you have questions or concerns about histrionic personality disorder please consult with your health care provider.