The Dimensional Perspective
DimensionsHere is a hypothetical profile, in terms of the five-factor model of personality, for Histrionic Personality Disorder (speculatively constructed from McCrae, 1994, pg. 306):
High Neuroticism
- Chronic negative affects, including anxiety, fearfulness, tension, irritability, anger, dejection, hopelessness, guilt, shame; difficulty in inhibiting impulses: for example, to eat, drink, or spend money; irrational beliefs: for example, unrealistic expectations, perfectionistic demands on self, unwarranted pessimism; unfounded somatic concerns; helplessness and dependence on others for emotional support and decision making.
- Low Extraversion
- Social isolation, interpersonal detachment, and lack of support networks; flattened affect; lack of joy and zest for life; reluctance to assert self or assume leadership roles, even when qualified; social inhibition and shyness.
- High Openness
- Preoccupation with fantasy and daydreaming; lack of practicality; eccentric thinking (e.g., belief in ghosts, reincarnation, UFOs); diffuse identity and changing goals: for example, joining religious cult; susceptibility to nightmares and states of altered consciousness; social rebelliousness and nonconformity that can interfere with social or vocational advancement.
- High Agreeableness
- Gullibility: indiscriminate trust of others; excessive candor and generosity, to detriment of self-interest; inability to stand up to others and fight back; easily taken advantage of.
- Low Conscientiousness
- Underachievement: not fulfilling intellectual or artistic potential; poor academic performance relative to ability; disregard of rules and responsibilities can lead to trouble with the law; unable to discipline self (e.g., stick to diet, exercise plan) even when required for medical reasons; personal and occupational aimlessness.
Specific Affects
Exaggerated, shallow emotions; enthusiasm, anger, boredom (Millon, pg. 158).Hysteria; sadness, jealousy, disappointment, fear, boredom (Stone [Briquet], pg. 318).
The Behavior Perspective
Motivations
Desire to coerce, manipulate, and deceive others into giving help and to establish and maintain dependency."The inordinate and demanding dependency displayed by many of these patients plays so important a role in hysterical psychopathology as to constitute a kind of organizing principle for many of the other features, which can be seen as distorted efforts to gratify dependency or as defensive reactions to its presence" (Chodoff, pg. 2727).
Behaviors
Overly dramatic, reactive, and intensely expressed behavior; strident and superficial emotionality, emotional storms, constant attention-seeking, sexually seductive behavior, histrionics, submissiveness, eagerness to please, ruthless willfulness (Chodoff, pp. 2727-2728).Affectation, overreaction, stimulus-seeking, intolerance of inactivity, impulsiveness, theatricality, flirtatiousness, demandingness, attention-seeking, exhibitionism (Millon, pp. 138, 140).
Emotional manipulation, seductiveness; demands for constant attention; cravings for novelty, stimulation, and excitement; suicide gestures and threats (American Psychiatric Association, pg. 656).
Bombast.
Associated Disorders
Somatization Disorder, Conversion Disorder, Major Depressive Disorder (American Psychiatric Association, pg. 656). Depression, Hysteroid Dysphoria (Chodoff, pp. 2735-2736).
The Life Story Perspective
Childhood
Inconsistent parenting style: alternation between insensitive non-involvement and rewards for exhibitionist behavior.
| Universal Personality Disorder | Basic Passions | Sadistic |
Erroneous Value-judgments
Histrionic personality disorder is a typological representation of bad character, of a vicious disposition formed by habitual passion. Passions are, or are the results of, erroneous value-judgments. The objects of passion listed below (derived mostly from Beck, Freeman, and associates, 1990, pp. 50-51) are external, indifferent things that the Histrionic personality incorrectly judges to be good or bad. (Evolutionary Psychology and Behavior Genetics provide adequate scientific explanations of the origins of these impulses.) The cure of Histrionic personality disorder will require correcting these habitual, erroneous value-judgments by making proper use of impressions.
| Habitual Passions | |
|---|---|
| Desires/ Pleasures | Fears/ Distresses |
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Cognitive Effects
Basic Belief: I need to impress. Strategy: Dramatics (Beck, Freeman & associates, pg. 26). In Cognitive Therapy of Personality Disorders , Aaron T. Beck, Arthur Freeman, and associates (1990) list typical beliefs associated with each specific personality disorder. Here are the typical beliefs that they have listed (pg. 362) for Histrionic Personality Disorder:
- I am an interesting, exciting person.
- In order to be happy I need other people to pay attention to me.
- Unless I entertain or impress people, I am nothing.
- If I don't keep others engaged with me, they won't like me.
- The way to get what I want is to dazzle or amuse people.
- If people don't respond very positively to me, they are rotten.
- It is awful for people to ignore me.
- I should be the center of attention.
- I don't have to bother to think things through?I can go by my "gut" feeling.
- If I entertain people, they will not notice my weaknesses.
- I cannot tolerate boredom.
- If I feel like doing something, I should go ahead and do it.
- People will pay attention only if I act in extreme ways.
- Feelings and intuition are much more important that rational thinking and planning (362).