Histrionic+Personality+Disorder

= = **PERSONALITY DISORDERS **


 * Histrionic Personality Disorder **

People with this disorder tend to be enthusiastic, outgoing, and flirtatious, but nonetheless often alienate others because they always need to dominate the spotlight and be the centre of attention. They make efforts to win everyone over with charming repartee, a confiding manner, elaborate storytelling, subtle or not so subtle seductiveness, and special attention to clothing, makeup and grooming. Perhaps the most vivid portrayals of this personality are Scarlett O’Hara in __Gone with the Wind__ and Blanche DuBois in __A Streetcar Named Desire.__Their emotions tend to run very hot and very cold. Theatricality in the way they do things makes them seem shallow and superficial even when they do care deeply. It is very disappointing to these individuals when other people are insufficiently involved with them. People with this disorder feel closer to others than others do to them and may tend to become too quickly and overly familiar.

The seductive behaviour of someone with this disorder is meant to be more social than sexual, but people who are approached may not discern the difference. Other people sometimes think these individuals are “coming on” to them when it is not meant in that way. This misunderstanding may lead to embarrassing moments or concerns about sexual harassment. Persons with the disorder may have a tendency to bristle in response to any criticism about personal appearance and to work hard to look much younger than they really are. They may be so concerned about looking their best that they may spend hours in front of the mirror before venturing out, even if it’s only to go to the store for some milk.

Same gender friendships usually don’t work out well because of competitive feelings and the conviction that gender mates will necessarily be jealous. These individuals tend to like excitement and variety, fall in love easily, only to become quickly bored and disappointed. Torrid relationships burn out quickly because of the individual’s fear of commitment and her/his difficulty becoming emotionally intimate.

According to the diagnostic manual, someone has Histrionic Personality Disorder if: They have a pattern of seeking attention and displaying their emotions excessively. The pattern is expressed by having at least five of the following maladaptive traits:

• Acting in a sexually seductive or provocative way that is inappropriate to the situation.

• Feeling uncomfortable when in situations in which s/he is not the centre of attention.

• Demonstrating emotions which appear to others to be rapidly shifting, shallow, and superficial.

• Using one’s physical appearance to draw attention to oneself.

• Talking in an excessively impressionistic way that lacks specific detail.

• Having a tendency to be overly dramatic and theatrical when expressing oneself or telling a story.

• Being overly suggestible and easily influenced by others’ opinions.

• Viewing relationships as more intimate than they really are.

Influenced by the gender role stereotypes in our society, it seems likely that Histrionic Personality Disorder may be over-diagnosed in women and under-diagnosed in men. Most people are more attuned, for example, to the histrionic flamboyance of Blanche DuBois than to the equally over-the-top macho style of Stanley Kowalski, who shows strong histrionic elements as well. What is considered a normal quota of seductiveness, demonstrative behaviour, and dramatic emotionality varies greatly with one’s age, gender, and culture. “Normal” and adaptive seductiveness can help attract a partner. Being demonstrative can help bring vividness and colour to all relationships and activities. A Personality Disorder should be considered only when this need to be the centre of attention becomes excessive and negatively affects one’s self and others rather than attracting them.

Treatment  With all Personality Disorders, the first step to successful treatment is the recognition that there is a problem with how personality affects one’s life and the lives of others. For most people, increased awareness does not lead to a radical personality change but rather a smoothing of the rough edges and a modulation of the most troubling behaviours. Therapy is often helpful, and necessary, in identifying a personality problem – either to make changes or to learn skills to improve functioning. Medication has demonstrated effectiveness in treating secondary diagnosis of depression or anxiety that can be present with a diagnosis of a personality disorder. []


 * __DSM -IV-TR__**

A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
 * 1) is uncomfortable in situations in which he or she is not the center of attention
 * 2) interaction with others is often characterized by inappropriate sexually seductive or provocative behavior
 * 3) displays rapidly shifting and shallow expression of emotions
 * 4) consistently uses physical appearance to draw attention to self
 * 5) has a style of speech that is excessively impressionistic and lacking in detail
 * 6) shows self-dramatization, theatricality, and exaggerated expression of emotion
 * 7) is suggestible, i.e., easily influenced by others or circumstances
 * 8) considers relationships to be more intimate than they actually are

Diagnostic Features The essential feature of Histrionic Personality Disorder is pervasive and excessive emotionality and attention-seeking behavior. This pattern begins by early adulthood and is present in a variety of contexts. Individuals with Histrionic Personality Disorder are uncomfortable or feel unappreciated when they are not the center of attention (Criterion 1). Often lively and dramatic, they tend to draw attention to themselves and may initially charm new acquaintances by their enthusiasm, apparent openness, or flirtatiousness. These qualities wear thin, however, as these individuals continually demand to be the center of attention. They commandeer the role of "the life of the party." If they are not the center of attention, they may do something dramatic (e.g., make up stories, create a scene) to draw the focus of attention to themselves. This need is often apparent in their behavior with a clinician (e.g., flattery, bringing gifts, providing dramatic descriptions of physical and psychological symptoms that are replaced by new symptoms each visit). The appearance and behavior of individuals with this disorder are often inappropriately sexually provocative or seductive (Criterion 2). This behavior is directed not only toward persons in whom the individual has a sexual or romantic interest, but occurs in a wide variety of social, occupational, and professional relationships beyond what is appropriate for the social context. Emotional expression may be shallow and rapidly shifting (Criterion 3). Individuals with this disorder consistently use physical appearance to draw attention to themselves (Criterion 4). They are overly concerned with impressing others by their appearance and expend an excessive amount of time, energy, and money on clothes and grooming. They may "fish for compliments" regarding appearance and be easily and excessively upset by a critical comment about how they look or by a photograph that they regard as unflattering. These individuals have a style of speech that is excessively impressionistic and lacking in detail (Criterion 5). Strong opinions are expressed with dramatic flair, but underlying reasons are usually vague and diffuse, without supporting facts and details. For example, an individual with Histrionic Personality Disorder may comment that a certain individual is a wonderful human being, yet be unable to provide any specific examples of good qualities to support this opinion. Individuals with this disorder are characterized by self-dramatization, theatricality, and an exaggerated expression of emotion (Criterion 6). They may embarrass friends and acquaintances by an excessive public display of emotions (e.g., embracing casual acquaintances with excessive ardor, sobbing uncontrollably on minor sentimental occasions, or having temper tantrums). However, their emotions often seem to be turned on and off too quickly to be deeply felt, which may lead others to accuse the individual of faking these feelings. Individuals with Histrionic Personality Disorder have a high degree of suggestibility (Criterion 7). Their opinions and feelings are easily influenced by others and by current fads. They may be overly trusting, especially of strong authority figures whom they see as magically solving their problems. They have a tendency to play hunches and to adopt convictions quickly. Individuals with this disorder often consider relationships more intimate than they actually are, describing almost every acquaintance as "my dear, dear friend" or referring to physicians met only once or twice under professional circumstances by their first names (Criterion 8). Flights into romantic fantasy are common. []

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