Histrionic Personality disorder

Presented by-Jasleen Kaur Brar

INTRODUCTION

• The word personality is derived from the Greek term persona.

• It was originally used to describe the theatrical mask worn by some dramatic actors at the time. Over the years, it lost its connotation of pretense and illusion and came to represent the person behind the mask—the “real” person.

• The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) (American Psychiatric Association [APA], 2000) defines personality traits as “enduring patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts.”

Personality Disorders

• Personality disorders occur when these traits become inflexible and maladaptive and cause either significant functional impairment or subjective distress.

• A personality disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable with time, and leads to distress or impairment (American Psychiatric Association [APA], 2000, p. 685).

Personality disorder subtypes classified in DSM-IV TR

1. Cluster A: Behaviors described as odd or eccentric• Paranoid personality disorder• Schizoid personality disorder• Schizotypal personality disorder2. Cluster B: Behaviors described as dramatic, emotional, or erratic• Antisocial personality disorder• Borderline personality disorder• Histrionic personality disorder• Narcissistic personality disorder3. Cluster C: Behaviors described as anxious or fearful• Avoidant personality disorder• Dependent personality disorder• Obsessive-compulsive personality disorder

Theories of Personality Disorders

• Family dynamics – growing up in a dysfunctional, abusive, invalidating, overprotective, controlling, or uncaring environment; poor parenting; parent-child relationship

• Genetic Influences• Biological/biochemical Influences • Trauma & other significant experiences• Continuum model – personality disorders represent

extreme variations of normal personality traits

Histrionic Personality disorder

DEFINITION OF HISTRIONIC PERSONALITY DISORDER

A pervasive pattern of excessive emotionality and attention-seeking behavior

According to ICD-10 F60.4:- Histrionic personality disorder is a pattern of excessive emotionality and attention seeking including an excessive need for approval and inappropriate seductiveness.

• It begins in early adulthood

Facts & Figures:

• Prevalence: 2-3% in general population• Gender: diagnosed more frequently in women;

prevalence may be equal for males & females• Sex role stereotypes influence the behavioral

expression of the disorder• Aging presents special difficulties• Course: chronic, but may improve with age• Contributing Factors: Unmet needs for attention

& success

ETIOLOGICAL FACTORS

FAILURE TO DEVELOP HEALTHY INTIMATE RELATIONSHIPS

IRRATIONAL FORM OF THINKING

LACK OF TRUST ON SELF &OTHERS

MANIFESTATIONS

PSYCHODYNAMICS

MANIFESTATIONSPervasive and excessive pattern of

emotionality and attention seeking, i.e. constant seeking of reassurance or approval.

Individuals are lively, excessive dramatics with exaggerated display of emotions.

Enthusiastic and flirtatious.

Inappropriately seductive appearance or behavior.

• Excessive concern with physical appearance.

• Self centeredness, self indulgent and intensely dependent on others.

• Low tolerance of frustration or delayed gratification.

• Rapidly shifting emotional states that may appear shallow

Opinions are easily influenced by other people, but difficult to back-up details.

Tendency to believe that relationships are more intimate than they actually are.

Makes rash decisions.

Threaten or attempts suicide to get attention.

Inappropriately sexually provocative. Express strong emotions with an impressionistic style.

• Project their own unrealistic fantasized intentions onto people with whom they are involved.

• Selection of marital or sexual partners is highly inappropriate.

• Women may have inappropriate and intense anger, may engage in manipulative suicide threats by manipulating interpersonal behavior.

• Males show identity diffusion, disturbed relationships, lacks of impulse control

• Antisocial tendency are inclined to exploit physical symptoms.

• Engage in uninhibited behavior.

• Able to function at a high level and can be successful socially and at work.

• Affects persons’ social and romantic relationships or their ability to cope with losses and failures.

Often fails to see their own situation realistically, tends to dramatize and exaggerate.

Failure or disappointment is usually blamed on others.

Goes through frequent changes in job, easily bored, have trouble in dealing with frustration as they crave for novality, competitiveness and excitement, they may place themselves in risky situations, thus ending up in depression.

A style of speech, that is excessively impressionistic and lacking in detail.

Shows self dramatization, exaggerated expression of emotions.

Over involvement (superficial resonance with others )

Aggressiveness

Over concern with physical attractiveness.

Egocentricity.Self indulgence.Persistent manipulative behavior in achieving

the needs.  

Criteria of Histrionic 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

MnemonicA mnemonic that can be used to remember the criteria

for histrionic personality disorder is PRAISE ME:

P - provocative (or seductive) behaviorR - relationships, considered more intimate than they areA - attention, must be at center ofI - influenced easilyS - speech (style) - wants to impress, lacks detailE - emotional lability, shallownessM - make-up - physical appearance used to draw

attention to selfE - exaggerated emotions - theatrical

ICD 10 Creteria• A. The general criteria of personality disorder (F60) must be

met.

• B. At least four of the following must be present:

(1) Self-dramatization, theatricality, or exaggerated expression of emotions.

(2) Suggestibility, easily influenced by others or by circumstances.

(3) Shallow and labile affectivity.

(4) Continually seeks excitement and activities in which the subject is the centre of attention.

(5) Inappropriately seductive in appearance or behaviour.

(6) Overly concerned with physical attractiveness.

Dual diagnoses

• HPD has been associated with alcoholism and with higher rates of somatization disorder , conversion disorder , and major depressive disorder .

• Personality disorders such as borderline, narcissistic, antisocial, and dependent can occur with HPD.

Diagnosis

• Observation of appearance, behaviour• Collection of history• Psychological evaluation

TREATMENTPsychotherapy based on case report method aimed at self development through resolution of conflict.

Dynamic therapy remains the treatment of choice to externalize patient’s inner emotions in treatment of histrionic PD.

In this therapy interpretation of pathological relationships may evoke intense feelings of anxiety, which have to be handled respectfully without humiliating the patients.

• Self help groups and therapeutic community setting is more productive than institutionalization in producing a change.

Family therapy based on manifestations

Complications:

• Individuals with this disorder may have difficulty achieving emotional intimacy in romantic relationships. Without being aware of it, they often act out a role (e.g., "victim" or "princess").• They may seek to control their partner through

emotional manipulation or seductiveness on one level, whereas displaying a marked dependency on them at another level.• Impaired relationships with same-sex friends

because of their sexually provocative behavior or their demands for constant attention.

• They crave novelty, stimulation, and excitement and have a tendency to become bored with their usual routine. • They often initiate a job or project with

great enthusiasm, their interest may lag quickly. • The Diagnostic actual risk of suicide is

not known, but individuals with this disorder are at increased risk for suicidal gestures and threats to get attention

Defence Mechanisms use

--Denial--Identification--Somatization--Repression--Acting out--Fantasy of love and attention--Dissociation--Regression

Thank you