HISTRIONIC: A related disorder compared to BPD

There is an unfortunate overlap between the criteria on DSM-III for histrionic personality and for the borderline category. These criteria suggest a close relationship between the two in which the borderline group might be considered to be a more dysfunctional variant. Thus both groups tend to be dependent, manipulative, and affectively expressive.

There is greater stability and better function with this group. The criteria for both suicidal behavior and psychotic experiences will no longer be used to characterize the histrionic group. More critically, the central role of sexuality in the regulation of self-esteem and its overt interpersonal expressions in seductiveness, erotization, and rivalry with members of the same sex should become criteria for the histrionic group.

The histrionic patient is not predominantly angry as with the borderline patient. Moreover, the histrionic patient may experience some periods of sustained well-being and pleasure.

An excellent review of histrionic personality disorder (HPD) by Horowitz is found in Synopsis of Treatments of Psychiatric Disorders, edited by Gabbard & Atkinson, American Psychiatric Press, 1996. Basically, HPD is a chronic, often life-long pattern of maladaptive behavior, characterized by excessive emotional expression and attention-seeking behavior. Individuals with HPD tend to be flirtatious, demanding of attention, seductive, but emotionally shallow. They are prone to impulsive and dramatic displays of emotion and are easily influenced by others. HPD individuals find it difficult to delay gratification, and are often crushed by what they perceive as rejection; this can lead to serious depressive bouts and even suicidal gestures. Unfortunately, well-designed research studies of treatment of HPD are not available; most of the data consist of case reports. Psychotherapy aimed at helping the individual develop a more mature sense of self is said to produce good results (see the chapter by Horowitz), but well-validated success rates are not available.

HISTRIONIC PERSONALITY DISORDER These individuals display overly dramatic and attention seeking behaviours. They are shallow of emotions, self-centered and they can be inappropriately sexually provocative.

Causes Roughly 2/3 also meet the criteria for antisocial personality disorder. The two disorders may represent sex-typed alternative expressions of the same underlying condition. Females exhibit a histrionic pattern whereas males exhibit an antisocial pattern.

Behaviour therapy has been used to target the attention seeking behaviours and encouraging more appropriate interpersonal behaviours.

Cognitive Profile:

* Core beliefs include "I am basically unattractive" or "I need other people to admire me in order to be happy".

* They use dramatics and demonstrativeness in order to bind people towards them; when they don't get their own way they believe that they are being treated unfairly and they try to coerce compliance or get even by throwing temper tantrums.

* The most prominent affect is gaiety and other high spirits; there may be an undercurrent of anxiety that reflects their fear of rejection.

Here's one version of the criteria

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:

                                   How They Appear When Clustered

            The DSM-III-R groups the personality disorders into three clusters: 

     Cluster A:  disorders marked by odd or eccentric behaviors.   
     Cluster B:  disorders characterized by dramatic, emotional or erratic behaviors. 

     Cluster C: disorders characterized by anxious or fearful  behaviors.  
                                                 obsessive compulsive 
                                                 passive aggressive

Shmuel (Sam) Vaknin, Ph.D. is probably the most outspoken self proclaimed narcissistic person on the internet. He even has his own discussion group for other narcissistic people.

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This page was created June 27, 1998 Updated 4 JUL 1999