Histrionic personality disorder, often abbreviated as HPD, is a type of personality disorder in which the affected individual displays an enduring pattern of attention-seeking and excessively dramatic behaviors beginning in early adulthood and present across a broad range of situations. Individuals with HPD are highly emotional, charming, energetic, manipulative, seductive, impulsive, erratic, and demanding.
Mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders (the DSM ) to diagnose mental disorders. The 2000 edition of this manual (the fourth edition text revision, also called the DSM-IV-TR ) classifies HPD as a personality disorder. More specifically, HPD is classified as a Cluster B (dramatic, emotional, or erratic) personality disorder. The personality disorders which comprise Cluster B include histrionic, antisocial, borderline, and narcissistic.
Description
HPD has a unique position among the personality disorders in that it is the only personality disorder explicitly connected to a patient's physical appearance. Researchers have found that HPD appears primarily in men and women with above-average physical appearances. Some research has suggested that the connection between HPD and physical appearance holds for women rather than for men. Both women and men with HPD express a strong need to be the center of attention. Individuals with HPD exaggerate, throw temper tantrums, and cry if they are not the center of attention. Patients with HPD are naive, gullible, have a low frustration threshold, and strong dependency needs.
Cognitive style can be defined as a way in which an individual works with and solves cognitive tasks such as reasoning, learning, thinking, understanding, making decisions, and using memory. The cognitive style of individuals with HPD is superficial and lacks detail. In their inter-personal relationships, individuals with HPD use dramatization with a goal of impressing others. The enduring pattern of their insincere and stormy relationships leads to impairment in social and occupational areas.
Causes and symptoms
Causes
There is a lack of research on the causes of HPD. Even though the causes for the disorder are not definitively known, it is thought that HPD may be caused by biological, developmental, cognitive, and social factors.
NEUROCHEMICAL/PHYSIOLOGICAL CAUSES. Studies show that patients with HPD have highly responsive noradrenergic systems, the mechanisms surrounding the release of a neurotransmitter called norepinephrine. Neurotransmitters are chemicals that communicate impulses from one nerve cell to another in the brain , and these impulses dictate behavior. The tendency towards an excessively emotional reaction to rejection, common among patients with HPD, may be attributed to a malfunction in a group of neurotransmitters called catecholamines. (Norepinephrine belongs to this group of neurotransmitters.)
DEVELOPMENTAL CAUSES. Psychoanalytic theory, developed by Freud, outlines a series of psychosexual stages of development through which each individual passes. These stages determine an individual's later psychological development as an adult. Early psychoanalysts proposed that the genital phase, Freud's fifth or last stage of psychosexual development, is a determinant of HPD. Later psychoanalysts considered the oral phase, Freud's first stage of psychosexual development, to be a more important determinant of HPD. Most psychoanalysts agree that a traumatic childhood contributes towards the development of HPD. Some theorists suggest that the more severe forms of HPD derive from disapproval in the early mother-child relationship.
Another component of Freud's theory is the defense mechanism. Defense mechanisms are sets of systematic, unconscious methods that people develop to cope with conflict and to reduce anxiety. According to Freud's theory, all people use defense mechanisms, but different people use different types of defense mechanisms. Individuals with HPD differ in the severity of the maladaptive defense mechanisms they use. Patients with more severe cases of HPD may utilize the defense mechanisms of repression, denial , and dissociation.
Repression. Repression is the most basic defense mechanism. When patients' thoughts produce anxiety or are unacceptable to them, they use repression to bar the unacceptable thoughts or impulses from consciousness.
Denial. Patients who use denial may say that a prior problem no longer exists, suggesting that their competence has increased; however, others may note that there is no change in the patients' behaviors.
Dissociation. When patients with HPD use the defense mechanism of dissociation, they may display two or more personalities. These two or more personalities exist in one individual without integration. Patients with less severe cases of HPD tend to employ displacement and rationalization as defenses.
Displacement occurs when a patient shifts an affect from one idea to another. For example, a man with HPD may feel angry at work because the boss did not consider him to be the center of attention. The patient may displace his anger onto his wife rather than become angry at his boss.
Rationalization occurs when individuals explain their behaviors so that they appear to be acceptable to others.
BIOSOCIAL LEARNING CAUSES. A biosocial model in psychology asserts that social and biological factors contribute to the development of personality. Biosocial learning models of HPD suggest that individuals may acquire HPD from inconsistent interpersonal reinforcement offered by parents. Proponents of biosocial learning models indicate that individuals with HPD have learned to get what they want from others by drawing attention to themselves.
SOCIOCULTURAL CAUSES. Studies of specific cultures with high rates of HPD suggest social and cultural causes of HPD. For example, some researchers would expect to find this disorder more often among cultures that tend to value uninhibited displays of emotion.
PERSONAL VARIABLES. Researchers have found some connections between the age of individuals with HPD and the behavior displayed by these individuals. The symptoms of HPD are long-lasting; however, histrionic character traits that are exhibited may change with age. For example, research suggests that seductiveness may be employed more often by a young adult than by an older one. To impress others, older adults with HPD may shift their strategy from sexual seductiveness to a paternal or maternal seductiveness. Some histrionic symptoms such as attention-seeking, however, may become more apparent as an individual with HPD ages.
Symptoms
DSM-IV-TR lists eight symptoms that form the diagnostic criteria for HPD:
Center of attention: Patients with HPD experience discomfort when they are not the center of attention.
Sexually seductive: Patients with HPD displays inappropriate sexually seductive or provocative behaviors towards others.
Shifting emotions: The expression of emotions of patients with HPD tends to be shallow and to shift rapidly.
Physical appearance: Individuals with HPD consistently employ physical appearance to gain attention for themselves.
Speech style: The speech style of patients with HPD lacks detail. Individuals with HPD tend to generalize, and when these individuals speak, they aim to please and impress.
Dramatic behaviors: Patients with HPD display self-dramatization and exaggerate their emotions.
Suggestibility: Other individuals or circumstances can easily influence patients with HPD.
Overestimation of intimacy: Patients with HPD overestimate the level of intimacy in a relationship.
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