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301.50 Histrionic Personality Disorder

According to the DSM-IV-TR criteria, the key feature of Histrionic Personality

Disorder (HPD) is pervasive and excessive emotionality combined with attention-seeking

behavior. There is a prevalent need for those presenting the criteria to do something

dramatic, be the life of the party, and to draw attention to themselves by any means

necessary. These individuals can be overly trusting and easily influenced by trends, fads,

and those they perceive as authority figures. The individuals presenting these criteria are

very influenced by sex role stereotypes and will often present a physical appearance that

will draw attention to them accordingly (American Psychological Association, 2005). Those

presenting the behaviors associated with HPD often have marked dependency in

relationships and perceive relationships as being more intimate than they are in reality.

Often most romantic and intimate relationships are superficial (Harper, 2004).

The individual who meets HPD criteria may present a flirtatious and a provocative

interpersonal style. These behaviors are known to cause riffs in friendships and

relationships for those individuals. The one key feature that separates the Narcissistic

diagnoses from the Histrionic diagnoses is that individuals who are diagnosed with

Narcissistic Personality Disorder (NPD) require admiration for their superiority and refuse

to appear weak or victimized. An individual with HPD finds no setback in “playing the

victim” to gain attention whenever they deem it necessary (American Psychological

Association, 2005). Those who meet the criteria for HPD and NPD are often drawn to the

entertainment industry and fields that allow them to garner attention professionally. This

tendency to gravitate to the entertainment industry and like fields creates a micro-culture

that “normalizes” these conditions and the resulting behaviors (Sansone & Sansone, 2011).

Treatment Approach

Cognitive forms of therapy appear to offer the most promise in successful treatment

of HPD. Looking to Kellett (2007), the form of treatment that is suggested is Cognitive

Analytic Therapy (CAT). CAT is a therapy with many qualities similar to Cognitive

Behavioral Therapy (CBT), but is the treatment is time-limited. Those participating in

Kellett’s study participated in 24 sessions of CAT, and 4 follow-up sessions spread over 6-

months post therapy. Kellett found some success with this form of therapy, but found

regression to be a major issue at the point of therapeutic termination (Kellett, 2007).

Butcher, Mineka, and Hooley (2012) support the use of Cognitive types of therapy

with those who exhibit HPD criteria by emphasizing the importance of addressing core

dysfunctional beliefs and maladaptive schemas. Harper (2004) recognizes that Substance

Abuse and Depression are common comorbid disorders and strongly emphasizes the

importance of intensive and consistent CBT with those presenting HPD behaviors. He lists

Unreflective, Poorly Organized Thinking and Flighty Impulse Behaviors as potential

impairments to successful therapy for those presenting additional disorders, but suggests

that the attention seeking behavior of the disorder can assist in client retention (Harper,

2004).

Rasmussen (2005) offers Personality-Guided Cognitive-Behavioral

Conceptualization (PGCBC) as the most effective treatment option. He emphasizes client

independence from external confirmation and validation as the main goal of the

therapeutic relationship. Specific recommendations Rasmussen makes when treating a

client presenting HPD criteria are to validate the individual’s desire for rewarding

interpersonal relationships, to control the fickleness of the client, to help the client

maintain therapeutic focus, and to work with these clients in a non-confrontational way.

Rasmussen also points to increasing the client’s tolerance for not being the center of

attention as the first concern that should be addressed in therapy (Rasmussen, 2005).

How Diagnosis Informs Treatment Planning

As with many personality disorders, treatments that are personality guided will

offer the greatest chance of success. Each personality disorder presents specific challenges

and issues that make one treatment method preferential to others. Learning about the

specifics of a condition informs treatment planning by offering insight as to the course that

the therapeutic relationship should take.

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References

American Psychological Association (2005). Diagnostic and statistical manual of mental

disorders fourth edition text revision. (IV ed., Vol. TR). Daryaganj, New Delhi: Jaypee

Brothers Medical Publishers (P) LTD.

Brimstone, R., Thistlethwaite, J., & Quirk, F. (2007). Behaviour of medical students in

seeking mental and physical health care: exploration and comparison with psychology

students. Medical Education, 41(1), 74-83.

Butcher, J. N., Mineka, S., & Hooley, J. M. (2012).Abnormal psychology. (14 ed.). Boston:

Pearson Education, Inc.

Harper, R. G. (2004). Histrionic personality. In , Personality-guided therapy in behavioral

medicine (pp. 111-131). Washington, DC US: American Psychological Association.

doi:10.1037/10650-005

Kellett, S. (2007). A time series evaluation of the treatment of histrionic personality

disorder with cognitive analytic therapy. Psychology And Psychotherapy: Theory, Research

And Practice, 80(3), 389-405. doi:10.1348/147608306X161421

Rasmussen, P. R. (2005). The Histrionic Prototype. In , Personality-guided cognitive-

behavioral therapy (pp. 147-166). Washington, DC US: American Psychological

Association. doi:10.1037/11159-008

Sansone, L. A., & Sansone, R. A. (2011). Personality disorders: A nation-based perspective

on prevalence. Innovations in Clinical Neuroscience, 8(4), 13-18. pmcid: pmc3105841