Histrionic+Personality+Disorder

//by Rachel Schmieder-Gropen//

Formerly known as hysteria, Histrionic Personality Disorder (HPD) is one of the Cluster B (dramatic) personality disorders, which are characterized by emotional and behavioral volatility and theatricality, as well as distorted self-images. Individuals suffering from HPD are particularly dramatic, hence its name: histrionic, n, of or relating to actors.

Famous fictional characters with HPD include //Harry Potter//'s Bellatrix Lestrange and Scarlett O'Hara from //Gone With the Wind.// //………Bellatrix Lestrange………………………….Scarlett O'Hara………………...//


 * I. Inside the Brain of an HPD Patient:**



Individuals with HPD tend to have over-reactive noradrenergic systems, which dictate the release of the neurotransmitter norepinephrine, a member of the neurotransmitter group called catecholamines. Malfunctioning catecholamines may be the neurochemical cause of HPD patients' highly emotional reaction to rejection.


 * II. General Overview:**

//a) Prevalence in general population:// Depending on the source used, HPD has a prevalence of either 1.8% or 2-3% in the general population. Although women are more likely than men to be diagnosed with HPD, structured studies have showed that women and men are equally likely to suffer from HPD and that gender role stereotypes often influence clinicians' perceptions of behavioral issues.

//b) Prevalence in children and/or teenagers:// It is very rare for a child or adolescent to be diagnosed with HPD because personality disorders seek to describe long-lasting behavioral patterns, and an individual's personality is still developing throughout his or her childhood and adolescence. In fact, a diagnosis of HPD in an individual under eighteen years of age is regarded as tentative even if it is based on over a year of persistent symptoms. The vast majority of HPD patients are diagnosed as young adults.

//c) Symptoms:// The DSM-IV-TR //(Diagnostic and Statistical Manual of Mental Disorders)// lists the following eight symptoms as the formal diagnostic criteria for HPD:
 * 1) Preoccupation with being the center of attention
 * 2) Inappropriately seductive, exhibitionist, or flirtatious behaviors
 * 3) Shallow, volatile emotions
 * 4) Provocative dress and/or excessive attention to physical appearance
 * 5) Theatrical, opinionated speech that lacks details and factual support
 * 6) Exaggerated emotions and dramatic behaviors
 * 7) Gullibility and tendency to be easily influenced by situations or other people
 * 8) Overestimation of the level of intimacy in a relationship

To be valid diagnostic criteria for HPD, the patient must display at least five, and the above symptoms must cause significant distress to the patient; result in the impairment of his or her social and/or occupational functioning; and not be due to the effects of substance abuse or other medical conditions. Diagnoses are often made based on semi-structured interviews and can be inaccurate due to HPD's high co-morbidity rate with other personality disorders and conditions such as depression, anxiety disorders, body dysmorphic disorder, eating disorders, PTSD, and substance abuse. Some psychologists have identified six separate variations of HPD in combination with other personality disorders: Other symptoms of HPD include a constant need for others' approval, a low tolerance for boredom and delayed gratification, self-dramatization, risk-seeking behavior, self-centered behaviors, and threats of suicide or self-harm. Although HPD patients are generally charming and able to function well in social situations, their close relationships often suffer.

HPD patients tend to have relatively normal lives except in severe cases, which can cause significant daily problems in patients' personal and professional lives. Like other personality disorders, HPD is generally long-lasting, although symptoms tend to decrease with age.

//d) What life is like for HPD patients:// In general, HPD patients function well both at home and at work. However, in more severe cases, individuals with HPD often suffer from unstable relationships with others; risk-taking behaviors; separations and divorces; and disruptive work patterns such as absenteeism, frequent job changes, and low productivity. HPD patients are also at a higher risk for depression and anxiety due to failed relationships and interpersonal conflict.

HPD patients frequently frustrate and alienate friends because they constantly need to be the center of attention. Because they crave stimulation and excitement, individuals with HPD often engage in a cycle in which they discard long-term relationships, jobs, and projects in favor of new ones -- which are abandoned in turn as soon as the novelty wears off.

//e)Treatment:// Psychoanalytic therapy helps HPD patients with self-awareness of underlying conflicts and allows them to decrease their emotional reactivity. Therapists focus on thematic dream material -- a difficult exercise because HPD patients tend to repress material and often have difficulty recalling their dreams. Unfortunately, psychodynamic therapy is not always effective, largely because HPD generally requires at least one to three years of psychotherapeutic treatment, and individuals with HPD tend to have trouble sticking with therapy for an extended length of time. As a treatment method, cognitive-behavioral therapy (CBT) aims to redirect dysfunctional thought patterns to healthier, more positive ways of thinking. Specifically, CBT, which includes techniques such as modeling, response cost, and behavioral rehearsal, helps HPD patients to decrease impulsive and overly dramatic behaviors, to develop better problem-solving skills, to be more assertive in their interactions with others, and to challenge automatic thoughts about their own inferiority. Group therapy, which often focuses on group role play, can help HPD patients to decrease dramatic behaviors and, consequently, to improve their interpersonal relationships with coworkers, friends, and family members. There are no drugs that can be used to treat HPD, but drugs can help to reduce symptoms if HPD occurs along with mood (antidepressants) or anxiety [benzodiazepines, buspirone, Selective Serotonin Reuptake Inhibitors (SSRIs)] disorders. Meditation can help extroverted HPD patients to relax and to focus on their own feelings rather than on the outside environment. Therapists can also use hypnosis to help HPD patients to manage the physiological symptoms (fast heart rate or palpitations) associated with excessively dramatic or excitable behavior.
 * Psychodynamic therapy:
 * Cognitive-behavioral therapy:
 * Group therapy:
 * Medications:
 * Meditation:

Even if they do not seek treatment, individuals with HPD tend to display fewer and less severe symptoms as they age.

//f) Recent news story about HPD:// http://abcnews.go.com/blogs/health/2012/06/11/sandusky-defense-argues-he-has-histrionic-personality-disorder/ "Sandusky Defense Argues Letters Consistent With Personality Disorder," //ABC News,// 11 June 2012 Charged with 52 counts of sexual molestation, former Penn State football coach Jerry Sandusky pled insanity, hoping to excuse the "creepy love letters" he allegedly sent to his victims as evidence of HPD.

//Videos:// media type="custom" key="25884492" This video provides a general overview of the symptoms of HPD, as well as examples of individuals who display histrionic personality traits: Lady Gaga, Don Juan, Marilyn Monroe, and others.

media type="custom" key="25884576" Two college students taking an "Abnormal Psychology" course at the University of Central Oklahoma make the (somewhat debatable) case that Regina George from //Mean Girls// suffers from HPD.

http://www.mayoclinic.org/diseases-conditions/personality-disorders/basics/symptoms/con-20030111 http://www.webmd.com/mental-health/histrionic-personality-disorder http://www.health.am/psy/histrionic-personality-disorder/ http://www.minddisorders.com/Flu-Inv/Histrionic-personality-disorder.html http://psychcentral.com/disorders/histrionic-personality-disorder-symptoms/ http://www.patient.co.uk/doctor/personality-disorders-and-psychopathy
 * Sources:**