Tuesday, July 16, 2013

Histrionic Personality Disorder

Remember when your parents would tell you that some kid was acting up just because they wanted attention? Well, it is possible that they could have been right. There is a relatively rare personality disorder in which the primary motivation for all behaviors, positive and negative, is to gain the attention of others.

Personality disorder: disorder in which a person adopts a persistent, rigid, and maladaptive pattern of behavior that interferes with normal social interactions. There are 10 listed personality disorders in the DSM-IV-TR, 7 of which made the list in the DSM-V. In the DSM-IV-TR, the personality disorders are broken down into three basic categories, or clusters. Cluster A is the odd or eccentric types, usually seen as "weird" by others. This includes the paranoid, schizoid, and schizotypal personality disorders. Cluster B includes the dramatic or erratic types, typically individuals who tend to over (or under) react to things. Within this category are the antisocial, borderline, histrionic, and narcissistic personality disorders. Cluster C is known as the anxious or fearful category. Individuals fall into this grouping when their main emotional response seems to be an over abundance of caution, fear, and/or anxiety. Found in this group are the avoidant, dependent, and obsessive-compulsive (not to be confused with obsessive-compulsive disorder, an anxiety disorder) personality disorders.

Histrionic Personality Disorder: characterized by a tendency to overreact and use excessive emotions to draw attention from and manipulate others. This individual thoroughly enjoys being the center of attention. However, unlike the narcissistic personality disorder, histrionic individuals do not care if the attention is positive or negative, so long as they are in the midst of it. Individuals with this type of personality disorder have a tendency to "make a mountain out of a mole-hill" and are sometimes referred to by others as "drama queens/kings." Attitudes may change rapidly, along with moods, and great pleasure is derived from shocking others with their behaviors, appearances, and/or opinions. It is not uncommon for someone with a histrionic personality disorder to dress completely inappropriately for the social situation (e.g. a young woman wearing a low-cut, provocative dress that shows off as much as legally possible to a funeral) or to attempt to pick a fight (verbal or physical) with someone if they are not already the center of attention. When one situation is "milked" for all it can be--friends get tired of praising them for their promotion or congratulating them on their new boyfriend/girlfriend--these individuals may manufacture another situation in order to regain the center of attention. They might quit their job, complain about some real or imagined hardship, use another person's dilemma to their own advantage (e.g. "feel sorry for me because my cousin's dog was run over"), force a break-up with their significant other in order to generate sympathy, get a piercing or tattoo in order to elicit comments from others, or make shocking statements to see how others respond. Fishing for compliments is also a common behavior for these individuals.

The root cause of histrionic personality disorder is not fully understood. Some theorists suggest that a mismatch between the child's character and the parenting style with which they were raised could be the culprit. Some suggest that there is a genetic link, as this type of maladaptive behavior sometimes runs in families. Others theorize that the children picked up the behaviors from their parents or others who may have had the same disorder. Still others suggest that the children did not receive the right amount of attention that they needed, and thus lash out for any kind they can get as adults.

As with other personality disorders, it is not always easy to identify behaviors as disordered, unless you have more exposure to the individual and detect significant patterns. It is also highly unlikely that the individual will see anything wrong or maladaptive with their behavior, assuming the rest of the world needs to change, not themselves. This is what makes treating personality disorders so difficult. A key component to the success of all psychotherapy is the desire on the part of the client/patient to want to change.