Histrionic personality disorder is a mental condition that is characterized by dramatic and attention-seeking behavior. This disorder is often confused with histrionic character, which is a less severe form of the disorder.
With histrionic personalities, individuals tend to be high-anxiety, high-intensity, and highly reactive – especially when it comes to interpersonal relationships. These people may be attracted to personal drama and danger and pass through situations of crisis frequently. Because of the stress and the challenges they face, their own emotionality may seem unimportant and superficial to others. Additionally, their feelings may shift rapidly.
We are not sure what the main feelings of histrionic people are, but some have suggested that they are intense, hypersensitive, and crave attention and erotic closeness. Freud suggested that people who become histrionic often have powerful appetites. Blatt and Levy have reviewed extensive empirical data attesting to their tilt in the anaclitic direction. This means they tend to seek stimulation but can get overwhelmed by too much of it. They may have trouble processing distressing experiences and be more dependent on right-hemisphere brain functioning.
Freudian analysts and other analysts have suggested that histrionic personality traits may be caused by a fixation on oral and oedipal issues.
For example, a sensitive girl who needs responsive maternal care in infancy may become disappointed with her mother and forcefully turn her intense love towards her father instead. This can cause problems when she tries to resolve the oedipal conflict by taking her mother as a role model, thus competing with her same-sex parent. As a result of the fixation, the girl may change her outlook and see males as strong and exciting and females as weak and insignificant. The girl may try to bolster her degree of adequacy and self-esteem by attaching herself to men. At the same time, the girl may also subconsciously punish males for their supposed superiority.
Mechanisms of the Histrionic Personality
People with histrionic personalities often repress their emotions, sexually act out, and regress to earlier stages of development. They may act in ways that are counter to their fears or phobias, and they often dissociate from their emotions.
The main mechanism of the histrionic condition is repression, so the key to a successful therapy appears to be releasing the repressed material. However, some of the “memories” that are recovered by histrionic patients may actually be fantasies. The symptom of glove paralysis influenced Freud’s idea that histrionic ailments achieve a primary gain in resolving a conflict between a wish and a prohibition. People with histrionic personalities often do not feel pleasure during sexual activity because they tend to repress any erotic desires or conflicts that make them anxious. They may also behave in a seductive manner without realizing it and may regress to a childish state when they feel insecure or challenged. “Acting out” behavior is often counterphobic, which means they set themselves up to suffer what they are unconsciously scared of.
Many histrionic people have a history of dissociative behaviors and are easily overwhelmed. They might use dissociative mechanisms to trim down the quantity of affectively charged details that they should deal with as a response, thereby shielding themselves and their sensitive natures from stress.
Dissociation presents in a number of ways, including feigned indifference, detachment from the seriousness of symptoms or situation; pseudo-recognition, the belief of having recalled something that did not happen; fantasies and daydreaming; describing fantastic events as fact, and amnesia, particularly concerning aspects of traumatic events; body memory; the memory of a trauma imprinted on the body; and dissociated behaviors, such as binge eating, histrionic displays of self-pity, etc.
Origin, Gender, and the Histrionic Personality
Someone who is heterosexual and grew up in a place where they were denied opportunities because of their gender can be said to have a background that is conducive to the development of histrionic traits. This can often lead to the person feeling rejected because of their gender.
Fathers of women with histrionic personality disorder may be seductive and intimidating figures. Their daughters may learn to view people of their own gender as less valuable and approach people of their father’s gender with caution. A sense that one’s sexual identity is problematic is often a source of histrionic personality structure. Some people who are raised with simplistic gender stereotypes go through cycles of overvaluing and devaluing people of the other gender, where power is sexualized, but sexual satisfaction is absent or fleeting.
People with histrionic personality disorder feel deep insecurity and fear, which causes them to try to control those around them. Although they may come across as shrewd, this is actually just a defense mechanism to try and stabilize their own self-esteem and create a sense of safety in a seemingly scary world. Their manipulations are not motivated by a desire to hurt or gain benefit over others but rather by a need for approval and protection.
Histrionics may also try to care for an internal representation of themselves as the unloved son or daughter by helping children who are at risk, or they may change or heal present-day replacements for a terrifying object from their infancy. For example, kind, loving females may fall in love with ravenous, damaging males in the expectation of “fixing” them and thereby fixing themselves.
Although histrionic people tend to be as self-satisfied and alluring as narcissistic people, they are not so cold and indifferent as narcissists.
While narcissistic people seek attention to fill up a void and are indifferent to the interests of others, histrionic people seek attention to avoid being exploited and rejected but are not indifferent to others. If histrionic people are not scared, they are naturally sympathetic and considerate.
Histrionic individuals who experience emotional depth below the surface, but are scared to really be themselves, often try to exaggerate their emotions, trying to convince themselves and others of the need to express themselves. They do this because they feel worried about communicating with someone they see as powerful.
In the course of therapy, people with histrionic personality disorder eventually feel understood and depend more on plain descriptions of emotions if they are respected by the therapist.
Transference in the Histrionic Personality
Something that is very commonly observed in clients who suffer from histrionic problems is transference. Transference is when the client projects their feelings for past relationships onto the therapist. These clients with histrionic dynamics may be excited, intimidated, and defensively seductive with male therapists. With female therapists, they are often subtly hostile and competitive.
Even high-functioning histrionic clients, however, can have transferences of such intensity that they feel almost psychotic. The transferences of male histrionic patients, which are used to describe the relationship with their therapist, will vary depending on whether the father or mother figure has more control in their minds. The majority of people with histrionic personality disorder are willing to collaborate and gratefully respond to treatment, but those with borderline elements or those with very severe disorders, are reluctant to accept help because their behavior is so destructive, and they are so distrustful of the treatment relationship.
The transference of a person with histrionic dynamics becomes painfully intense before he or she has sufficient faith in the therapist to tolerate that intensity. In these cases, particularly when the transference is somewhat unfamiliar, a change of therapists to someone who seems less like the original challenging or deflated object may be beneficial.
Countertransference is a term describing the feelings that the therapist may go through as a result of treating the client. In the case of the histrionic personality, countertransference may be more problematic in male therapist and female client relationships, especially if the therapist’s personality is a little narcissistic.
This is because it will be difficult to attend respectfully to the histrionic clients’ emotions; even for professionals, it may be hard to treat the histrionic person with the dignity that they deserve. In the eyes of many, histrionic patients may look ridiculous.
However, most histrionically organized people are very sensitive to interpersonal behavior, which means an attitude of suppressive amusement may bring damage.
The behavioral pattern of a histrionic person is largely influenced by unpleasant past experiences. Therefore, they can be transformed if they face some opposition in their attempt to use people. They will find faith in others when they realize that those they depend on really do care for them. This will help them to believe that others have good intentions.
Psychotherapy for the Histrionic Personality
Psychotherapy helps individuals understand how their past experiences may affect their current choices and perceptions. It encourages them to adopt different ways of thinking and behaving in order to attain better functioning in all areas of life.
Normal behavior is often a result of learned social customs and expectations. Sometimes, the observable behavior of an individual may be due to an underlying mental disorder. Mental disorders are medical conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others, and daily functioning. Just as cancer or heart disease can be treated with medication and/or surgery, most mental disorders can be treated as well.
How Histrionic Personality Disorder is Diagnosed
Those with undiagnosed physiological conditions may be misdiagnosed with a histrionic personality disorder.
When it comes to histrionic and psychopathic personality types, there are similarities and differences. For instance, histrionic people are often more scared and conflicted than psychopathic people, who tend to be more ravenous and less responsive to fear. Therefore, it is necessary for therapists to be aware of these differences when working with clients in order to form a good therapeutic relationship and achieve successful treatment.
What we see as the main difference between histrionic and narcissistic personality disorder is that histrionic individuals are thoughtful and empathetic, whereas narcissistic individuals only care about their own selves. Histrionic individuals also tend to see others as either all good or all bad, while narcissistic individuals simply see others as better or worse. The traditional way to treat histrionic individuals is through analytic therapy, while narcissistic individuals may require special therapeutic efforts.
Psychopathic people cannot specify the main characteristics of their feeling because of their inability to articulate emotion. Rather than speaking their emotions, they act them out. They might be experiencing some basic arousal in the absence of their feeling for specific affect. When they feel something, what they experience may be either blind rage or frantic trepidation. The treatment of psychopathic individuals is quite different from other therapies, primarily because the clinician could not expect to make an alliance by reflecting the client’s presumed feelings.
The word “hysterical” is most of the time put into describing physical symptoms that are said to be of psychological origin. In therapy, it is of great significance to ponder the possibility that these symptoms, as reported by histrionics, really do have a physical origin.
For instance, some systemic illnesses, such as multiple sclerosis, are more frequently assumed to be of histrionic origin. In addition, there are some “female complaints” that often frustrate physicians that may also really be caused by physical conditions. It is crucial to thoroughly investigate the possibility of an organic problem in histrionic (dramatic, emotional, erratic) people in order to send a therapeutic message to a timid being whose basic dignity has not always been respected that now there is someone taking them seriously.