Histrionic and Narcissistic Personality Disorders

Abstract

In keeping with the drama inherent in this personality disorder, Histrionic Personality Disorder, itself, has had a dramatic history. The use of the term “histrionic” is relatively recent. Originally, the term used to describe this disorder was “Hysterical Personality.” The use of the term “hysteria” has varied widely over its 4000-year history and has often been a source of controversy (Vieth, 1977). Hysteria has at times been used to refer to conversion disorder, Briquet’s Syndrome, a personality disorder, and a personality trait. Perhaps most commonly, it has been used pejoratively to describe hyperexcitable female clients who are difficult to treat. The concept of hysteria has been strongly rejected by feminists who view it as a sexist label due to the denigrating use of the term “hysterical” to discount the problems presented by the female client. Perhaps as an attempt to reduce the confusion regarding the use of the term “hysteria,” the American Psychiatric Association did not include it in either DSM-III-R (1987) or DSM-IV-TR (2000). Instead, separate categories of Somatization Disorder, Conversion Disorder, Hypochondriasis, Dissociative Disorders, and Histrionic Personality Disorder have been designated. This chapter will focus on the treatment of people who fit the DSM-IV-TR criteria for Histrionic Personality Disorder (Table 9.1). Table 9.1. DSM-IV-TR Diagnostic Criteria for Histrionic Personality Disorder A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following : (1) is uncomfortable in situations in which he or she is not the center of attention (2) interaction with others is often characterized by inappropriate sexually seductive or provocative behavior (3) displays rapidly shifting and shallow expre ssion of emotions (4) consistently uses physical appearance to draw attention to sel (5) has a style of speech that is excessively impressionistic and lacking in detail (6) shows self-dramatization, theatricality, and exaggerated expression of em (7) is suggestible, i.e., easily influenced by others or circumstances (8) considers relationships to be more intimate than they actually are