Hilde is a 42-year-old woman diagnosed with Histrionic Personality Disorder (HPD),
engaged in therapy as a referral from her family physician for untreatable
psychosomatic pain. Initially she
rambled about the good old days of the past, frequently changing topics but
could not pinpoint any single issue that could give cause for her existing
distress. When pressed about her current
situation, she became irritated and would pass blame to anyone other than
herself indicating excessive life stresses were the reasons for her headaches
and depression. An unfaithful husband
perhaps, or a lack of intimacy, but no details were provided. Hilde’s husband, Steve, indicates that Hilde
was once very attractive and always has been extremely social. Initially their relationship was intense but
quickly waned after the lavish wedding and honeymoon celebration was over but recently
he has grown tired of her misplaced chronic flamboyance and childish,
superficial manner. In addition Steve
indicates that their children show patterns of the same spoiled, superficial,
and manipulative behavior patterns that Hilde portrays. Although Hilde indicates that her children
are “wonderful” (Meyer, Chapman, & Weaver, 2009, p. 204).
After briefly reviewing Hilde’s situation it becomes
necessary to explain the biological, emotional, cognitive, and behavioral components
that play into the pervasive patterns of excessive emotionality and
attention-seeking, which began in early adulthood and have presented in a
variety of contexts throughout her life that brings the therapist to a
diagnosis of histrionic personality disorder.
Biological Components
of HPD
Although the exact biological cause of histrionic
personality disorder is unknown, personality disorders have been found to be
highly genetic, especially those personality disorder’s within the DSM-IV-TR cluster
B category. Known as the dramatic,
emotional, or erratic personality disorders they are thought to be linked to
problematic functioning of the prefrontal cortical area, which controls temperament
(Kendler, Aggen, Czajkowski, Roysamb, Tambs, Torgersen, Neale, &
Reichborn-Kjennerud, 2008). In addition it
is noted, based on the principles of multiple causality that children of
mothers with histrionic personality disorder are likely to suffer from the
disorder too, as is most likely in Hilde’s case. According to her history her parents were
never able to manifest openly their own personal vulnerabilities but rather
oriented around social activities that involved little self-disclosure, and the
same behaviors (e.g., spoiled behaviors) are perpetuating in her own children
according to her husband, Steve (Hansell & Damour, 2008; Meyer, Chapman,
& Weaver, 2009). As for biological
corrections assertiveness training rather than manipulation is suggested and,
according to Meyer, Chapman, and Weaver (2009), developing an analytic and
problem-solving thought pattern is extremely helpful in correcting maladaptive
traits and increasing attention to detail.
Emotional Components
of HPD
Hilde was raised as a prized possession of her parents,
encouraged and rewarded to display her beauty rather than develop her intellect;
she learned superficially to use her looks as a way to draw attention to
herself and deflect punishment but lacked the ability to express any meaningful
self-expression. In high school and
college people seemed to be drawn to her flair and social grace; however, she
never developed any meaningful connection with anyone. Even her whirlwind romance with Steve was
more of a social affair wrapped around the wedding than a meaningful
relationship with true intimacy.
Although her marriage lacks any depth (or sexual intimacy for that
matter), Hilde believes that her beauty is fading and has caused her husband’s
adulterous wanderings. Repression is a
key defense mechanism for Hilde in dealing with the emotional conflict in her
life, causing her psychosomatic disorders in the form of headaches and depression,
which sent her to the doctor in the first place. Avoiding any special treatments or rewards
for presentation behaviors, it would be appropriate to reward only Hilde’s
attentions directed toward reflective thought designed toward genuine change.
Cognitive-Behavioral
Components of HPD
“Dramatic and overly emotional behavior[s]” are thought to
be caused by distorted thoughts based “on vague impressions instead of
precision, reason, and concrete facts” (Hansell & Damour, 2008, p. 431). In Hilde’s case, as stated by Meyer, Chapman,
and Weaver (2009), her “cute and charming manner” could not compensate for her
inability to provide reflective depth to the issues of her situation causing
her to become “petulant and irritated” toward her therapist (p. 203). Such distorted thinking and behavioral
patterns were passed on to Hilde from her parents. Led to believe that life should always be
pleasant and charming, thus when asked about her own children she adamantly
insists that they are fine rather than stating factually that they too have
difficulties; such as keeping up with schoolwork. For this reason treatment options need to
challenge such superficial beliefs. Furthermore,
because Hilde’s focus was typically based on superficial and subjective
measures, such as her own outer beauty, she found it easy to manipulate people
with her sexuality but never able to form meaningful, long-term relationships. Normally these behaviors are formed during
adolescents and young adulthood and would prepare someone for the mutual
intimacy and pleasures that marriage offers, rather Hilde only saw the lack of
indulgence she once received from her parents.
Conclusion
Histrionic Personality Disorder is listed in the DSM-IV-TR as
a cluster B, dramatic, emotional, or erratic personality disorder. As seen by the case study of Hilde,
individuals with histrionic personality disorder are typically overly
flirtatious, showy, and dramatic but lack the depth and insight that it takes
to effectively deal with meaningful relationships. Temperament traits that pass from parent to
child are a key biological factor for personality disorders. In addition, histrionic personality disorder’s
like Hilde’s thrive in varied social environments in which she (or he) can be
the center of attention; however, repression of true emotions is likely to
cause psychosomatic pain but keeps one from suffering any real emotional pain
from existing conflicts. Inappropriate
learned behaviors produce the inability to think beyond the superficial, thus producing
dramatic, emotional, and shallow personality traits. However, when attentions wane from an
individual with histrionic personality disorder he or she may repress the
painful emotions with elaborate behavioral displays as a way to manipulate and
show dependence. Treatment of histrionic
personality disorders is achieved by gaining trust, redirecting maladaptive thought
patterns, and teaching productive, and reflective behaviors. Regardless of how the media portray
femininity in the movies histrionic personalities are not appealing nor are
they captivating in real life.
Could you guide me to the original journal please?
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