Sufferers of histrionic personality disorder, or HPS for short, exhibit marked theatrical and egocentric behavior. Treatment can only occur when sufferers show insight and seek help for themselves, and consists of many years of psychotherapy.
What is histrionic personality disorder?
Like all personality disorders, HPS manifests in a pattern of perception and behavior described as abnormal. This affects the entire personality in its thinking, feeling and relationship behavior and has a negative impact on the entire professional and everyday life of the affected person. Affected persons with histrionic personality disorder show emotionality that is perceived as exaggerated by others and tend to dramatize their experiences. However, these displayed feelings appear superficial and contrived to others, because sufferers cannot and do not want to allow deep, genuine feelings and have no real sense of identity. Affected persons are therefore easily influenced and change their minds very quickly. Another symptom is the constant search for attention and new experiences. Histrionics are sensitive to not being the center of attention and try by all means to attract attention to themselves. People who suffer from HPS show erratic and fast-moving relationship behavior. Their social contacts rarely go deep and are based on sexual attraction, making same-sex friendships especially difficult.
Causes
The causes of histrionic personality disorder have not been sufficiently researched to date to provide detailed information on this subject. The cause, as with all personality disorders, seems to lie in childhood. If children were unable to develop an identity of their own, if they were given a false sense of love and attention, or if they lacked stable, supportive relationships and sufficient attention from the outside world for feelings, a personality disorder develops. Psychological research also suspects a genetic predisposition in those affected. The causes of the personality disorder apparently lie in traumas of early childhood or even pregnancy. However, how it is decided which type of personality disorder the affected person develops is not clear.
Symptoms, complaints, and signs
Signs of histrionic personality disorder rarely arise from observation or a singular character trait alone. Symptomatic of histrionic personality disorder, however, is that a person often displays an unnatural urge for self-expression when viewed as a whole. In this context, the emotions, which usually appear very exaggerated to third parties, usually revolve around finding recognition, being praised and gaining attention for the personal life situation. A special theatricality of the feelings, which lasts, is typical for this form of the personality disorder. Common to many of those affected is that they initially seem quite interesting, funny and entertaining to their fellow human beings. However, the urge to always want to be the center of attention in social situations and to live out one’s own feelings in a very exaggerated way often leads to increasing social isolation of those affected. In most cases, people suffering from this disorder do not perceive their own appearance as conspicuous compared to that of their fellow human beings. As with many mental illnesses, there is a lack of insight into the illness at the beginning of the diagnosis. Affected people notice that they cannot maintain social contacts for long, they experience themselves as socially excluded, but often do not attribute this to their own external appearance.
Diagnosis and course
The diagnosis is made in the diagnostic department of a psychiatric or psychotherapeutic clinic. First, the presence of a personality disorder must be demonstrated using standardized testing methods. Subsequently, the exact personality disorder must be diagnosed using the criteria of the Diagnostic and Statistical Manual of Mental Disorders, DSM-IV. Differential diagnoses must be considered and clearly excluded.If at least five of the following symptoms are present, histrionic personality disorder has been demonstrated:
1. feeling of discomfort when the person is not the center of attention
2. the patient tries to attract attention with his physical appearance
3. interpersonal contacts of the affected person are characterized by an exaggerated sexually-attractive behavior
4. the emotional state of the affected person changes rapidly and appears superficial
5. is theatrical and exaggerated and the affected person tends to self-dramatization
6. descriptions of the affected person are not very detailed
7. the patient is easily influenced
8. the relationship is disturbed, relationships are perceived as closer than they are. The histrionic disorder is created in childhood and first appears as such in early adult life. The extent to which those affected can be enabled to lead a life that is considered normal depends on the severity of the disorder and timely therapeutic intervention. In principle, however, personality disorders are not considered to be completely curable.
Complications
Because histrionic personality disorder is characterized by egocentrism, a constant search for attention, histrionic behavior, exaggerated emotionality, strong emotional swings, and manipulative behavior combined with a low tolerance for frustration and a lack of empathy for the needs of others, it results in a number of complications in interpersonal interactions. Affected individuals find it difficult to form stable, healthy relationships. The environment usually reacts alienatingly to their behavior. This is especially true when trivial events (which they are not for the patients) are blown out of proportion. Also, the constant search for attention and the need to be the center of attention often makes fellow people keep their distance. This is also the case when the manipulative techniques that histrionics use to try to assert their needs are recognized and rejected. These early learned strategies, which are inherent to histrionic personalities, lead to interpersonal conflicts again and again. However, even if histrionics receive adequate treatment, the deeply anchored behavioral patterns are difficult to correct because they were usually learned in childhood. In dealing with such patients, consistent behavioral therapy is indicated, whereby clear rules and limits must be formulated. In addition, histrionic characters have an increased tendency to depression and anxiety disorders, so that there is often a comorbidity. Depression and anxiety can be treated with medication. Overall, however, this results in a very complex treatment need.
When should you see a doctor?
Conspicuous behavior that is described by fellow people as deviating from the norm should always be examined by a doctor. If people in the immediate environment perceive a change in the usual demeanor, it is advisable to seek medical advice. In the case of histrionic personality disorder, it is part of the clinical picture that there is no insight into the illness on the part of the person affected. Therefore, the affected persons are dependent on the support and judgment of relatives or persons of the social environment. They have an increased responsibility to contact a doctor and ask for help. It is advisable to gain the trust of the affected person in order to be able to initiate a visit to the doctor together with him or her. A doctor should be consulted as soon as a person’s behavior is very emotionally hurtful or rules that have been set up are not observed in everyday life. If the person behaves inconsiderately, violates the privacy of others or is irreverent, it makes sense to investigate the cause. If the behavior can no longer be tolerated by several people in the social environment despite all attempts, a visit to the doctor is advisable. In particularly difficult situations, a compulsory hospitalization can take place. For this, a public health officer must be called, who will give an assessment of the situation.
Treatment and therapy
Histrionic personality disorder requires protracted treatment, which is strenuous for the patient, relatives, and also the psychotherapist. Therapy is only possible when the affected person himself sees a need for action and therapy, since his cooperation is an important prerequisite for the success of therapy.Compared to other personality disorders, HPS sufferers seem to seek help more quickly and bring greater insight. Behavioral therapy offers the best prospects. Causal research can be done and be helpful, but it is more important to show the affected person new behavioral possibilities and to practice them. Psychotropic drugs can be used to accompany therapy if sufferers are depressed, but are not helpful in pure HPS.
Outlook and prognosis
Therapy for histrionic personality disorder is difficult and lengthy. Sufferers lack any insight into the nature of their disorder. Therefore, the prognosis is generally not very good. Setbacks and treatment dropouts are to be expected with histrionic personality disorder. The problem lies in the lack of recognition and acceptance of this diagnosis by those affected. Most people with histrionic personality disorder think they are physically ill or have some other mental illness. Even when it has been proven by careful differential diagnosis that this is not so, they persist in their assumption. The patient therefore often refuses therapy. Often there are suicidal tendencies due to the dramatic personality structure. The intransigent patient wants to achieve by all means that the therapy is broken off or suspended. The prognosis is improved only if the affected person is willing to acknowledge the reality of his disorder of histrionic personality disorder. To date, histrionic personality disorder is not treatable without long-term therapy. There are currently no medications for such disorders. In this respect, the prospect of improvement is poor for a large proportion of those affected. Only long-term cognitive behavioral therapy can achieve any success at all. However, the behavioral abnormalities and irrational actions will persist if the patient is not confronted with alternative courses of action.
Prevention
Histrionic personality disorder can only be prevented by parents in early childhood by raising their offspring to be strong personalities. Affected individuals themselves have no means of prevention.
Aftercare
After inpatient or partial hospitalization therapy has been completed, outpatient care should be provided for further treatment of histrionic personality disorder. This aftercare often focuses on the patient’s rehabilitation and reintegration into the professional and private environment. From a behavioral therapy perspective, treatment of people with personality disorders takes several years. The coping methods learned in therapy must be stabilized, which can only be ensured through continuous care. During this time, the patient has the opportunity to try out new ways of behaving and experiencing, which can be consolidated in further outpatient therapy. Therefore, important measures in the aftercare represent the cooperation with a psychotherapist or the community in a group therapy. In cases of particular severity and persistent problems, renewed psychotherapeutic treatment – in the sense of interval treatment – may be necessary after a few years. By means of questionnaires, interviews or expert reports, the success of treatment can be evaluated in the various stages of rehabilitation and after treatment has been completed. Once the symptoms have subsided and the patient has been successfully reintegrated, he or she is considered rehabilitated. However, the patient should continue to be given the option to seek psychotherapeutic help or be provided with permanent contacts.
What you can do yourself
Due to the ego-synthesis of the disorder, sufferers with Histrionic Personality Disorder rarely seek treatment for the disorder as such. They are more likely to seek medical attention for secondary psychological disorders such as anxiety disorders or depression. To date, no medication has been developed to treat this disorder. However, those affected can certainly be helped within the framework of psychotherapies. Cognitive behavioral therapy, in which the psychotherapist works with the patient to break down dysfunctional thought structures, is considered particularly promising.It is important that the personality traits behind the disorder are not abandoned. As with any personality disorder, they are part of one’s own character. In the course of therapy, however, the affected person learns to reduce the manifestations of his personal characteristics to a reasonable level, so that a histrionic personality disorder can become a histrionic personality style. If the affected person manages to find his way back to (genuine) recognition and happiness, then the conditions that justify intervention, namely suffering pressure and impairment, are reduced. In this process, the relatives can help the affected person with empathy and a lot of patience. For this, they need education about the clinical picture so that they can correctly interpret the behavior of the affected person.