Transcription
Hi, I'm Dr. Tracey Marks, a psychiatrist. And I make mental health education videos. Today I'm talking about histrionic personality disorder, what it is and what we do about it. This is based on a viewer question.
Histrionic personality falls into the cluster B grouping of personality disorders. I explain the different groupings of personality disorders and what even constitutes a personality disorder, in this video. Cluster B refers to the group of personality disorders that share the characteristics of being dramatic, emotional, or erratic. And the personalities that fit into this group are antisocial, borderline, histrionic, and narcissistic. I mention this because typically people don't fit neatly into one personality disorder; it's more common for someone to have a mixture of traits from the different disorders, particularly the ones that are within the same cluster.
Keep in mind, personality disorders start in the late teen years to early adulthood. It's not something that shows up for the first time at 30; also, you can have some of these personality traits without having the full disorder. Personality disorders cause problems that manifest mostly through relationships. But it can also cause internal distress and unhappiness, and I'll show you what I mean by that.
So let's look at what histrionic personality disorder looks like; the criteria is based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Histrionic disorder is a pattern of excessive emotionality and attention seeking, beginning in early adulthood and present in a variety of contexts, as indicated by five or more of the following.
Number one, is uncomfortable in situations in which he or she is not the center of attention. This is more than just wanting or wishing that people would pay attention to you for a change. This is a deep-seeded discomfort that makes you act in certain ways to become the center of attention. For example, you can do this in a superficial way by dressing dramatically or making up stories that are exaggerated to get people listening to you, and captivated by you. Showering people with compliments when you talk to them, is another way you can pull in their attention. These are not schemes that the person cooks up and then implements just at the right time; it's done on an unconscious level. Yes, it's common sense that if you compliment people or tell interesting stories you'll get them to listen to you. But it's not this deliberate plan to divert attention from everyone else and put it on you; it's just this natural pattern of behavior that you learn over time, that doing these things gives you warm fuzzies because people are listening to you and want to be around you.
Number two, your interactions are often sexually seductive or provocative. What does this look like? This is not being seductive or provocative with someone you wanna hook up with, even if you wanna hook up with a lot of people. This is being provocative in multiple settings, including professional settings where that kind of behavior is beyond what's socially acceptable.
Number three, displays rapidly shifting or shallow expression of emotions.
Number four, consistently uses physical appearance to draw attention to yourself. You may make dramatic changes to your hair frequently or wear flashy clothes, not because you happen to like a certain designer who has a lot of flair, but because you know that you want people to look at you when you walk into a room. You spend a lot of time trying to impress people with your appearance. Another way this can look, is you may milk people for compliments by putting yourself down in the hopes that they'll compliment you in return.
Number five, has a style of speech that is excessively impressionistic and lacking in detail. This could sound like speech that has a lot of fluff to it, but not much behind it. Here's an example. Let's say I say, "Judy is just amazing; she does amazing work." Now, you know that I barely know Judy, so you say, "What is it about her work that's amazing?" I say, "Well, just look at her, she's a doll; I just love her." I've said nothing of substance with that answer. If you press me on it I'll just get annoyed and think, "Why are you all over me, back up?" You think, "I don't like her because she's fake and shallow." And this is one of the ways that this personality can cause friction and problems in relationships.
Number six, shows self-dramatization, theatricality, and exaggerated expression of emotion. So this is over-the-top emotional expression that can embarrass people close to you. Like I can run up to you and give you a kiss on the mouth and tell you how much I've missed you, even though I just saw you yesterday and you're my cubicle mate. Or upsetting things make me need to fan myself and faint.
Number seven, is suggestible or easily influenced by others or circumstances. This characteristic can really be a problem because you can be overly trusting of people and susceptible to brainwashing, or you can make big decisions based on hunches, but those hunches change with the latest trend.
The last one is, you consider relationships to be more intimate than they actually are. You relate to people as if you're the closest of friends. Here's an example. You go to see your new doctor, Dr. Samuel Jones, and within 15 minutes of the visit you're calling him Sammy. Now, it's one thing to drop someone's professional title and call them by their first name, but using a presumed childhood nickname takes it to another level. Social conventions are that you don't call people by a nickname unless you've been given permission or you knew them back in the day when they went by that name. Someone may think, "The nerve of this person." But you're not deliberately trying to be disrespectful; you feel close enough to this person that you're comfortable being that casual. Another example is using terms of endearment, like "honey" and "sweetie" all the time. Some people are very offended by that, but you feel connected enough to that person that it seems like a natural thing to say.
You may recognize some of these things in yourself, and as I've said, we all have traits of some of the personalities, but for the disorder, you need at least five of these. And these are things that you do a lot in multiple settings, and they cause problems for you.
What can you do about histrionic personality disorder? Well, like most of the personality disorders, because it's a part of your makeup you don't usually seek help for the personality issues. In fact, often the person with histrionic personality disorder doesn't see that they have a problem. They may think that they just have problems finding a partner or they have a problem with their partner. In those cases, they may seek help for the relationship but not the personality. Also, there's a threshold issue to this. There are people who are just more dramatic with their emotional expression and will even say, "I'm not for everyone." And they'll usually connect with a more low-key person who likes their energy and doesn't mind letting them be the center of attention.
What's the difference between this and an extrovert? Extroversion is a personality trait where a person's orientation to life is more focused on the external object. And in this case, an object means a person. That's how it was originally proposed by the psychiatrist Carl Jung. A more modern explanation of extroversion is that it's a personality style where the person is more outgoing and derives energy from interacting with people. Whereas the introverted person still interacts with people, they need some amount of mental solitude and time in your own head to be recharged. Too much interaction depletes the introvert; too much mental solitude depletes the extrovert.
With histrionic personality, there's more to the personality than being energized by people; it has more to do with this insatiable need for attention and the things that you do, and the lengths to which you will go to get that attention. Think of histrionic personality disorder as having an internal deficit that's driving the behavior. As I went through the criteria, it sounds as though this is the personality of someone who's just dramatic and fun, but it's not fun. People with histrionic personality disorder can have serious emotional intimacy problems, because of the superficial connectedness that they have. They tend to attach very quickly and easily, but it's not reciprocated because it's too much too soon. Their provocative mannerisms can cause conflict with same-sex friends who might feel threatened by this kind of behavior. They tend to get bored very easily and have affairs, or multiple job changes, or just general instability because they can't stay happy with something.
The treatment for histrionic personality disorder depends on the problems that it causes. This disorder is associated with higher rates of depression, as well as somatic symptom disorder. And this is a disorder where you can over-focus on having a physical problem; an old term for this is hypochondriasis or hypochondriac. I talk about that disorder in this video. If you develop depression and anxiety because of this, you could see a psychiatrist for possible medication treatment. To really get at the heart of changing your personality, you would have to recognize that the root of your problems with other people is your personality. And that's a hard step for most people to get to. They're more likely to see their problems as caused by their circumstances. But if you choose to focus on changing yourself, you would need psychotherapy. And this could be psychoanalytically focused, cognitive behavior therapy, or interpersonal therapy. Dialectical behavior therapy is a variation of cognitive behavior therapy used for borderline personality disorder. And it may be a good choice, because there is overlap between histrionic and borderline personality disorder, especially with the way it affects relationships.
That's histrionic personality disorder. Thanks for watching. See ya next time.