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Histrionic Personality Disorder

According to the DSM-IV-TR criteria, the key feature of Histrionic Personality Disorder (HPD) is pervasive

and excessive emotionality combined with attention-seeking behavior. There is a prevalent need for

those presenting the criteria to do something dramatic, be the life of the party, and to draw attention to

themselves by any means necessary. These individuals can be overly trusting and easily influenced bytrends, fads, and those they perceive as authority figures. The individuals presenting these criteria are

very influenced by sex role stereotypes and will often present a physical appearance that will draw

attention to them accordingly (American Psychological Association, 2005). Those presenting the

behaviors associated with HPD often have marked dependency in relationships and perceive

relationships as being more intimate than they are in reality. Often most romantic and intimate

relationships are superficial (Harper, 2004).The individual who meets HPD criteria may present a

flirtatious and a provocative interpersonal style. These behaviors are known to cause riffs in friendships

and relationships for those individuals. The one key feature that separates the Narcissistic diagnoses

from the Histrionic diagnoses is that individuals who are diagnosed with Narcissistic Personality Disorder

(NPD) require admiration for their superiority and refuse to appear weak or victimized. An individualwith HPD finds no setback in playing thevictimto gain attention whenever they deem it necessary

(American Psychological Association, 2005). Those who meet the criteria for HPD and NPD are often

drawn to the entertainment industry and fields that allow them to garner attention professionally. This

tendency to gravitate to the entertainment industry and like fields creates a micro-culture that

normalizesthese conditions and the resulting behaviors (Sansone & Sansone, 2011).

Treatment Approach

Cognitive forms of therapy appear to offer the most promise in successful treatment of HPD. Looking to

Kellett (2007), the form of treatment that is suggested is Cognitive Analytic Therapy (CAT). CAT is a

therapy with many qualities similar to Cognitive Behavioral Therapy (CBT), but is the treatment is time-

limited. Those participating in

Kelletts study participated in 24 sessions of CAT, and 4 follow

-up sessions spread over 6-months post therapy. Kellett found some success with this form of therapy,

but found regression to be a major issue at the point of therapeutic termination (Kellett, 2007).Butcher,

Mineka, and Hooley (2012) support the use of Cognitive types of therapy with those who exhibit HPD

criteria by emphasizing the importance of addressing core dysfunctional beliefs and maladaptive

schemas. Harper (2004) recognizes that Substance Abuse and Depression are common comorbid

disorders and strongly emphasizes the importance of intensive and consistent CBT with those presentingHPD behaviors. He lists Unreflective, Poorly Organized Thinking and Flighty Impulse Behaviors

as potential impairments to successful therapy for those presenting additional disorders, but suggests

that the attention seeking behavior of the disorder can assist in client retention

(Harper,2004).Rasmussen (2005) offers Personality-Guided Cognitive-Behavioral Conceptualization

(PGCBC) as the most effective treatment option. He emphasizes client independence from external

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confirmation and validation as the main goal of the therapeutic relationship. Specific recommendations

Rasmussen makes when treating a

client presenting HPD criteria are to validate the individuals desire for rewarding

interpersonal relationships, to control the fickleness of the client, to help the client maintain therapeutic

focus, and to work with these clients in a non-confrontational way.

Rasmussen also points to increasing the clients tolerance for not being the center of

attention as the first concern that should be addressed in therapy (Rasmussen, 2005).

How Diagnosis Informs Treatment Planning

As with many personality disorders, treatments that are personality guided will offer the greatest

chance of success. Each personality disorder presents specific challenges and issues that make onetreatment method preferential to others. Learning about the specifics of a condition informs treatment

planning by offering insight as to the course that the therapeutic relationship should take.