Histrionic Personality Disorder, Essays (university) of Medicine

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Histrionic Personality Disorder

CHAPTER I

INTRODUCTION

In life, a person from an early age has a tendency or habit to use a pattern that is relatively similar in responding to a problem he is facing which, when considered further, the way or method of solving it appears as something that has a special pattern and can be identified as a feature or sign in recognize that someone. This phenomenon is known as character or personality Personality disorders must be distinguished from personality traits. Personality traits are patterns of behavior that last a long time, relate to the environment and oneself, and emerge in the form of social and personal contexts. Personality traits are also flexible and the clinical picture does not meet diagnostic criteria or guidelines, and is milder than personality disorders. When this behavior pattern becomes significantly maladaptive and causes serious impairment in personal and social functioning, it is called a personality disorder. 1, In an individual with a personality disorder, there is dysfunction in family relationships, work, and social functioning. According to Kurt Schneider, a person with a personality disorder is someone who makes it difficult and detrimental to himself and society because of these constitutional personality traits (not acquired after the individual has developed or not due to significant stress). Constitutional means the result of bodily and psychological interactions. Thus, things that can cause personality disorders are sought in these two elements since childhood, namely, especially heredity, developmental disorders of the nervous system and hormones as well as environmental influences in childhood. 1,

CHAPTER II

LITERATURE REVIEW

A. Histrionic Personality Personality disorders are inflexible and maladaptive personality traits that cause significant dysfunction or subjective suffering. In the 5th Diagnostic and Statistical Manual of Mental Disorders (DSM-V), personality disorder is defined as a long-lasting pattern of behavior and internal experiences that deviates markedly from one's cultural expectations, is pervasive, has onset during adolescence or young adulthood, is stable from time to time, and cause unhappiness and deterioration. 1, Literally, the word histrionic comes from the Latin, namely "histrionicus" which means "pertaining to be an actor". The main hallmarks of histrionic personality disorder are excessive and diffuse self-dramatization, excessive emotionality, and attention-seeking. Behind it all, sufferers are often unable to maintain deep and lasting relationships. This personality disorder tends to occur among people who have experienced separation from their partner and is associated with depression and poor physical health. 1, Consciously, histrionic patients want to be seen as attractive, charming, warm, intuitive, sensitive, and generous. In addition, these patients also appear exhibitionist, seeking attention, seductive, manipulative, and often over- dramatized, easily hurt, do not think about the feelings of others, and whimper with episodes of crying or anger. These patients have the capacity to experience one emotional state after another at a very rapid pace. In a way, their experience

of affectivity is similar to that of small children who can quickly switch from laughing to crying The histrionic patient presents himself to the world in three domains. The first is 'dramatic', which includes exhibitionism, exaggeration, emotionally unstable, very passionate, and very generous. The second is 'manipulative' in which the interpersonal world is controlled and gratification is taken from there, such as seeking attention, not being promiscuous in social matters, being demanding, easily hurt, not thinking about others, and being dependent. The third is related to the aspect of 'ego functioning', usually histrionic patients are often impulsive, scattered, disorganized, easily bored, rarely punctual, and difficult to trust. 3, They tend to magnify their thoughts and feelings, making things sound more important than they really are. Seductive behavior is often found in both men and women. They may think that by acting on their sexual impulses they can reassure themselves that they are attractive to the other sex. The dramatic type histrionic personality suppresses feelings, colors, and attention. Such individuals process their world effectively, appreciate the effects of emotions, and express their emotions easily and openly. They experience life through sensation and romance, deliberately making themselves physically attractive, consciously dressing with the opposite sex in mind and being attractive, charming, or even seductive. Many are highly intuitive with a quick sense of what to talk about and how others want to be treated. Most trust others easily and readily involve themselves in a relationship.3,

individual, who constantly engages in theatrical and dramatic expression, the normal type is not too extravagant without a desire to take on a leading role. While disturbed individuals are easily swayed by the influence of others, normal types are able to make their own decisions, even at the risk of losing attention and approval. Finally, individuals with the disorder perceive relationships as more intimate or intimate than they really are, while the normal type is anchored in a more intact self. thus providing the opportunity for a greater sense of continuity and a deeper self-awareness into the nature of personal relationships. 5, B. Etiology Millon et al. mentioning the etiological dynamics experienced by a person so that he has a histrionic personality disorder: 7, 8

1. Genetics
2. Female gender, male is synonymous with antisocial personality disorders.
3. Childhood trauma, shaped through the relationship between the opposite sex of parents, childhood experiences and developmental consequences for psychosexual development and character formation that exist today.
4. Low mental function at the oral stage, from high mental function at the oedipal stage of development, where the growth of a sense of sexual desire is an unconscious attitude towards parents of the opposite sex.
5. Problems with object relations.
6. Not forming a strong super ego.

7. Sometimes the same behavior is rewarded, sometimes not (inconsistently so children experience frustration to get their parents' attention and exaggerate behavior to get protection, praise, affection).
8. Barriers to identity development.
9. Cognition and ego defense mechanism systems combine to protect oneself.
10. Rejecting situations that should provide knowledge for them thereby limiting their opportunities to face intellectual challenges.
11. There is modeling from family members. 7, C. Histrionic Personality Characteristics Patients with histrionic personality disorder exhibit high attention-seeking behavior. People with histrionic personality disorder tend to express their emotions excessively. They tend to magnify their thoughts and feelings, making things sound more important than they really are. They show temper tantrums, fear, and accusations when they are not the center of attention or are not getting praise or appreciation.5, Flirting behavior is common in both sexes. Sexual fantasies about people involved with the patient are frequent, but the patient is inconsistent about verbalizing these fantasies and may be coy or flirtatious instead of sexually aggressive. In fact, histrionic patients may have psychosexual dysfunction: women may be anorgasmic, and men may be impotent. They may exercise their sexual impulses to reassure themselves that they are attractive to the other sex. Their need for security is endless. However, their relationships tend to be superficial, and patients can fail, be self-absorbed, and fickle. Their strong dependence causes them to be very trusting and gullible.5,

These patients create impressions by using the body as an expression of love, but this is simply the result of a desire to be perceived as accepted, admired and protected rather than to feel intimacy or sexual desire. The patient will respond competitively antagonistically to other people using the same equipment to get attention.8, d. dependent Male patients more frequently display pseudo-independent behavior, which can be recognized as a defense due to an emotional response of excessive fear or anger. Whereas female patients show themselves as very dependent and helpless people, who expect doctors to guide them in every action. He is also possessive in relationships. This patient requires great attention from all around him and is unable to entertain himself. Boredom is a constant problem for these patients as they consider themselves boring.8, e. Suggestible Although suggestible, patients are sometimes only suggestive of suggestions that they think are true.8, f. Marriage and sexual problems In female patients it may be anorgasmic and males tend to be impotent.8, g. Somatic disorders Somatic complaints involving multiple organ systems usually begin during the patient's teenage years and continue throughout life. Symptoms are dramatically described and include headache, back pain, conversion symptoms, and in women often with pelvic pain and menstrual disturbances.8,

D. Histrionic Personality Clinical Manifestations a. Theatrical Histrionic Highly dramatic, romantic, and attention-seeking, theatrical histrionic is a summary of basic histrionic patterns. Described by Fromm's "marketing orientation," such individuals essentially live as commodities, market themselves as chameleons to social demands, and change the characteristics they display to suit the audience and the circumstances. For them, nothing is intrinsic. Instead, the self is under social economic requirements - transformed, synthesized, manufactured, and packaged to optimize their attractiveness in a given market segment. Style is not only valued over goods but also valued as an exception to goods. As a result, theatrical histrionics exists largely without depth, since having an inner identity limits potential maneuvers. In fact, reading other people's motives and reflecting back on themselves what is attractive, pleasing, and seductive is their most important endeavor. 10, b. Infantile Histrionic The infantile histrionic, similar to Kernberg's infantile personality, represents a mixture of borderline and histrionic personalities. As previously stated, many histrionic individuals have strong dependency problems. By prematurely sexualizing relationships and drawing powerful others into their orbit, histrionic individuals experience more indulgence and less frustration. Therefore, they do not need to develop a full-fledged sense of identity whose shape starts with what analysts call the reality principle, the awareness that life is intrinsically so frustrating that some common physical tool, namely the ego, would be needed to deal with it. 10,

In behavior, their movements are fast and lively. Comes and goes with attention. Although they are only superficial thinkers, their ideas often flow so quickly and easily that others become swayed by their excitement. Those who are more normal walk around, solve problems, start projects, and persuade others to join in with the energy and friendliness of a natural salesperson. But others pursue temporary desires without accomplishing anything, leaving broken promises, empty wallets, and disappointed partners. Not surprisingly, many vivacious histrionics also have narcissistic traits. 12, d. Appeasing Histrionics The appeasing subtype combines histrionic, dependent, and compulsive features. Approval is their main mission in life: You have to like them; you have to be their friend. To achieve this goal, they constantly compliment, flatter, please, approve, and make you feel that they would do anything for you: "You are so smart! You have done a perfect job! You look so beautiful! How can I help you?" ?" Whenever they feel indifference, they quickly add to the action, positioning their judgment back in a positive direction. As a result, they present an image of absolute goodwill, one for whom rewards are of moral importance. When a mismatch occurs, they quickly begin to smooth things over again, even when they have to make sacrifices, compromise their own will, or agree on important points. 12, Rather than attacking those who cannot be reconciled, they choose to feel the wound, portraying themselves as innocent victims trapped in a cruel world, martyrs who suffered the outrageous spears and arrows of fate, always feeling deserving of sympathy and compassion. The implication of such a conciliatory lifestyle is compensation for a substantial void. Behind their friendly smiles lies the emptiness of the histrionics, the guilt of compulsions, and the inferiority and helplessness of dependents. Most feel that

they are problematic individuals who are unloved and inadequate. Therefore, they become eager to please others, always alert to even the most subtle symptoms of when and where respect and approval may be obtained. 12, Developmentally more advanced than basic histrionics, these individuals have internalized the punishing parental voice that falls with criticism and rebuke. Like hyperconform compulsives, these individuals satisfy their tormentors, consciously anticipate their needs, and offer only good intentions and gestures in return for anger and hostility. In essence, they become so kind and sweet that they can make even the superego of a sadist feel guilty. 12, e. Tempestuous Histrionic The tempestuous (turbulent) variant combines negativistic histrionic personality traits. Such individuals can best be described as highly moody and emotionally volatile. During the better periods, they exhibit only histrionic traits, display attractive faces, superficially become sociable predictors, talk to others, and add in return their own independent emotional expressions. Like the theatrical histrionics, they are quickly bored, overly dramatic, hyperreactive to outside stimuli, and impulsive seekers of sensation. When combined with borderline traits, the result is emotional overdrive. 12, Like the borderline individual, the temperamental histrionic is hypersensitive to criticism, intolerant of frustration, and socially immature—characteristics that almost ensure that the good times last. Most alternate between periods of extreme emotional excitement and acting out impulsively, followed by bouts of anger that turn into depressive-like symptoms of exhaustion and changes in eating and sleeping patterns. While the normal individual develops a strong sense of self-identity that encapsulates

and physical confrontation. For some, antisocial influences stop here with traits that are perceived as the result of normal delinquency. However, others combine histrionic and more psychopathic characteristics. These individuals synergize skills, charms, and histrionic social skills that are more adaptive to reading the motives and desires of others with calculated malicious intent. 13, Clearly, this variant is more egocentric, deliberately insincere, and perhaps more aware of their manipulation than the basic histrionic pattern. They often seem to enjoy conflict, deriving some degree of satisfaction or pleasure from the resulting tension and stress. Because antisocial individuals usually interpret kindness as weakness, their friendly, histrionic nature sometimes makes them fear that others will come to see them in exactly the same way. If they feel this is true, they may reciprocate the wrong impression by becoming predators (people who exploit others). 13, E. Diagnosis and Differential Diagnosis Diagnosis In interviews, patients with histrionic personality disorder were generally cooperative and willing to provide a detailed history. Their mannerisms and dramatic emphasis on speech are unheard of, they can mispronounce frequently, and their language is very colorful. Shows of affection are common, but if forced to deal with certain feelings (such as anger, sadness, and sexual desire), they may respond in surprise, anger, or denial. Cognitive examination results are usually normal, although lack of persistence may be demonstrated on arithmetic or concentration tests.15,

People with histrionic personality disorder display a high degree of attention-seeking behavior. They tend to exaggerate their thoughts and feelings and make things sound more important than they really are. They exhibit temper tantrums, cry, and accuse, if they are not the center of attention or do not receive praise or approval. 15, Seductive behavior is common in both sexes. Sexual fantasies about the person involved with the patient are also common, but the patient is inconsistent in verbalizing these fantasies and may act coy or flirtatious rather than sexually aggressive. In fact, histrionic patients can have psychosexual dysfunction: Women can be anorgasmic and men can be impotent. The need to be reassured is relentless: they may act on their sexual impulses to convince themselves that they are attractive to the opposite sex. However, their relationships tend to be shallow, and they can be arrogant, preoccupied with themselves, and fickle. their need to depend makes them overly trusting of others and gullible. 15, The main defenses for patients with histrionic personality disorder are repression and dissociation. In this regard, the patient is not aware of his true feelings and cannot explain his motivation. Under pressure, reality testing is easily disrupted. 15, To diagnose histrionic personality disorder in clinical practice, a diagnostic guideline is needed, which are included in the Diagnostic and Statistical Manual of Mental Disorder V (DSM V) and PPDGJ III. 15, Diagnostic criteria for histrionic personality disorder according to DSM V, as indicated by five (or more) of the following:17,

1. Uncomfortable in situations where he is not the center of attention

conditions can be diagnosed in the same patient, the clinician must separate the two. Somatization disorder (Briquet's syndrome) may coexist with histrionic personality disorder. Patients with brief psychotic disorder and dissociative disorder may also have a histrionic personality diagnosis. 17, F. Management Psychotherapy Patients with histrionic personality disorder are often unaware of their true feelings. Clarification of internal feelings is of therapeutic importance. Psychoanalytically oriented psychotherapy, both individual and group, may be the treatment of choice for histrionic personality disorder. a. Cognitive-behavioral therapy To help individuals recognize and change ways of thinking that arise from feelings and behavior. 19, b. Group therapy Used to help individuals with histrionic personality disorder work in interpersonal relationships. 19, c. Expressive Psychodynamic therapy This therapy can help the sufferer to be more aware of what he is feeling. 19, Pharmacotherapy Pharmacotherapy may be an adjunct to therapy if the blood is related to symptoms (such as the use of antidepressants for depression and somatic complaints, antianxiety agents for anxiety and antipsychotics for delirium and illusions). 19,