Histrionic personality disorder

This is a rare type of personality disorder, and diagnosis is controversial. However, symptoms include the fact that sufferers seek constant attention and exaggerated show of emotion. It tends to occur more in women than men.

Women with HPD are described as self-centered, self-indulgent, and intensely dependent on others. They may engage in manipulative suicide threats as one aspect of general manipulative interpersonal behaviour.

Males with HPD usually present with identity diffusion, disturbed relationships, and lack of impulse control. They have antisocial tendencies and are inclined to exploit physical symptoms. These men are emotionally immature, dramatic, and shallow. Both men and women with HPD engage in disinhibited behaviour.

Essentially, the disorder arises due to problems concerning the personality, or character of an individual. In effect who they are and how they behave are at odds with commonly held social and emotional expectations of what is regarded as ‘normal’. This means that a diagnosis has to be made with regard to the context of the rules, obligations and social expectations held within a particular community. What is considered normal in the army for example during war, will be different from what is considered normal among civilians in times of peace. Personality disorders of all types tend to appear in late childhood or adolescence and continues through to adulthood. It is, therefore, unlikely that the diagnosis of personality disorder will be appropriate before the age of 16 or 17 years.

The prevalence of personality disorder in the UK ranges from 2-13 per cent, and it is more common among people who are in institutions, such as hospitals and prisons. Research published by the office of national statistics in 1998 found 64 per cent of sentenced male prisoners and 50 per cent of all female prisoners have a personality disorder.

Experts cannot agree about the precise causes and there has been very little research done on the subject. However, it is believed that possible causes may include problems in early childhood such as abuse, inadequate parenting, neglect and trauma.

How is it diagnosed?

People who have HPD usually have three of more of the following clinical symptoms. Diagnostic criteria (ICD-10)

The International Statistical Classification of Diseases

• (a) A tendency towards self-dramatisation, theatricality, and exaggerated expression of emotions;
• (b) Heightened suggestibility, easily influenced by others or by circumstances;
• (c) Shallow and labile affectivity;
• (d) Continuous need for excitement, appreciation by others, and activities in which the patient is the centre of attention;
• (e) Inappropriate seductiveness in appearance or behaviour;
• (f) Over-concern with physical attractiveness.

Associated features may include egocentricity, self-indulgence, continuous longing for appreciation, feelings that are easily hurt, and persistent manipulative behaviour to achieve own needs.
Although the WHO and the American Psychiatric Association, two major international bodies on psychiatric health, agree on the general definition of personality disorder, they each give different categories within the definition. The WHO has substantially revised its classification of personality disorders in the past 20 years. Some doctors contend that some personality types represent little more than the personal opinion. Many psychiatrists believe PD are untreatable and mental health staff are often reluctant to take on people with the condition, which has led to charities such as Mind calling it a “dustbin diagnosis”.

Other key points:

• Most people diagnosed with a personality disorder fit the criteria for at least two different types of personality disorder
• Most people diagnosed with a personality disorder are not dangerous
• People diagnosed as borderline or paranoid personality disorder may be at higher risk of self-harm and/or suicide than other people
• People with personality disorders have multiple needs and vulnerabilities

Treatments

Personality disorders are usually treated with a combination of drugs and psychotherapy. The research that has been undertaken to date suggests that most forms of personality disorder may be treatable or manageable, especially the more moderate forms, but no single treatment or management strategy will be effective in all cases.

In the UK treatment for personality disorders varies considerably, depending to a large extent on whether people are in a general NHS setting, an in-patient psychiatric unit, special hospital or in the prison system. The availability of appropriate resources including qualified staff, therapeutic environments and management support for innovative treatments is also a major issue. The Department of Health has established a national personality disorder programme to develop new ways to manage and treat PD. Eleven projects have been set up across England to help ensure that people with PD are no longer excluded from mental health services.

People with the disorder may be given drug therapy in the short-term to relieve severe stress.

Psychotherapy will involve personality structure and development. It aims to provide insight for people allowing them to understand their feelings and to find better coping mechanisms. This approach has had limited success and is likely to be less successful for those with addiction and/or antisocial personality disorder.

Most cognitive behavioural approaches address specific aspects of thoughts, feelings, behaviour or attitude, and do not claim to treat the entire personality disorder of the person. Research suggests that there are some short-term benefits to these approaches but more research is required into the long term benefits.

Experts cannot agree about the precise causes and there has been very little research done on the subject. However, it is believed that possible causes may include problems in early childhood such as abuse, inadequate parenting, neglect and trauma.