608 CHAPTER 13
or angry, which directly affects brain mechanisms (neurological factor) and in turn
makes their relationships less volatile (social factors). Similarly, the honest and car-
ing feedback from others within the therapeutic environment (part of DBT, IPT, and
intensive psychodynamic therapy) challenges patients to alter their behaviors and
ways of thinking about themselves and their relationships (psychological and social
factors), which in turn decreases their emotional reactivity (neurological and psycho-
logical factors).Histrionic Personality Disorder
You may know someone who initially seemed charming, open, enthusiastic—maybe
even fl irtatious. After a while, did he or she seem to go to great lengths to be the
center of attention, behaving too dramatically? Did the person have temper tan-
trums, sobbing episodes, or other dramatic displays of emotion that appeared to
turn on and off like a light switch? These are the qualities of people with histrionic
personality disorder, who seek attention and exaggerate their emotions (American
Psychiatric Association, 2000).
Rachel Reiland relates her desire to be the center of attention and the dramatic
behaviors she engaged in to obtain that attention:
I wanted to be the entire focus of any person I was obsessed with. My incessant hun-
ger for attention had been a part of my life for as long as I could remember. The
burning heartache of emptiness obsessed me even when my peers had been taken with
Barbie dolls and coloring books. I knew even then that these constant feelings were
not normal....
When the object of my longing—the teacher, the coach, the boss—was present in
the room, I geared everything to that person. I contrived every word, action, infl ection,
and facial expression for him. Does he see me laughing? Does he see how funny every-
body thinks I am?
(2004, pp. 335–336)
Reiland’s behavior involved some features of histrionic personality disorder; in what
follows we examine the disorder in more detail.What Is Histrionic Personality Disorder?
Table 13.16 lists the specifi c diagnostic criteria for histrionic personality disorder.
Beyond the overt attention seeking and dramatic behavior, people with histrionic
personality disorder may exhibit more subtle indications of the disorder: When they
feel bored or empty, they seek out novelty and excitement. They may have diffi culty
delaying gratifi cation and tend to become easily and excessively frustrated by life’s
challenges. Being in long-term relationships with people with histrionic personalityTable 13.16 • DSM-IV-TR Diagnostic Criteria for
Histrionic Personality DisorderA pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood
and present in a variety of contexts, as indicated by fi ve (or more) of the following:
(1) is uncomfortable in situations in which he or she is not the center of attention
(2) interaction with others is often characterized by inappropriate sexually seductive or provoca-
tive behavior
(3) displays rapidly shifting and shallow expression of emotions
(4) consistently uses physical appearance to draw attention to self
(5) has a style of speech that is excessively impressionistic and lacking in detail
(6) shows self-dramatization, theatricality, and exaggerated expression of emotion
(7) is suggestible, i.e., easily infl uenced by others or circumstances
(8) considers relationships to be more intimate than they actually are.
Source: Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders,
Text Revision, Fourth Edition, (Copyright 2000) American Psychiatric Association.Histrionic personality disorder
A personality disorder characterized by
attention-seeking behaviors and exaggerated
and dramatic displays of emotion.