Personality Disorders 609
disorder can be challenging because they usually don’t recognize their symptoms;
they don’t feel as though they are overreacting or being overly dramatic or seduc-
tive, although—like the woman in Case 13.7—they clearly are. Table 13.17 pro-
vides additional facts about the personality disorder.
CASE 13.7 • FROM THE OUTSIDE:Histrionic Personality Disorder
A 23-year-old single woman was referred for a psychological assessment by her gyne-
cologist. The patient had been described as “outgoing, effusive, and ‘dressed to kill’.”
She had been experiencing debilitating pain for over half a year, but the pain seemed to be
medically unexplainable. Throughout the interview, she used facial and other nonverbal ex-
pressiveness to dramatize the meaning of her words. In describing her pain, for example, she
said she felt as though “I will absolutely expire” as she closed her eyes and dropped her head
forward to feign death. However, when asked about her pain, she became coquettish and was
either unable or unwilling to provide details. She talked freely about topics tangential to the
interview, skipping quickly from topic to topic and periodically inserting sexual double en-
tendres. She described her family as happy and well-adjusted but acknowledged confl ict with
her mother and complained that her older brothers treated her like a baby. She described her-
self as close to her parents and said that she calls home every day. She was not currently in a
serious relationship, but stated with a giggle that most boys “fi nd me very attractive,” adding
that they “just want me for my body.” She also reported that she found it easy to get to know
others. At the time of the interview, she was working as a dancer at an adult club; she particu-
larly liked the attention and the money that the job provided. She felt that, in contrast to the
other girls, she was an artist. Her family believed that she was teaching ballet.
(Millon & Davis, 2000, p. 237; quoted in Horowitz, 2004, pp. 190–191)Distinguishing Between Histrionic
Personality Disorder and Other Disorders
Although people with antisocial personality disorder, borderline
personality disorder, and histrionic personality disorder are all
manipulative and impulsive, their motivations differ: People with
histrionic personality disorder desire attention; people with anti-
social personality disorder seek power or material gain; and peo-
ple with borderline personality disorder want nurturance (Skodol,
2005). Moreover, although both histrionic and borderline person-
ality disorders involve rapidly shifting emotions, only with the lat-
ter are the emotions usually related to anger.
Reiland’s behavior fi t some of the criteria for histrionic per-sonality disorder, in that some of her dramatic displays seemed
to be motivated by a desire for attention. She might be diagnosed
with histrionic personality disorder as a comorbid disorder; how-
ever, the elements of her behavior that indicate borderline person-
ality disorder overshadow the features of histrionic personality
disorder. A clinician trying to make a defi nitive diagnosis (or diag-
noses) would want to fi nd out more about any thoughts, feelings,
or behaviors that might indicate or rule out histrionic personality
disorder.
Understanding Histrionic Personality Disorder
Unfortunately, little formal research has been conducted on his-
trionic personality disorder, but clinical observations have led to
theories about how this disorder arises. Various psychological and
social factors are theorized to contribute to the disorder. First, pa-
tients with this disorder are thought to believe themselves to be
special, view other people as potential admirers, and apparently
are sensitive to negative evaluation (Farmer & Nelson-Gray, 2005),
Prevalence- Approximately 2–3% of the general population will have histrionic
personality disorder at some point during their lives (American Psy-
chiatric Association, 2000; Grant, Hasin et al., 2004). - Among people seeking treatment in inpatient and outpatient men-
tal health settings, the prevalence of this disorder is 10–15%.
Comorbidity - Common comorbid Axis I disorders are somatoform disorders and
major depressive disorder. - Common comorbid Axis II disorders are borderline, narcissistic,
antisocial, and dependent personality disorders (Skodol, 2005).
Onset - As with other personality disorders, symptoms must emerge by
young adulthood.
Course - Symptoms of histrionic personality disorder typically improve over
time (Seivewright, Tyrer, & Johnson, 2002).
Gender Differences - Some studies fi nd histrionic personality disorder to occur as fre-
quently in men as in women, but others fi nd that it is diagnosed
more frequently in women. - Men with histrionic personality disorder may appear “macho” and
seek attention for their athletic skills, not their appearance.
Source: Unless otherwise noted, the source is American Psychiatric Association, 2000.
Table 13.17 • Histrionic Personality Disorder
Facts at a Glance