610 CHAPTER 13
perhaps because of a temperament that is high in reward dependence. This personal-
ity disorder—in fact all four of the dramatic/erratic personality disorders—involve a
sense of entitlement that drives the manipulative behavior (“I deserve this so I can
do whatever it takes to get it”) and a poor tolerance of negative emotions (Beck,
Freeman, & Davis, 2004). When frustrated or angry, people with histrionic person-
ality disorder tend to have dramatic outbursts; others may, in turn, respond with
attention, inadvertently reinforcing these outbursts (Farmer & Nelson-Gray, 2005).
Social factors that are thought to contribute to this disorder include the child-
rearing practices of the parents. Specifi cally, one possibility is that people who de-
velop histrionic personality disorder received signifi cantly less attention than they
desired during childhood; their subsequent inappropriate attempts (dramatic de-
mands) to obtain attention were inadvertently reinforced, leading to a (maladaptive)
belief that they must make an extraordinary effort to obtain attention (Kraus &
Reynolds, 2001; Turner, 1994).Treating Histrionic Personality Disorder
A goal of treatment for histrionic personality disorder is to help patients recog-
nize and then modify their maladaptive beliefs and strategies (which are outlined in
Table 13.20). Specifi cally, using techniques from CBT or psychodynamic therapy,
the therapist tries to help patients increase their capacity to tolerate distress, de-
velop more adaptive ways of responding to frustration, recognize the negative im-
pact that their actions have on their relationships, and shift their view of themselves
and other people (Beck, Freeman, & Davis, 2004; Farmer & Nelson-Gray, 2005).
Like other patients with dramatic/erratic personality disorders, those with histrionic
personality disorder often do not remain in treatment for long; they become bored
or frustrated and continue to see other people as the primary problem.Narcissistic Personality Disorder
People with narcissistic personality disorder have an infl ated sense of their own im-
portance, they expect—and demand—praise and admiration, and they lack empathy
(American Psychiatric Association, 2000). This sense of self-importance, however,
masks mixed feelings. On the one hand, they are preoccupied with their own con-
cerns and expect others to be as well, and they get angry when other people don’t
defer to them. They overvalue themselves and undervalue other people, which is true
of Patricia in Case 13.8. On the other hand, their self-esteem can be fragile, leading
them to fi sh for compliments. They are relatively insensitive to others’ feelings and
points of view. Table 13.18 lists the diagnostic criteria for narcissistic personality
disorder, and Table 13.19 presents additional information about this disorder.CASE 13.8 • FROM THE OUTSIDE: Narcissistic Personality Disorder
Patricia was a 41-year-old married woman who presented at an outpatient mental health clinic
complaining of interpersonal diffi culties at work and recurring bouts of depression. She de-
scribed a series of jobs in which she had experienced considerable friction with coworkers,
stating that people generally did not treat her with the respect she deserved. She attributed
her depression to the recent suspicion that perhaps people did not like her because of her
behavior.... Patricia reported a long history of banking jobs in which she had experienced
interpersonal discord. Shortly before her entrance into treatment, Patricia was demoted from
a supervisory capacity at her current job because of her inability to effectively interact with
those she was supposed to supervise. She described herself as always feeling out of place
with her coworkers and indicated that most of them failed to adequately appreciate her skill
or the amount of time she put in at work. She reported that she was beginning to think that
perhaps she had something to do with their apparent dislike of her. Patricia stated several
times... that the tellers at the bank were jealous of her status and abilities as a loan offi cer
and that this made them dislike her.
(Corbitt, 2002, pp. 294–295)Narcissistic personality disorder
A personality disorder is characterized by an
infl ated sense of importance, an excessive
desire to be admired, and a lack of empathy.