Histrionic personality disorder

Borderline Personality Disorder, Histrionic Personality Disorders. The... 

Clnster B includes the so-called dramatic and emotional disorders. This group is comprised of antisocial personality disorder (ASPD), borderline personality disorder (BPD), narcissistic personality disorder (NPD), and histrionic personality disorder (HPD). In each of these disorders, the person is attention seeking, is emotionally unstable, and finds it difhcnlt to conform to social norms. Unlike the odd and eccentric Cluster A patients and the anxious and withdrawn Cluster C patients, those with Cluster B personality disorders seldom escape clinical attention for very long. The disruptive nature of these personality disorders often leads them to psychiatric or legal intervention no later than their early adult life. 

The patient with histrionic personality disorder (HPD) craves attention from others and resorts to excessive displays of emotion to obtain it. Like the narcissistic patient, the histrionic demands to be the center of attention but typically without the haughty arrogance of the narcissist. They are also manipulative and easily frustrated like the antisocial patient but able to experience remorse and are generally more law abiding. Finally, the histrionic patient experiences mood instability much like the borderline patient but is typically not as severely impaired. Whereas the borderline patient is frequently self-destructive and feels chronically empty, the histrionic patient is usually not prone to these more severe disturbances. 

Of the Cluster B personality disorders, only BPD has received any significant degree of attention in terms of psychopharmacology research. However, the implications of that research as well as other studies into the treatment of nonspecific aggression may be applicable to antisocial, narcissistic, and histrionic personalities as well. 

In a retrospective chart review of 167 patients with a variety of anxiety disorders, excluding patients with evidence of current or previous mood disorder, manic episodes were recorded in five patients, a rate of 3% (20). While this might suggest a clear effect of SSRIs to induce mania, two of the patients were taking clomipramine, a tricyclic antidepressant, albeit a potent serotonin reuptake inhibitor. In addition, all the affected patients had additional diagnoses of histrionic or borderline personality disorder, known to be associated with mood instability. It is still therefore plausible that SSRIs cause mania only in patients with an underlying predisposition, although this may be more subtle than a personal or family history of bipolar illness. 

Histrionic personality disorder a pattern of excessive emotionality and attention seeking. 

Dr. P decides to first address the alcohol abuse of Mr. B by asking him to stop drinking completely, which he agrees to do. But Dr. P is less sure about the dramatic presentation of Mrs. B s life story and the intensity of her affect. Although she says she is not suicidal, she does indicate deep despair. Dr. P internally considers possible diagnoses like depression, borderline personality disorder, or histrionic personality disorder. In addition. Dr. P attempts to clarify the terms for therapy Are they looking for individual or marital therapy Dr. P decides to address these questions directly with Mr. and Mrs. B. They both say that they want marital therapy but feel that Mrs. B s pain needs prompt attention also. She s looking for some relief. 

Borderline personality disorder (BPD) belongs to cluster B - the dramatic cluster (along with narcissistic, histrionic, and antisocial personality disorders). The disorder is usually characterized by stormy interpersonal relations, unstable affect, and behavior dyscontrol. The prevalence of BPD is about 2% in the general population and up to 20% in psychiatric inpatients. BPD is the most studied personality disorder because it is clinically common and it is responsive, at least to some extent, to pharmacological interventions. 

Pfohl, B. (1991). Histrionic personality disorder A review of available data and recommendations for DSM-IV. Journal of Personality Disorders 5 150-66. 

Some data indicate that those who make multiple attempts (i.e., greater than five) are different from those who will die from suicide. Multiple suicide attempters tend to be younger and to have a diagnosis other than a depressive disorder (e.g., antisocial, histrionic, or borderline personality). Although they are likely to make future attempts, they do not constitute a substantial proportion of those who die of suicide. 

Borderline disorders have been viewed both from a behavioral-symptomatic perspective (such as that of DSM-IV) and a theoretical perspective (for example, borderline personality organization a la Kemberg and others). As Grinker and many subsequent researchers and clinicians agree, borderline patients are not all alike they present in many different sizes and shapes. You can see borderline characteristics in the context of a number of different personality styles schizoid-detached, obsessional, paranoid, narcissistic, and histrionic. However, all varieties share a few common characteristics ... 

DSM-IV presents but one version of borderline disorder (a type of histrionic-dependent borderline). Speaking more broadly in this book, we will refer to borderline disorders as including a host of personality "styles" that share the common core features listed above. In addition, it is helpful to delineate three subgroups of borderlines. These subgroups have been derived both by research methods (cluster and factor analysis) and by a method that psychopharmacologist Donald Klein calls "pharmacological behavioral dissection." This latter approach looks at how different groups of patients respond to psychotropic medications based on their response patterns, subtypes can be identified. 

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