Mental health articles

histrionic personality disorder case study Histrionic personality disorder (HPD)
is characterized by excessive emotionality and attention-seeking behavior
(American Psychiatric Association, 2000). Individuals with HPD are lively,
overdramatic, demanding, dependent, and overreactive, always looking for
reassurance. Th ey also have been characterized as shallow, egocentric, and
manipulative (Maxmen & Ward, 1995). Millon et al. (2000) describe them
as viewing “the world through their own imprecise and overemotional lens,”
whereby they “tend to make broad overgeneralizations . . . [and] fail to develop
a well-formed sense of identity[,] . . . never identifying goals and putting together
a life plan” (p. 268).
Th ese dysfunctional behaviors are particularly problematic at college. Histrionic
students feel incapable of making the many decisions that college life
demands or committing to fi elds of study, career paths, or social relations. Th e
college years can also be a time of sexual awakening and experimentation.
Individuals with HPD tend to be sexually unaggressive and have a negative
attitude about sex, yet, at the same time, are preoccupied with sex and oft en
experience sexual dysfunction (Stone, 2005).
Th ere is little agreement about prevalence, but the range of HPD seems to
be about 10–15% in clinical settings, with the majority of individuals being
female (Maj, Akiskal, Mezzich, & Okasha, 2005), though in young adults
equal numbers of males and females are diagnosed (Nestadt et al., 1999). Th e
prevalence of HPD at college counseling centers is unclear and oft en confusing
because comorbid diagnoses may be present.

Kimberly was a junior brought to the counseling service by her roommates,
who were getting tired of her dramatic and inconsistent behavior.
Kimberly told them that she was extremely depressed and questioned the
point in living, yet immediately became the life of the party, all giggles
and full of stories about herself when the boys across the hall invited
people to watch a movie. Kimberly admitted that she liked male attention
and acknowledged her fl irtatious behaviors. She was quite noticeable
in the counseling service waiting area, conspicuously applying makeup
and wearing a halter top in the middle of winter. In her session Kimberly
dramatically talked about herself, producing only a vague and diffi cult-tofollow
history with unremarkable symptoms or problems, and oft en tried
to get her young male therapist to smile or laugh. Th e therapist needed to be careful not to be seduced by Kimberly’s
fl irtatiousness or wish to be liked. Th e goal of treatment with these students
is to develop mature coping skills. To do this, they must fi rst learn
to focus attention and come up with goals that give immediate gratifi cation.
In her case, the focus was on improving Kimberly’s relations with
her roommates and peers. Th e therapist helped her recognize her anxiety
when she was not the center of attention and gave her listening skills to
use during these anxious moments.

Maxmen and Ward (1995) suggest that the treatments of choice for HPD
include psychoanalytical approaches and supportive, problem-solving, or
cognitive therapy. However, there have been no controlled or uncontrolled
studies of treatment modalities (Crits-Christoph & Barber, 2004). Short-term
psychodynamic treatments such as those of Davanloo (1980) and Mann (1973)
might focus on how past dysfunctional relationships may be re-occurring in
current relationships, including the therapeutic relationship. Cognitive therapy
can be used to counter the simplistic, global generalizations that students
with HPD oft en make. Having the student identify with detail and clarifi –
cation what she truly likes and dislikes helps her develop a clearer identity.
Assertiveness workshops have also been useful for some students who have
trouble asking for what they want in a direct manner. If the student is unable
to cope at college, taking a medical leave from school might be in order. In
these cases, day treatment programs that utilize both unstructured, insightoriented
groups as well as structured, skill-oriented groups have been reported
as eff ective (Livesley, 2003).

Tags: disorder, Personality Disorder