Wednesday, December 22, 2010

Histrionic Personality Disorder (HPD)

Blanche Dubios in Street Car Named Desire, Scarlett O' Hara in Gone with the Wind, and the Bette Midler character in Beaches are films that help illustrate the strong personality disorder of HPD revealed in their main characters. While these characters exemplify HPD quite well, we may also look to many famed celebrities that may or may not exemplify HPD including Madonna, Angelina Jolie, Drew Barrymore, and perhaps even the late Marilyn Monroe.
HPD may be quite difficult to differentiate from some other personality disorders including narcissism and more rampant in our celebrities and in our friends that just need more time to be less self-involved on this earth. To help understand HPD over other disorders is one key component; it is the sole personality disorder where the disorder is explicitly linked to the patient's appearance. Understandably, better than average appearances may comorbidize to HPD.
For further assistance in identifying traits of HPD the DSM-IV-TR (APA, 2000) has the following eight characteristics for HPD:
Center of Attention
Sexually Seductive
Shifting Emotions
Physical Appearance
Speech Style
Dramatic Behaviors
Overestimation of Intimacy

Two qualities that may be the most difficult to treat within HPD would be the narcissism aspect and the fact that extroverted behavior is much more valued in our society. Engaging in the discussion of celebrities and narcissim and how the media reinforces negative messages is celebrity addiction specialist Dr. Drew Pinsky. In a recent publication, The Mirror Effect, Dr. Pinsky creates a dialogue about how culturally the media holds up some very destructive people as role models and celebrities thus warping our sense of normal, acceptable, and even healthy behaviors.
Narcissism aside, the taming of the extrovert and the center of attention in HPD actually may be not favorable at all to the patient. In many settings extroverted individuals are preferred time and time again in matters of social networks, promotions in the work environment, in school performance, and other situations.
To best treat HPD, perhaps adressing aspects of the most hurt towards the self and others is where the focus should reside. For instance, psychotherapy may address the denial and defense mechanisms put on by the patient acting within the constraints of HPD. As the patient lets down these defenses with their identification, HPD's attributes will subside as they get closer to being their true authentic self rather than the shell of ego defense of HPD pathology. As ego defenses are minimized, the capacity of the tru self emerges perhaps healed enough to enter into true intimacy of friendship or more over sustained psychotherapy intervention.


American Psychological Association. (2000). Diagnostic and Statistical Manual for Mental Disorders, Fourth Addition, Text Revised. Washington, D.C.

Pinsky, D., Young, M. (2009) The Mirror Effect:How Celebrity Narcissism is Seducing America. London, U.K. Harper Collins.

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