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50 Histrionic Personality Disorder According to the DSM-IV-TR criteria, the key feature of Histrionic Personality Disorder (HPD) is pervasive and excessive emotionality combined with attention-seeking behavior. There is a prevalent need for those presenting the criteria to do something dramatic, be the life of the party, and to draw attention to themselves by any means necessary. These individuals can be overly trusting and easily influenced by trends, fads, and those they perceive as authority figures. The individuals presenting these criteria are very influenced by sex role stereotypes and will often present a physical appearance that will draw attention to them accordingly (American Psychological Association, 2005). Those presenting the behaviors associated with HPD often have marked dependency in relationships and perceive relationships as being more intimate than they are in reality. Often most romantic and intimate relationships are superficial (Harper, 2004). The individual who meets HPD criteria may present a flirtatious and a provocative interpersonal style. These behaviors are known to cause riffs in friendships and relationships for those individuals. The one key feature that separates the Narcissistic diagnoses from the Histrionic diagnoses is that individuals who are diagnosed with Narcissistic Personality Disorder (NPD) require admiration for their superiority and refuse to appear weak or victimized. An individual with HPD finds no setback in playing the victim to gain attention whenever they deem it necessary (American Psychological Association, 2005). Those who meet the criteria for HPD and NPD are often drawn to the entertainment industry and fields that allow them to garner attention professionally. This tendency to gravitate to the entertainment industry and like fields creates a micro-culture

that normalizes these conditions and the resulting behaviors (Sansone & Sansone, 2011). Treatment Approach Cognitive forms of therapy appear to offer the most promise in successful treatment of HPD. Looking to Kellett (2007), the form of treatment that is suggested is Cognitive Analytic Therapy (CAT). CAT is a therapy with many qualities similar to Cognitive Behavioral Therapy (CBT), but is the treatment is time-limited. Those participating in Kelletts study participated in 24 sessions of CAT, and 4 follow-up sessions spread over 6months post therapy. Kellett found some success with this form of therapy, but found regression to be a major issue at the point of therapeutic termination (Kellett, 2007). Butcher, Mineka, and Hooley (2012) support the use of Cognitive types of therapy with those who exhibit HPD criteria by emphasizing the importance of addressing core dysfunctional beliefs and maladaptive schemas. Harper (2004) recognizes that Substance Abuse and Depression are common comorbid disorders and strongly emphasizes the importance of intensive and consistent CBT with those presenting HPD behaviors. He lists Unreflective, Poorly Organized Thinking and Flighty Impulse Behaviors as potential impairments to successful therapy for those presenting additional disorders, but suggests that the attention seeking behavior of the disorder can assist in client retention (Harper, 2004). Rasmussen (2005) offers Personality-Guided Cognitive-Behavioral Conceptualization (PGCBC) as the most effective treatment option. He emphasizes client independence from external confirmation and validation as the main goal of the therapeutic relationship. Specific recommendations Rasmussen makes when treating a client presenting HPD criteria are to validate the individuals desire for rewarding

interpersonal relationships, to control the fickleness of the client, to help the client maintain therapeutic focus, and to work with these clients in a non-confrontational way. Rasmussen also points to increasing the clients tolerance for not being the center of attention as the first concern that should be addressed in therapy (Rasmussen, 2005). How Diagnosis Informs Treatment Planning As with many personality disorders, treatments that are personality guided will offer the greatest chance of success. Each personality disorder presents specific challenges and issues that make one treatment method preferential to others. Learning about the specifics of a condition informs treatment planning by offering insight as to the course that the therapeutic relationship should take.

References American Psychological Association (2005). Diagnostic and statistical manual of mental disorders fourth edition text revision. (IV ed., Vol. TR). Daryaganj, New Delhi: Jaypee Brothers Medical Publishers (P) LTD. Brimstone, R., Thistlethwaite, J., & Quirk, F. (2007). Behaviour of medical students in seeking mental and physical health care: exploration and comparison with psychology students. Medical Education, 41(1), 74-83. Butcher, J. N., Mineka, S., & Hooley, J. M. (2012).Abnormal psychology. (14 ed.). Boston: Pearson Education, Inc. Harper, R. G. (2004). Histrionic personality. In , Personality-guided therapy in behavioral medicine (pp. 111-131). Washington, DC US: American Psychological Association. doi:10.1037/10650-005 Kellett, S. (2007). A time series evaluation of the treatment of histrionic personality disorder with cognitive analytic therapy. Psychology And Psychotherapy: Theory, Research And Practice, 80(3), 389-405. doi:10.1348/147608306X161421 Rasmussen, P. R. (2005). The Histrionic Prototype. In , Personality-guided cognitivebehavioral therapy (pp. 147-166). Washington, DC US: American Psychological Association. doi:10.1037/11159-008 Sansone, L. A., & Sansone, R. A. (2011). Personality disorders: A nation-based perspective on prevalence. Innovations in Clinical Neuroscience, 8(4), 13-18. pmcid: pmc3105841