Histrionic Personality Disorder
Treatment Techniques
cont. from
Assessment of individuals who may have a
histrionic personality disorder should
include the following questions:
- Have other people told you that you
always need to be the center of
attention?
- Do people sometimes
misinterpret your friendliness as a romantic or sexual
invitation?
- Do your emotions change quickly? Has anyone ever commented that your
emotions do not seem real or sincere?
- Are you disappointed if people don't notice how you look?
- (Note if during the assessment these individuals do not relate concrete
examples with appropriate detail about significant events. Are they
impressionistic and vague rather than specific and detailed?)
- Do you think you would make a good actor or actress?
- Do your opinions change depending on who you are with? If someone says they
have a headache or upset stomach, do you find you feel the same thing?
- Do you sometimes get hurt in relationships because you think the
relationship is more serious than the other person does?
- Do you feel a close personal relationship with a boss or a professional you
have not known very long (Zimmerman, 1994, pp. 110-112)?
Assessment of individuals who may have Histrionic Personality Disorder (HPD) must include exploration of substance
abuse issues. These individuals are prone to alcoholism and drug addiction and
are quite adept at denying the related behaviors. They seek easy escape from
pain, deny negative consequences, and fail to observe or accept responsibility
for the impact of their behavior on others. These factors foster both entry into
and maintenance of addiction. In a case example, a male histrionic personality
disordered professional engaged in mutual alcoholic behavior with his wife until
he wanted out of the marriage. At that time, he hospitalized his wife after she
had a black-out but continued to deny his own drinking problem which was
considerably more severe than his wife's level of addiction.
A special therapeutic emphasis for individuals with HPD is attention to the
fears related to the loss of an exciting lifestyle, a sense of never ending
youthfulness, and evasion of the harder issues of adulthood. In a sense,
individuals with HPD attempt to live life like the prototypic American movie,
i.e., a happy ending so matter how severe the adversity or obstacles. Working
with HPD clients can feel like being Scrooge before his conversion; the
reflection of life's negative consequences and inevitable pain are almost
unseemly in the face of HPD compulsive optimism, denial, dissociation, and
evasion. Yet, it is important to foster behaviors that are mature, responsible,
and based in reality if these individuals are to emerge from their position of
childlike powerlessness and the growing negative consequences for their
vocational, interpersonal, marital, and parental failures.
Treatment Goals
Adler (Adler, Ed., 1990, pp. 26-32) proposes that treatment goals for all
personality disorder treatment include: preventing further deterioration,
establishing or regaining an adaptive equilibrium, alleviating symptoms,
restoring lost skills, and fostering improved adaptive capacity. Goals may not
necessarily include characterological restructuring. The focus of treatment is
adaptation, i.e., how the individual responds to the environment. Treatment
interventions teach more adaptive methods of managing distress, improving
interpersonal effectiveness, and building skills for affective regulation. It is
also important to remember that many individuals with personality disorders do
not complete treatment with the same service provider. For individuals with
Histrionic Personality Disorder,
treatment must necessarily involve pressure to delay gratification and
essentially grow-up. These clients need to learn to regard themselves as agents
of action rather than merely the recipients of the actions of others. There is,
however, a reason why individuals with HPD have little interest in learning to
think clearly, focus, and hold steady under pressure. A basic dynamic of HPD is
the excessive, unresolved effort to have all their needs met by someone else and
they fear that if they were to become skilled in these matters, no one would
take care of them anymore (Benjamin, 1993, p. 185). Addressing these fears with
a positive frame would mean developing treatment goals that include integration
of gentleness with strength, moderating emotional expression, and encouraging
warmth, genuineness, and empathy (Sperry, 1995, pp. 105-106). Further, many
individuals with HPD have the habit of not knowing facts that are emotionally
distressing. They use an array of avoidant control processes: suppression,
repression, disavowal, denial, and behavioral avoidance. Treatment helps them to
focus sustained attention on topics that contain irrational beliefs, conflicting
motives, contradictions in the sense of self, and unresolved dilemmas. Service
providers must assist individuals with HPD to focus attention on topics that are
usually avoided and unresolved (Horowitz, Gabbard & Atkinson, Eds, 1996, pp.
979-981). Individuals with Histrionic Personality Disorder need to learn to live with reality on its terms
rather than on their terms; see reality as it is; cope with reality as they find
it; increase self-reliance; gain self-confidence; increase courage; and increase
genuine self-esteem (Sperry & Carlson, 1993, p. 415).
continue: Dual Diagnosis - Histrionic
Personality Disorder Plus Addiction
top .
pages 1 2
3
4 .
send to friend .
personality disorders site map
Reviewed: 04/2006
|
REALMENTALHEALTH
CARE PROVIDER
DIRECTORY
Find a Local Therapist
|
|
del.icio.us
Digg
Furl
Google
StumbleUpon
Yahoo