Treating the Addicted Histrionic Personality Disorder

cont. from

Cluster B: Incidence of Co-Occurring Substance Abuse Disorders

Cluster B Personality Disorders has the highest incidence of co-occurring substance abuse disorders of the three DSM-IV personality disorder clusters (Nace, O'Connell, Ed., 1990, p. 184).

Richards (1993, pp. 227-239) believes that individuals with personality disorders have an increased inclination to use drugs and alcohol as alternative solutions to life problems. Faulty adaptation to normal stressors and frequent failures in self-regulation can be attributed to deficiencies or disturbances in the personality. This accounts for continued addiction even in the face of catastrophic negative consequences.

For individuals with Histrionic Personality Disorder, the shallowness and absence of internal integration are mirrored in a superficial involvement in the details of life; they have little ability to understand and integrate emotional experiences across situations. Alcohol and drugs serve as an alternative to personality integration and increased maturity. This is particularly effective for individuals with HPD because drug use facilitates dissociative behavior. Not only will they use drugs and alcohol for self-regulation and as a self-soothing alternative to facing life problems, they will view themselves as victims to their addiction. They often cycle rapidly between the role of enraptured drug user and the victimized person suffering from the illness of addiction (Richards, 1993, pp. 240-247).

Millon & Davis (1996, p. 378) state that individuals with HPD may become involved in drug or alcohol abuse because the substances can free them to act out in ways that are congenial to their inclination to be stimulus-seeking. Through drugs and alcohol, these individuals are able to transform themselves; they gain feelings of well-being, bolster a flagging sense of self-worth, and perhaps even come to feel omnipotent. Drugs and alcohol can disinhibit controlled HPD impulses so that there need be no assumption of personal responsibility or guilt for behavior.

Drugs of Choice for the Histrionic Personality Disorder

Peele (1989, p. 149) believes that all addictions accomplish something for the addict. They are ways of coping with feelings with which addicts cannot otherwise manage; they block out sensations of pain, discomfort, or negative affect. Further, addictive involvements make people less aware of themselves and others. Hoskins (1989, p. 11) notes that addictive behavior may look insane to an outsider, but there in an internal logic for the addict that is based on fear and a childlike view of the world and leads to an addictive life style. Drug use is neither a result nor a cause of the development of this life-style; it is just another example. Addiction fits the person; that is why is it so hard to eliminate it from the person's life (Peele, 1989, p. 156).

For individuals with Histrionic Personality Disorder, the coping patterns of dissociation, denial, evasion, and stimulus seeking all lend themselves to addiction. Drugs of choice for these individuals include antianxiety agents and stimulants but are often greatly influenced by what is fashionable to use within their social context. Not only are they influenced by others concerning drug of choice, they are likely to follow others in their choice of places and circumstances to use, route of administration, and even which treatment centers to attend. These individuals rarely use in an asocial context. They use drugs and alcohol as part of their interpersonal interaction. Accordingly, they may use drugs or alcohol as a significant role in their sexual and romantic behavior (Richards, 1993, pp. 247-248).

For individuals with Histrionic Personality Disorder, it is important to watch for an emerging sexual addiction with abstinence from drugs and alcohol. This alternative addiction may become apparent in the context of AA or NA involvement and subvert recovery.

continue: Dual Diagnosis Treatment

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Reviewed: 04/2006