Dual Diagnosis Treatment for Histrionic Personality Disorder

cont. from

Salzman (Mule, ed., 1981, pp. 346-347) believes that the inner forces that initiate and sustain addiction are immaturity and inappropriate, magical coping techniques. Dual diagnosis treatment must involve recognition of these tendencies that foster addictive behavior, i.e., immaturity, escapism, and grandiosity. New ways must be learned for dealing with feelings of powerlessness and helplessness other than compulsivity. Peele (1985, p. 156) proposes that a nonaddicted lifestyle must include the awareness that negative feelings, insoluble problems and a sense of inadequate rewards will never disappear entirely. To move beyond addiction, individuals must: 1) be willing to tolerate the uncertainty of life; 2) believe they have the strength to withstand uncertainty and discomfort; and, 3) believe they can generate positive rewards for themselves (Peele, 1985, p. 156).

Individuals with Histrionic Personality Disorder are vulnerable to addiction via their immaturity, inclination to avoid unpleasantness, and stimulus-seeking behavior. They define themselves as victims to their addiction and describe themselves as powerless, not over addiction, but in relation to recovery. These individuals usually have little experience in recognizing and tolerating the painful in life. They do not define reality as a positive force; they are much more inclined to prefer the fantasies they have about both themselves and others.

Accordingly, dual diagnosis treatment for individuals with Histrionic Personality Disorder must address:

• their self-definition as helpless;
  
• their stimulus-seeking behavior;
  
• their denial, escapism, and dissociation;
  
• their self-definition as childlike and weak vs. the power in others;
  
• their addiction sustaining social network;
  
• their need for a recovery-based social support system;
  
• the benefits and consequences of a reality-focused consciousness; and conversely,
  
• the consequences and perceived benefits of evading reality and seeking fantasies;
  
• the function of the drug(s) of choice; and,
  
• the power of AA or NA in their lives, not only for recovery, but to learn a more self-responsible and principled way of life.

Richards (1993, p. 278) notes that individuals with Histrionic Personality Disorder will demand to be special in treatment. They are inclined to become the star patient in a treatment group or the problem child due to relapse. They may also, consciously or not, view service providers (or their group) and their drug(s) of choice as jealous lovers fighting over them and for their allegiance. This is a situation these individuals tend to relate to with relish (Richards, 1993, pp. 247-248).

Confrontation usual to substance abuse treatment can often be useful with this client population. If it is not well tolerated, look for a co-occurring borderline personality disorder. Abstinence as a prerequisite of treatment may be possible but should not be used when there is a co-occurring personality disorder. Substance use should be confronted but not result in termination from treatment. These individuals may well be able to utilize the experience for recovery. Once again, their inclination to please others may work on their behalf in a recovery-oriented context.

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Reviewed: 04/2006