Histrionic Personality disorder
...tensely dependent on others. They are emotionally labile and cling to others in the context of immature relationships. In addition, they may also present themselves as Ill-tempered and display intense anger. They may engage in manipulative suicide threats as one aspect of general manipulative interpersonal behavior (Kernberg, 1992). Males, with HPD, on the other hand, display identity diffusion, disturbed relationships, and lack of impulse control. They are often promiscuous and bisexual (Kernberg, 1992). Individuals with HPD are consumed with attention to superficialities and spend little time or attention on their internal life. Because they know themselves so little, they often have no sense of who they are apart from their identification with others. They are able to change their attitudes and values depending upon the views of significant others in their lives. They obtain their own identity from those to whom they are attached, taking only those qualities or characteristics of the people they admire and applying those characteristics to their own “act” to be portrayed to their admiring audience. These individuals also fail to attend the details and specifics of their experiences. They have, accordingly, memories that are diffuse and general with a tremendous lack of detail (Will, Retzlaff, ed., 1995). 3 Individuals with HPD are over-reactive, volatile, provocative, and engaging in their behavior. They are intolerant of inactivity, impulsive, emotional, and responsive. They have a penchant for momentary excitements, fleeting adventures, and ill advised hedonism (Donat, Retzlaff, ed., 1995). The HPD behavioral style is charming, dramatic, expressive, demanding, self-indulgent, and inconsiderate (Sperry, 1995). They tend to be capricious, easily excited, and intolerant of frustration, delay, and disappointment. The words and feelings they express appear shallow and simulated rather than real or deep (Millon & Davis, 1996). These individuals can be quite effective in situations where a first impression is important and vague expression of ideas is preferred over precision. They are less effective where performance is measured by objective measures of competence, diligence, thoroughness, and depth. Acting, marketing, politics, and the arts are fields where individuals with HPD will do well and manage competition effectively (Richards, 1993). HPD defenses include dissociative mechanisms. Individuals with HPD regularly alter and recompose themselves to create a socially attractive but changing facade. They engage in self-distracting activities to avoid reflecting on and integrating unpleasant thoughts and feelings (Kubacki & Smith, Retzlaff, ed., 1995). Repression is also a HPD defense; frequent splitting off from conscious awareness of self results in an intra-psychic impoverishment; psychological growth is precluded. These individuals remain immature and childlike in their behavior. Through repression, individuals with HPD remain unaware that their thoughts and feelings are attached to their behavior. Accordingly, they claim innocence when their conduct results in interpersonal conflict (Kubacki & Smith, Retzlaff, ed., 1995). McWilliams (McWilliams, 1994) describes the organizing defenses of HPD as repression, sexualization, and regression. Individuals with HPD will also behave in a counter phobic manner; they approach what they fear. However, they may become helpless and childlike when faced with potential abusers. 4 II Treatment Individuals with HPD may enter treatment via the criminal justice system or through self-referral. Because of their interpersonal skills and inclination to seek approval through pleasing others, they may initially look like the proverbial "dream client." However, these individuals usually are seeking relief from a crisis in their lives and the accompanying depression. Once the depressed mood is lifted, motivation for change is eliminated or greatly reduced. (Turkat,1990) Individuals with HPD should be treated for any concurrent Axis I disorder. As with all of the personality disorders, the specific features of HPD can affect compliance with medication. Individuals with HPD may respond to the side effects of various medications with an intense and dramatic overreaction (Ellison & Adler, Adler., 1990). Also, medication may not be needed by these individuals but may well be requested. Drug-seeking behavior is a significant issue in the histrionic personality disorder. Refusal to prescribe medication may result in a dramatic scene with the service providers attempting to set limits. Early in treatment, individuals with HPD may see the service provider as “the all-powerful rescuer who will make everything better.” The style of histrionic clients can be very appealing; dramatic renditions of experience can be quite absorbing and amusing (Beck,1990). Treatment may be viewed by individuals with HPD as an opportunity to socialize. Treatment providers are seen as valued sources of admiration, attention, and support (McCann, Retzlaff,1995). On the other hand, individuals with HPD are prone to impulsivity and angry tirades with explosive comments. Most of this is outside of awareness and confrontation usually results in denial, resistance, and an unwillingness to be introspective (Craig, Retzlaff, 1995). Treatment must involve confrontation of and management of demands for social contact outside of the treatment setting, sexually provocative behavior, and continuous avoidance of relevant issues. Clear treatment goals, focusing, and limit-setting are important for clients with HPD (McCann, Retzlaff,1995). 5 Adler (Adler, Ed., 1990) 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 character logical 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. For individuals with HPD, 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). 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). 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). Individuals with HPD 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,). 6 III CONCLUSION The cause of the Histrionc Personality Disorder is unknown. Many scholars and psychologists believe that it is contributed to through hereditary forms of parenting. Perhaps, the children were not given enough attention, or not praised for their accomplishments, casuing them (the children) to seek this praise an attention as adults. It is a time they cannot get back thus it is a never-ending search to fill this void. Similar to children, individuals with HPD have no real interest in others, other than to suffice their own needs. This act of repression only gets worse as they get older. None the less, the point of this paper is to note the affects and one specific circumstance that can arise when individuals, trying to accomplish so much for their children, by working two jobs or simply trying to take on too much, end up actually affecting their children in such a negative manner that it de...