Histrionic personality disorder (HPD) is defined by the American Psychiatric Association as a personality disorder characterized by a pattern of excessive emotionality and attention-seeking, including an excessive need for approval and inappropriate seductiveness, usually beginning in early adulthood. These individuals are lively, dramatic, enthusiastic, and flirtatious. They may be inappropriately sexually provocative, express strong emotions with an impressionistic style, and be easily influenced by others. Associated features may include egocentrism, self-indulgence, continuous longing for appreciation, feelings that are easily hurt, and persistent manipulative behavior to achieve their own needs.
Histrionic personality disorder shares a divergent history with conversion disorder and somatization disorder. Historically, they are linked to the ancient notion of hysteria, or "wandering womb."[1](Note, however, that according to the Online Etymology Dictionary, the word "histrionic" derives not from the Greek hystera, but from the Latin histrionicus, "pertaining to an actor.") Ancient Greeks thought that excessive emotionality in women was caused by a displaced uterus and sexual discontent.
A mnemonic that can be used to remember the criteria for histrionic personality disorder is PRAISE ME:[3][4]
P - provocative (or seductive) behavior R - relationships, considered more intimate than they are A - attention, must be at center of I - influenced easily S - speech (style) - wants to impress, lacks detail E - emotional lability, shallowness M - make-up - physical appearance used to draw attention to self E - exaggerated emotions - theatrical
People with this disorder are usually able to function at a high level and can be successful socially and professionally. People with histrionic personality disorder usually have good social skills, but they tend to use these skills to manipulate other people and become the center of attention.[5] Furthermore, histrionic personality disorder may affect a person's social or romantic relationships or their ability to cope with losses or failures.
People with this disorder lack genuine empathy. They start relationships well but tend to falter when depth and durability are needed, alternating between extremes of idealization and devaluation. They may seek treatment for depression when romantic relationships end, although this is by no means a feature exclusive to this disorder.
They often fail to see their own personal situation realistically, instead tending to dramatize and exaggerate their difficulties. They may go through frequent job changes, as they become easily bored and have trouble dealing with frustration. Because they tend to crave novelty and excitement, they may place themselves in risky situations. All of these factors may lead to greater risk of developing depression.
Additional symptoms include:
Exhibitionist behavior.
Constant seeking of reassurance or approval.
Excessive dramatics with exaggerated displays of emotions.
Excessive sensitivity to criticism or disapproval.
Inappropriately seductive appearance or behavior.
Excessive concern with physical appearance.
Somatic symptoms, and using these symptoms as a means of garnering attention.
A need to be the center of attention.
Low tolerance for frustration or delayed gratification.
Rapidly shifting emotional states that may appear superficial or exaggerated to others.
Tendency to believe that relationships are more intimate than they actually are.
Making rash decisions.[6]
A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
is uncomfortable in situations in which he or she is not the center of attention
interaction with others is often characterized by inappropriate sexually seductive or provocative behavior
displays rapidly shifting and shallow expression of emotions
consistently uses physical appearance to draw attention to self
has a style of speech that is excessively impressionistic and lacking in detail shows self-dramatization, theatricality, and exaggerated expression of emotion is suggestible, i.e., easily influenced by others or circumstances
considers relationships to be more intimate than they actually are. It is a requirement of DSM-IV that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.
Millon's subtypes
Theodore Millon identified six subtypes of histrionic [9][10]. Any individual histrionic may exhibit none or one of the following:
Theatrical histrionic - especially dramatic, romantic and attention seeking.
Infantile histrionic - including borderline features.
Vivacious histrionic - synthesizes the seductiveness of the histrionic with the energy level typical of hypomania.
Appeasing histrionic - including dependent and compulsive features.
Tempestuous histrionic - including negativistic (passive-aggressive) features.
Disingenuous histrionic - antisocial features.
Narcissistic personality disorder (NPD) is a personality disorder defined by the Diagnostic and Statistical Manual of Mental Disorders, the diagnostic classification system used in the United States, as "a pervasive pattern of grandiosity, need for admiration, and a lack of empathy."[1]
The narcissist is described as being excessively preoccupied with issues of personal adequacy, power, and prestige.[2] Narcissistic personality disorder is closely linked to self-centeredness.
The Diagnostic and Statistical Manual of Mental Disorders fourth edition, DSM IV-TR, a widely used manual for diagnosing mental disorders, defines narcissistic personality disorder (in Axis II Cluster B) as:[1]
A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions) requires excessive admiration
has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends
lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
is often envious of others or believes others are envious of him or her shows arrogant, haughty behaviors or attitudes
It is also a requirement of DSM-IV that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.
Millon's subtypes
Theodore Millon identified five subtypes of narcissist:[2][6]. Any individual narcissist may exhibit none or one of the following:
unprincipled narcissist - including antisocial features. A charlatan - is a
fraudulent, exploitative, deceptive and unscrupulous individual.
amorous narcissist - including histrionic features. The Don Juan or Casanova of our times - is erotic, exhibitionist.
compensatory narcissist - including negativistic (passive-aggressive), avoidant features.
elitist narcissist - variant of pure pattern. Corresponds to Wilhelm Reich's "phallic narcissistic" personality type.
fanatic type - including paranoid features. A severely narcissistically wounded individual, usually with major paranoid tendencies who holds onto an illusion of omnipotence. These people are fighting the reality of their insignificance and lost value and are trying to re-establish their self-esteem through grandiose fantasies and self-reinforcement. When unable to gain recognition of support from others, they take on the role of a heroic or worshipped person with a grandiose mission.
Causes ) The etiology of this disorder is unknown, according to Groopman and Cooper. However, they list the following factors identified by various researchers as possibilities.[8]
An oversensitive temperament at birth
Overindulgence and overvaluation by parents
Valued by parents as a means to regulate their own self-esteem
Excessive admiration that is never balanced with realistic feedback
Unpredictable or unreliable caregiving from parents
Severe emotional abuse in childhood
Being praised for perceived exceptional looks or talents by adults
Excessive praise for good behaviors or excessive criticism for poor behaviors in childhood
A 1994 study by Gabbard and Twemlow[12] reports that histories of incest, especially mother-son incest are associated with NPD in some male patients.
The exploitative, sense of entitlement, lack of empathy, disregard for others, and constant need for attention inherent in NPD adversely affect interpersonal relationships.
Borderline personality disorder (BPD) is a personality disorder defined in DSM-IV and described as a prolonged disturbance of personality function in a person (generally over the age of eighteen years, although it is also found in adolescents), characterized by depth and variability of moods.[1] The disorder typically involves unusual levels of instability in mood; black and white thinking, or splitting; chaotic and unstable interpersonal relationships, self-image, identity, and behavior; as well as a disturbance in the individual's sense of self. In extreme cases, this disturbance in the sense of self can lead to periods of dissociation.[2]
These disturbances can have a pervasive negative impact on many or all of the psychosocial facets of life. This includes difficulties maintaining relationships in work, home, and social settings. Self-harming is a marked symptom and even acts of attempted (or complete) suicide are possible, especially without proper care and effective therapy.[3]
Signs and symptoms
Borderline personality disorder is a diagnosis about which many articles and books have been written, yet about which very little is known based on empirical research.[11]
Studies suggest that individuals with BPD tend to experience frequent, strong and long-lasting states of aversive tension, often triggered by perceived rejection, being alone or perceived failure.[12] Individuals with BPD may show lability (changeability) between anger and anxiety or between depression and anxiety[13] and temperamental sensitivity to emotive stimuli.[14]
The negative emotional states specific to BPD may be grouped into four categories: destructive or self-destructive feelings; extreme feelings in general; feelings of fragmentation or lack of identity; and feelings of victimization.[15]
Individuals with BPD can be very sensitive to the way others treat them, reacting strongly to perceived criticism or hurtfulness. Their feelings about others often shift from positive to negative, generally after a disappointment or perceived threat of losing someone. Self-image can also change rapidly from extremely positive to extremely negative. Impulsive behaviors are common, including alcohol or drug abuse, unsafe sex, gambling and recklessness in general.[16] Attachment studies suggest individuals with BPD, while being high in intimacy- or novelty-seeking, can be hyper-alert[11] to signs of rejection or not being valued and tend toward insecure, avoidant or ambivalent, or fearfully preoccupied patterns in relationships.[17] They tend to view the world generally as dangerous and malevolent, and tend to view themselves as powerless, vulnerable, unacceptable and unsure in self-identity.[11]
Individuals with BPD are often described, including by some mental health professionals (and in the DSM-IV),[18] as deliberately manipulative or difficult, but analysis and findings generally trace behaviors to inner pain and turmoil, powerlessness and defensive reactions, or limited coping and communication skills.[19][20][21] There has been limited research on family members' understanding of borderline personality disorder and the extent of burden or negative emotion experienced or expressed by family members.[22]
Parents of individuals with BPD have been reported to show co-existing extremes of over-involvement and under-involvement.[7] BPD has been linked to increased levels of chronic stress and conflict in romantic relationships, decreased satisfaction of romantic partners, abuse and unwanted pregnancy; these links may be general to personality disorder and subsyndromal problems.[23]
Suicidal or self-harming behavior is one of the core diagnostic criteria in DSM IV-TR, and management of and recovery from this can be complex and challenging.[24] The suicide rate is approximately 8 to 10 percent.[25] Self-injury attempts are highly common among patients and may or may not be carried out with suicidal intent.[26][27] BPD is often characterized by multiple low-lethality suicide attempts triggered by seemingly minor incidents, and less commonly by high-lethality attempts that are attributed to impulsiveness or comorbid major depression, with interpersonal stressors appearing to be particularly common triggers.[28] Ongoing family interactions and associated vulnerabilities can lead to self-destructive behavior.[7] Stressful life events related to sexual abuse have been found to be a particular trigger for suicide attempts by adolescents with a BPD diagnosis.[29]
Individuals with BPD are at high risk of developing other psychological disorders such as anxiety and depression. Other symptoms of BPD, such as dissociation, are frequently linked to severely traumatic childhood experiences, which some put forth as one of the many root causes of the borderline personality. BPD has many similar characteristics to emotionally unstable personality disorder, subtype borderline; and complex post-traumatic stress disorder.[citation needed]
Millon's subtypes
Theodore Millon identified four subtypes of borderline [33][34]. Any individual borderline may exhibit none, or one or more of the following:
discouraged borderline - including avoidant, depressive or dependent features
impulsive borderline - including histrionic or antisocial features
petulant borderline - including negativistic (passive-aggressive) features
self-destructive borderline - including depressive or masochistic features
Psychopathic Personality Disorder is a personality disorder whose hallmark is a lack of empathy. Researcher Robert Hare, whose Hare Psychopathy Checklist is widely used, describes psychopaths as "intraspecies predators[3][4] who use charisma, manipulation, intimidation, sexual intercourse and violence[5][6][7] to control others and to satisfy their own needs. Lacking in conscience and empathy, they take what they want and do as they please, violating social norms and expectations without guilt or remorse".[8] "What is missing, in other words, are the very qualities that allow a human being to live in social harmony."[9]
Psychopaths are glib and superficially charming, and many psychopaths are excellent mimics of normal human emotion;[10] some psychopaths can blend in, undetected, in a variety of surroundings, including corporate environments.[11] There is neither a cure nor any effective treatment for psychopathy; there are no medications or other techniques which can instill empathy, and psychopaths who undergo traditional talk therapy only become more adept at manipulating others.[12] The consensus among researchers is that psychopathy stems from a specific neurological disorder which is biological in origin and present from birth.[10] It is estimated that one percent of the general population are psychopaths.[13][14]
Characteristics
The prototypical psychopath has deficits or deviances in several areas: interpersonal relationships, emotion, and self-control. Psychopaths gain satisfaction through antisocial behavior, and do not experience shame, guilt, or remorse for their actions.[15][16][17] Psychopaths lack a sense of guilt or remorse for any harm they may have caused others, instead rationalizing the behavior, blaming someone else, or denying it outright.[18] Psychopaths also lack empathy towards others in general, resulting in tactlessness, insensitivity, and contemptuousness. All of this belies their tendency to make a good, likable first impression. Psychopaths have a superficial charm about them, enabled by a willingness to say anything without concern for accuracy or truth. Shallow affect also describes the psychopath's tendency for genuine emotion to be short lived and egocentric with an overall cold demeanor. Their behavior is impulsive and irresponsible, often failing to keep a job or defaulting on debts.[18] Psychopaths also have a markedly distorted sense of the potential consequences of their actions, not only for others, but also for themselves. They do not, for example, deeply recognize the risk of being caught, disbelieved or injured as a result of their behaviour.[19]