Histrionic Personality Disorder

In 2000, my family offered me a free trip back to Australia for a month if I would consult with doctors of their choice. I said yes. One of the doctors I saw was a psychiatrist. We had a three-hour conversation. With my blessing, she shared the following diagnosis with my family:

Applying the DSMIV, he has a personality disorder of the histrionic/narcissistic type.
Luke is very dependent upon other people for his identity as a person.
He has poor identity integration and poor self esteem. Accordingly, Luke is always looking for mirroring – it’s called “narcissistic supply.” That is to say that Luke is always looking for external validation of himself as a person (i.e., he needs other people to tell him who he is). However, because it is not possible for people to mirror him all the time, he gets disappointed and this can turn to envy. Luke may not be conscious of the fact that he is very envious of his family as they seem to have things he would like to have but does not have. This leads to him fluctuating between, on the one hand, devaluing people such as the family (putting them down) and on the other, idealisation of people – such as Dennis Prager.
Luke tends to make unreasonable demands of people who are eventually driven to setting limits on him. Luke takes this very badly.
Luke needs five to ten years of insight orientation psychotherapy. It was the falling out with Dennis Prager which caused him to go to therapy. While Luke has a lot of therapy ‘speak’, he may not really understand the concepts involved. Luke’s therapist did well to keep him in therapy for 15 months – that is unusual for someone with Luke’s condition as such people often leave off therapy when it becomes too confronting. Luke will not continue therapy that is confrontational, particularly in the early stages.
Luke will continue to do what he is doing to satisfy his needs until such times as the rewards (reinforcement) are outweighed by the negative effects of same (punishment). Then he may do something about getting his life on track and getting therapy or going back to finish his degree (which would give him some self-esteem).
The negative effects of his current behavior are that no one will have a long term relationship with him as no matter how sane they are, people cannot live without getting something back – and Luke is always taking in without giving anything back. Second, any decent woman who looked at his website would be immediately repulsed.
Luke has a complicated personality. He has mood instability – perhaps mild cyclothymia. His personality type is prone to this.
Luke become very focused on one thing then, when he is not getting the desired rewards, he drops it and moves on.
Luke may have had some post viral illness but then the illness took on a life of its own. It is common for people to retreat into the sick role because it is a way of failing in a face-saving way. Luke was failing because of the lack of significant relationships in his life.
Luke in his current state would not be successful in employment.
He wants immediate results and if he does not get them, then he does not want a bar of it.
He does not have a bipolar condition. His reaction to Nardil was purely psychological as that drug does not work overnight. The same with the homeopathic treatment – one pill does not make any noticeable difference.
Epilim is a good mood stabilizer – better than Lithium – does not have the nasty side effects. But Luke is unlikely to remain on such medication and anyway it is only tinkering with the fringes of the problem.
As with most adolescent boys, Luke was obsessed with sex.
As with most super egos – it is not well integrated. His rules are situational and he justifies things.
Luke is capable of being exploitive.
Luke is reacting to the values of his family unit.
He is not really interested in what Dr. R. thinks of him. He is only here to enjoy the trip. There is no point him seeing Dr. R. on occasion before his return as it is long-term therapy he needs.
We [Luke’s family] have to have a firm boundary of where we go in his life. We should stay off his website – what we don’t know won’t hurt us. We should set limits on his unreasonable behavior. We must treat him as an adult that he is and stop babying him.
Luke has tunnel vision and difficulty seeing things as others see it. He is only looking for mirroring.
He has demonstrated the capacity to at times, not put his immediate gratification ahead of everything, i.e., taking his rabbi/synagogue off his website when requested. He respected those involved and did not want to lose a relationship with them. So he has the capacity to learn from his experiences.
Luke has a poor sense of identity – he is not well integrated – he has no sense of self – therefore he is very changeable in different circumstances.
The cause of his personality disorder is multi-factorial – the development of personality is a long process – it involves experiences, family environment as well as choices made by a person during the formative years. Personality disorders are not diagnosable until after age 18 because the personality is not developed before then.

I found that diagnosis useful. I have been in therapy ever since. When I learn about NPD, I see that it applies to me and it helps me to understand my life better.

I have a close friend (for decades) who’s always frantic, just bouncing from drama and crisis to drama and crisis. I have some of these tendencies in myself. Is there a psychological name for this disorder? I want to understand it better.

A social worker suggests the label of Histrionic Personality Disorder. According to Wikipedia:

Histrionic personality disorder (HPD) is defined by the American Psychiatric Association as a personality disorder. HPD is characterized by a pattern of excessive attention-seeking emotions, usually beginning in early adulthood, including inappropriately seductive behavior and an excessive need for approval. Histrionic people are lively, dramatic, vivacious, enthusiastic, and flirtatious. HPD affects four times as many women as men.[1] It has a prevalence of 2–3% in the general population and 10–15% in inpatient and outpatient mental health institutions.[2]
HPD lies in the dramatic cluster of personality disorders.[3] People with HPD have a high need for attention, make loud and inappropriate appearances, exaggerate their behaviors and emotions, and crave stimulation.[3] They may exhibit sexually provocative behavior, express strong emotions with an impressionistic style, and can be easily influenced by others. Associated features include egocentrism, self-indulgence, continuous longing for appreciation, and persistent manipulative behavior to achieve their own needs.

I find that label of NPD helps me to understand my friend better.

Eric Read: “I’m a therapist and this disorder is a Cluster B Personality Disorder. It is in the same category as Antisocial, Narcissist, and Borderline Personality Disorders. The speaker is right about problems with moods such as depression. These people are often confused with rapid cycling bipolar disorder but they aren’t. Mood is more steady and affect is more fluid. Affect is a good clinical word for emotions. People with this disorder struggle with emotional dysregulation and the only way to cope with that is through skills learned in therapy. The treatment proven to be most effective is dialectical behavioral therapy. My suggestion to anyone struggling with this is to speak with a qualified mental health professional and be assessed.”

About Luke Ford

I've written five books (see Amazon.com). My work has been covered in the New York Times, the Los Angeles Times, and on 60 Minutes. I teach Alexander Technique in Beverly Hills (Alexander90210.com).
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