A Cup of Coffee – When Personality Disorders Collide

Welcome back! Last week, we talked about Gout. If you missed that blog and would like to catch up, click HERE.

I think you’d have to live in a remote place with no TV or internet access to not know that there’s been a heck of an explosion on Court TV involving Amber Heard and Johnny Depp. Both are claiming abuse, and while I won’t take a stand either way (I’ll allow the jury to decide the outcome), what I do want to address is the diagnosis of Histrionic Personality Disorder, since it was alleged that Ms. Heard has this diagnosis.

It’s important that we talk about what this is, and what it isn’t, as many are making fun of this woman’s behavior on the stand, when in fact, there are explanations for her behavior, none of which are funny.

Some of you may have heard of the mental health diagnosis of Borderline Personality Disorder. Many of you may even carry the diagnosis. I expect far fewer of you will also carry the diagnosis of Histrionic Personality Disorder. While they may have symptoms that cross, they are not the same.

Out of all of you who have one of these diagnoses, even fewer will carry both of them.

What is a personality?

A human’s personality is the set of established patterns of behavior by which one relates to and understands the world around them. 

What is a personality disorder?

A personality disorder is when one becomes inflexible, and refuses to change one’s views and pattern of thinking and behaving, which significantly impairs social or occupational functioning and can cause interpersonal distress. The person becomes unable to adjust to social norms and fails to demonstrate appropriate adjustment to the environment or situation.

Can you list some common personality disorders?

Let’s start with identifying some of the Personality Disorders, also known as “Cluster B Personality Disorders“. There are more, but for the purposes of this blog, we won’t list them all.

Cluster B personality disorders include:

Narcissistic personality disorder,

Borderline personality disorder, and

Antisocial personality disorder.

The personality disorders listed above are commonly described as dramatic, excitable, erratic, or volatile. Many times they are confused with each other as they have symptoms that overlap.

How is Histrionic Personality Disorder “different”

Folks who have been diagnosed with Histrionic personality disorder are typically characterized as flirtatious, seductive, charming, manipulative, impulsive, and lively

Is Histrionic Personality Disorder rare?

According to Bridges to Recovery, Histrionic personality disorder is one of the least common of these disorders, affecting about 1.8 percent of the population, but that still represents about four million people.

How does one get diagnosed with Histrionic Personality Disorder?

Patterns of thinking and behaving must significantly deviate from cultural norms to meet the diagnostic criteria for this personality disorder.

The National Library of Medicine states that this disorder displays as disturbances with emotion and how those emotions are presented.

Cognition is affected (an inappropriate perception of self, others, or events ), along with

Impulse control (doing things without thinking through the consequences, or knowing the consequences and doing it regardless), and

Interpersonal functioning (how you “get along” with others, be it friends, family, coworkers, or intimate partners). 

These disturbances are not due to another mental disorder, substance abuse, or other medical condition.

So, to be clear, when one has a diagnosis of Histrionic Personality Disorder, it means that all other causes, such as medical, addictions, or other psychiatric disorders, have already been considered and ruled out.

But I know someone who has Histrionic PD and is also addicted to alcohol

This is not to say there may be what they call “comorbidity” which means you have another issue along with Histrionic Personality Disorder (Histrionic PD), but that the other diagnosis is not the cause of the behaviors being exhibited.

If that person stopped drinking, they would still have Histrionic PD.

Can you be more specific about symptoms?

Bridges to Recovery believes that an accurate histrionic definition focuses on the distinctive symptoms HPD produces, which include:

  • Strong and volatile emotions, both negative and positive
  • Rapid shifts in mood, often triggered by seemingly benign events
  • Self-centeredness, in conversation and behavior
  • Exaggerated gestures or words designed to draw attention
  • Expressions of sentiments toward others that seem shallow or insincere, as if meant to manipulate or create a certain impression
  • A lack of patience, often accompanied by childish reactions
  • Tendency to become flustered or frustrated when things go wrong
  • Extreme sensitivity to criticism or perceived rejection
  • Constant approval-seeking behavior
  • Flirtatious or sexually suggestive behavior that may violate interpersonal boundaries
  • Obsessive concern with physical appearance
  • A tendency to become bored or distracted, making it difficult to finish tasks or projects
  • Lack of empathy, no capacity to read the emotions of others or correctly interpret their words and actions
  • Inability to maintain satisfying relationships due to self-centered tendencies and emotional outbursts

DSM-5 (The manual used to diagnose mental health disorders)

Per DSM-5 criteria, a diagnosis of a histrionic personality disorder requires a pervasive and ubiquitous pattern of consistent attention-seeking behaviors and emotional dysregulation as outlined by specific manifestations. Diagnosis requires meeting five (or more) of the following criteria:

  1. Uncomfortable when not the center of attention
  2. Seductive or provocative behavior
  3. Shifting and shallow emotions
  4. Uses appearance to draw attention
  5. Impressionistic and vague speech
  6. Dramatic or exaggerated emotions
  7. Suggestible (easily influenced by others)
  8. Considers relationships more intimate than they are

Is there a treatment for this disorder?

Yes. While it is unknown what explicitly causes Histrionic personality disorder, it is likely a disorder that is multifactorial in its origin.  The person with the diagnosis would, ideally, seek out therapy and want to change their behavioral patterns in order to decrease the stress in their lives.

The treatment of choice for histrionic personality disorder is psychotherapy. Supportive psychotherapy is a recommended modality of treatment for patients with histrionic personality disorder, as this approach is found to be encouraging, reassuring, and non-threatening.

Psychodynamic psychotherapy (also called insight-oriented therapy) has also proven to be a successful approach in treating patients with a Histrionic personality disorder. The goal of this therapy is to alter an aspect of a patient’s dysfunctional personality by integrating crucial developmental milestones a patient may have missed during previous stages of emotional maturation. Psychodynamic psychotherapy aims to resolve underlying, unconscious conflicts in an effort for patients to understand themselves and their behaviors better.

Group therapy and family therapy are not typically recommended as the first-line modality in treating histrionic personality disorder. People with histrionic personality disorder tend to desire to be the center of attention, which may be distracting from therapeutic goals in a group setting.

Regardless of how this court case plays out, it is important to understand that this woman allegedly has not one, but two diagnoses of a personality disorder. She has a borderline personality disorder diagnosis along with histrionic personality disorder.

A doctor speaks on Borderline personality disorder symptoms

Dr. Lim Boon Leng, a psychiatrist at Gleneagles Hospital’s Dr BL Lim Centre for Psychological Wellness states that if a loved one appears to experience the following signs, there is ground to suspect BPD,

  • Feelings of abandonment by friends and family prompt frantic attempts to avoid being abandoned.
  • A pattern of intense relationships with family, friends, and loved ones that change rapidly from idealization to devaluation.
  • A distorted and unstable self-image.
  • Impulsive behaviors such as spending sprees, unsafe sex, binge eating, and reckless driving.
  • Self-harm, suicide threats, and suicide attempts.
  • Periods of intense emotions like sadness, irritability, and anxiety.
  • Chronic feelings of emptiness.
  • Intense anger followed by guilt.
  • Feelings of dissociation such as observing oneself from outside one’s body.

A call for empathy

If you combine the symptoms of Histrionic personality disorder and the above symptoms of Borderline personality disorder, you will quickly come to realize that her life is one that few will understand, and certainly, none will envy.

Be kind. You don’t have to agree with her or think her behaviors are justified to be kind.

As always, this blog is not a replacement for sound medical advice. I am not a doctor. Please make an appointment to see your healthcare provider and put a good plan in place that works for you and the needs of your body.

That’s all I have for you this week, dear reader. I’ll see you back here next Wednesday to share another cup of coffee. Until then, be good to yourself and each other.

Mind, Body, Spirit…Osteopathic Doctors treat the whole person, not just the ailment. Is your PCP a DO? Would you like to learn more about Osteopathic Physicians? Click HERE!

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